Shortly after Arizona Sen. John McCain voted to sink the GOP’s “skinny repeal” bill, he urged Republicans and Democrats to work together on health reform. Senate Minority Leader Chuck Schumer seemed only too happy to oblige, heaping praise on McCain in a statement made shortly after the vote: “On health care, but also in the Senate as a whole, I hope what John McCain did would be regarded in history as a turning point, where the Senate turned back from its partisanship and started working together.” Of course, what Schumer wants is bipartisanship on Democratic terms, and it remains to be seen if he’s going to get it.
The GOP health reform effort has been declared dead at least half a dozen times since March, when House Speaker Paul Ryan pulled the American Health Care Act when it became clear he didn’t have the votes to get it passed. While Schumer is taking a victory lap, and while we’re seeing yet another round of postmortems for repeal and replace, Republicans are regrouping. For Schumer to succeed, Republicans must first give up on passing an Obamacare overhaul on a party-line vote. They’re not quite there yet. If a bipartisan Obamacare fix ultimately does happen, it won’t be because Democrats will have accepted meaningful concessions on Obamacare’s basic structure, as they see no political need to do so. If the time comes when Republicans truly need Democratic votes, they will have screwed things up so badly that they’ll be in no position to ask for concessions.
How will the Republican Party respond to this latest health care failure? Most likely by coalescing around something like the amendment proposed by South Carolina Sen. Lindsey Graham and Louisiana Sen. Bill Cassidy, which is built on taking Obamacare’s premium subsidies and restructuring them as block grants. Under Graham-Cassidy, Obamacare’s taxes would be left largely untouched, and so for the most part would its Title I health insurance regulations, which GOP conservatives loathe and moderates are wary of messing with.
There are still many wrinkles to be worked out, including what is to be done with the Medicaid expansion. Senate Republicans have been divided between those representing states that accepted the expansion, and who don’t want the rug pulled up from under them, and those representing states that refused it, who resent the idea that they’ll wind up being treated less generously. One possibility is that a new and improved Graham-Cassidy could include somewhat more generous per capita caps and new funding to expand coverage in the nonexpansion states, and perhaps some modest deregulatory measures to keep conservatives from bolting.
Could a package along these lines get past the Senate parliamentarian? Assuming it cleared that high hurdle, could it win back one of the three GOP defectors who voted against skinny repeal? Maybe. If it didn’t, one can imagine Republicans trying to win Democratic votes by softening Graham-Cassidy. Indeed, Cassidy worked with Maine Sen. Susan Collins, the Republican who has been most reluctant to unravel Obamacare, on Cassidy-Collins, a proposal that would essentially allow Democratic states to preserve the Obamacare status quo while allowing GOP states to take their federal funds—including federal funds for the Medicaid expansion—to devise their own approaches to expanding insurance coverage. But Cassidy-Collins never found any takers among Democrats, as Cassidy himself lamented, according to the Los Angeles Times: “I keep coming back to the fact that Cassidy-Collins was written to invite bipartisanship and it was rejected by every single person on their side.”
The most likely bipartisan way forward is to use federal dollars to shore up the Obamacare exchanges but to attach that appropriation to some other “must-pass” legislation—a bill reauthorizing the State Children’s Health Insurance Program, for instance, or perhaps even a bill to raise the debt limit. It’s a safe bet that some conservative senators would balk at voting for a bill that would further entrench Obamacare, which is why Democratic votes would be needed to ensure passage. At this point, we’re still not all that close to seeing a health care bill that members from both sides of the aisle would consider voting for. If the Senate is still at an impasse in a few weeks, though, that could change, mostly because Republicans will have run out of options.