The Bill Lives

GOP senators delay the health care vote, but Trumpcare is still very much in play. 

Senate Majority Leader Mitch McConnell
Senate Majority Leader Mitch McConnell still wants to make this bill happen. Above, McConnell with other Republican leaders on Capitol Hill on Tuesday.

Aaron Bernstein/Reuters

I asked Georgia Sen. David Perdue Tuesday morning, as he was heading to a lunch with his GOP colleagues, if he thought there was any chance Republican leaders were bluffing when they said the health care bill needed to pass this week or never.

“Oh, I don’t think [our] leaders ever bluff,” he said.

About an hour later, Senate Majority Leader Mitch McConnell told Perdue and everyone else that he would delay the vote until after the Fourth of July recess, because the votes weren’t there.

Tuesday was the day that McConnell’s fantastically rushed timetable crashed into reality. It has never been clear how McConnell thought he could pass a comprehensive health care reform bill six or seven days after it was first unveiled to the public or two days after its Congressional Budget Office score came out. It was certainly never clear to those senators he was trying to lead, whose irritation finally emboldened them to press pause on the process they’ve griped about, ineffectually, for weeks. Even some of the more measured rank-and-file senators, who weren’t hollering in front of television cameras about how they would withhold their votes, were not prepared to go through with it so quickly.

Kansas Sen. Jerry Moran, for instance, who is the model image of a loyal and obedient senator, tweeted after Republicans’ closed-door lunch that the bill “did not have [his] support.” Florida Sen. Marco Rubio, who has not been a player in the health care debate, said that he was still waiting to see an “assessment” of how the bill would affect Florida to determine if tweaks were necessary. “There’s 49 other people who are going to have similar concerns,” he told reporters Tuesday. And he wasn’t buying one of the arguments leaders have been making for the rushed schedule: that the bill needed to pass this week to prevent a collapse in the insurance market as carriers set rates.

“I don’t think that collapse would happen in the next two weeks,” Rubio said.

Tennessee Sen. Bob Corker told reporters that he didn’t get a chance to comb through the CBO analysis until 4 a.m. Tuesday. It made for some eye-popping reading, and he asked the CBO to come to the senators’ lunch to answer some questions. He is happy there’s a delay.

“I think it’s a good thing, I really do,” he told reporters after the lunch. “People have issues that need to be addressed. As you go through [the CBO report], it raises questions and they’re legitimate. And so the only way for them to be answered is for additional inquiries at CBO, which take time.” Corker doesn’t think that the issues are all impossible to overcome. (When Corker was asked whether he would attend a White House meeting later in the afternoon to which all Republican senators were invited, he muttered dismissively, “I guess.” He then clarified that he didn’t mean it that way. It had been a long day.)

So where does this leave the bill and its prospects? Though the vote has been delayed until after recess, the discussion has not. Leaders hope to reach a rough agreement on changes before leaving town on Friday. “I think we’ll have a pretty good understanding of what” the changes would look like before recess, South Dakota Sen. Mike Rounds said, “but it’s still got to be scored” by the CBO.

It doesn’t take much to soothe the rank and file, and a couple weeks’ delay should be enough. They will get their information. And though it will still require an impossibly delicate balancing act to bring together a coalition of moderates and conservative holdouts, one can see the outlines of an eventual agreement.

Take the concerns of two moderate holdouts. Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia released a joint statement after the vote was delayed demanding changes. “The Senate draft before us includes some promising changes to reduce premiums in the individual insurance market,” Portman’s statement read, “but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.” Moore had similar concerns, arguing that the bill “as drafted” does “not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers.”

If only there was some massive pool of money out there that could alleviate some of their fears. Indeed, there is! The CBO found that the bill would save the government $321 billion—or $188 billion more than budget rules require it to save. One might read Portman and Capito’s statements as asking that all of that money be used to soften the long-term Medicaid cuts and significantly increase the funds available to combat the opioid crisis.

The conservative holdouts, meanwhile, could be granted more of the market reforms they want—like, say, state waivers for the Affordable Care Act’s community rating rules, which bar insurers from charging sicker people more. “We can rewrite our bill to bring down the price working families pay for health insurance—while still protecting Americans with pre-existing conditions,” Sen. Mike Lee said in a statement. In other words: Deregulate, and allow those with pre-existing conditions to take their rightful place in high-risk pools.

“You could kind of sense that there was a path forward,” South Dakota Sen. John Thune, the No. 3 Senate Republican, said later Tuesday afternoon after the White House meeting with President Trump.

“We know that Medicaid is an issue that creates some differences of opinion within our conference,” he said, “and then some of the market reforms, some conservatives are advocating that.”

I asked Thune if this is the “grand bargain” that saves the bill: Conservatives give on Medicaid spending, and moderates give on regulation.

“Could be,” he said.

That bargain may never congeal, and if it does, it may not be enough to turn the hard noes, like Sens. Rand Paul, Dean Heller, and Susan Collins, around. But the delay means that the will to pass a health care bill still exists among the vast majority of senators, just as that will existed among House Republicans after their first effort to pass the American Health Care Act was pulled in March. Senators want to get this done, the White House wants to get this done, and Mitch McConnell wants to get this done. The high-profile bill that everyone hates is still very much alive.