A few days ago, it looked as though Senate Majority Leader Mitch McConnell wouldn’t even be able to secure enough votes to begin a formal debate on the GOP effort to repeal and replace Obamacare, let alone corral enough GOP senators to pass the ever-evolving Better Care Reconciliation Act. To the surprise of many, McConnell managed to pass his “motion to proceed,” with an assist from Vice President Mike Pence, thus bringing repeal and replace back to life. How did he do it? And does this mean that Republicans in the Senate will be able to pass BCRA or something like it?
First, it’s important to note that passing the motion to proceed is a big deal. While all Republicans have done thus far is reach an agreement to debate a bill, moving the ball forward means the pressure ratchets up on individual GOP senators not to be the person who kills a bill that’s gotten this far. In practice, an individual senator has more leverage before debate begins than once it’s formally commenced.
That’s precisely why a handful of conservative Republican senators who were expected to back BCRA in some form or another, including Utah Sen. Mike Lee and Kansas Sen. Jerry Moran, threatened to sink the bill by holding up the motion to proceed late last week. There are many GOP senators, conservatives as well as moderates, who resent the secrecy and centralization that have defined McConnell’s leadership in general and his crafting of repeal-and-replace legislation in particular. Some on the right bristled at McConnell’s seeming belief that cutting a deal with Texas Sen. Ted Cruz, one of the more vocal conservatives in the Senate, would alleviate the concerns of all the Senate’s right-wingers. Not so. Lee and Moran, among others, understood that holding up the motion to proceed was the best way to make their voices heard.
In the end, both Lee and Moran voted for the motion, and they were joined, somewhat surprisingly, by Kentucky Sen. Rand Paul, who’s been one of the most vocal opponents of McConnell’s approach to repeal and replace. This doesn’t necessarily mean the reluctant conservatives will get what they want, but it is an indication that McConnell has at the very least given them a respectful hearing.
Whether McConnell can retain the votes of these reluctant conservatives is an open question. As of now, it seems that Paul is willing to vote for something that goes as far in the direction of undoing Obamacare as possible but unwilling to back anything that smacks of replacing Obamacare’s subsidies. Meanwhile, Republican moderates are extremely antsy about the possibility of passing legislation that will unravel health coverage for millions of Americans, for reasons both substantive (it’s bad) and political (it could cost them re-election). This is especially true for GOP senators from states that embraced the Obamacare Medicaid expansion, such as Ohio Sen. Rob Portman, who’s been pressing McConnell to spend more money to maintain coverage levels.
What this means is that McConnell is still walking a tightrope. The fact that he managed to clear the motion to proceed hurdle greatly increases the likelihood that Senate Republicans will pass something. It’s just not clear what they’ll wind up passing.
We know what won’t pass. A Rand Paul special that does nothing more than defund Obamacare definitely won’t. Neither will the last version of the BCRA to have been scored by the Congressional Budget Office, which alienates too many conservatives (not enough deregulation) and too many moderates (not enough money to maintain high coverage levels). McConnell and his allies need to slap together a new and improved BCRA, make sure all its provisions pass muster under the rules of reconciliation, and then get the CBO’s seal of approval so it can pass with 51 votes.
The messiness of this process has invited a great deal of ridicule and understandably so. But it’s worth keeping in mind the unusualness of the situation facing Republicans. Normally, you can count on a president of your own party to knock heads together and force an intraparty compromise. With Donald Trump in the White House, there’s no prospect of that happening. Republicans have been left to hash out their disagreements without an umpire. McConnell tried to play that role by tightly controlling the process, but he’s discovered that GOP senators on the right and the left of the conference won’t tolerate him dictating terms. Faced with the prospect of defeat, McConnell seems to have recognized that the only way a deal will get done is if both moderate and conservative Republicans feel they have a place at the table. By loosening his grip, the majority leader managed to pass the motion to proceed, but his toughest test still lies ahead.