To walk into the Senate side of the U.S. Capitol on Thursday morning was less to enter an ongoing, real-life debate of mysterious outcome than to assume your role in a hackneyed script.
About 100 reporters huddled outside the Mike Mansfield Room, where Republican senators were meeting to unveil the Better Care Reconciliation Act. Reporters in the script asked the senators questions as they entered, and senators, per the script, said, “We’ll see.” After the meeting, senators responded to most questions with, “I’m still reviewing the text, but it’s a promising start.” At least this is what the rank and file, who are largely content with the product, said.
The script requires small groups of moderates and conservatives to each have problems with the bill. They will now go about seeking changes—probably already known to the author, Senate Majority Leader Mitch McConnell, but preserved for revelation in a later act.
Conservative senators say that they can’t support the “Obamacare-lite” bill barring further changes. They have a point that the BCRA, like the House-passed American Health Care Act, is not a repeal of Obamacare in the classical sense. It leaves much of the individual market structure of subsidies and exchanges in place, but with cuts, and offers states certain regulatory waivers. It does, however, repeal Obamacare’s Medicaid expansion to finance tax cuts—and then reforms Medicaid entirely going forward.
But because it’s not full repeal, conservatives say that they can’t vote for it until it’s changed. Sens. Mike Lee of Utah, Ted Cruz of Texas, Rand Paul of Kentucky, and Ron Johnson of Wisconsin release a joint statement saying just that a few hours after the bill is posted. They cite a “variety of reasons” for that position. In talking with them, they all stress individual concerns. Paul seems to be the most difficult to get onboard, as one of his central concerns is the very existence of subsidies on the individual market and stabilization funds for insurers, neither of which will be eliminated, which he likely already knows. Cruz, who’s tried to remake himself into a consensus-builder within the conference this year, has a discrete set of four market and Medicaid reforms he’s distributing to fellow members. Johnson tells reporters that he fears the bill doesn’t do enough to lower premiums and wants it to more aggressively target core Obamacare regulations. (Do not expect Johnson to hold out to the bitter end. When I asked him what his discrete ask was, he responded, “Information.”) Lee, having just seen the text for the first time like the rest of us, is still developing his wish list.
Only McConnell knows what he’s prepared to offer the right-wing holdouts, but it’s going to be some grab bag of policies that either cut Medicaid further or loosen individual market regulations. It’s in the script; you’ll be able to read all about it in just a few days.
After at least three of those four conservatives are offered significant conservative policy changes, the script demands that moderates be mollified with special carve-outs or modest boosts in funding.
If he’s sticking to the script, McConnell has a list of giveaways that he saved to offer members later so that they can argue they only voted for the bill after extracting concessions. None stands out more visibly than the BCRA’s treatment of opioid crisis funds. Ohio Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito, especially, are hoping for $45 billion in funding for the crisis over 10 years as a way to make the phase-out of the Medicaid expansion go down easier. Instead, the bill offers… $2 billion for one year or until exhausted. McConnell could increase those funds to, say, $20 billion, and Portman and Capito could argue that they secured a 1,000 percent increase! in announcing their support for the bill. Other issue- or state-specific piles of cash, none of which do anything to affect the underlying, unpopular structure of the bill, could be doled out to the likes of Maine Sen. Susan Collins, Nevada Sen. Dean Heller, or Arizona Sen. Jeff Flake. It’s just a matter of figuring out who gets the two “no” vote lifeboats. McConnell probably already knows.
This bill could fail, but that would be an abrupt last-minute rewrite of a script from which none of the players, so far, have deviated. Conservatives are organized, coordinated, and eager to share with the press their early objections. They will move the bill further to the right. Moderates are disorganized and press-shy, keeping their objections within the family. They will get offered a few more bucks or state-specific carve-outs and then draw straws to determine who has to vote for it. The Senate sequel to the House bill process is playing out like the most disciplined scene-by-scene retread since Home Alone 2. Don’t expect a surprise ending.