John’s McCain’s vote to end the death watch over Republican repeal of the Affordable Care Act may, indeed, not have been welcomed by the president or the Congressional Republican leadership. But in reality he may have rescued them from an even worse debacle than the one they face now.
Imagine that McCain’s thumb had flipped up ― and the “Skinny Repeal” bill had cleared the Senate by a single vote. Imagine that House and Senate had then, as promised, appointed conferees. The bill they brought back would present some amalgam of the House bill, the original McConnell Senate bill, the revised Senate “partial repeal” bill, and the pure “Repeal and Replace Later” concept.
To satisfy the House, it would have had to include vicious cuts in Medicaid ― after all, that is where the money is, and that is where the long-term conservative project of cutting back the social safety net to finance massive tax cuts for the rich must begin. (The House Freedom Caucus signaled exactly this reality, when they made it clear that “Skinny Repeal” was no repeal at all, because it did not touch Medicaid.)
But during the run-up to the “Skinny Repeal” showdown, 13 Republican Senators had voted against bills containing the same lethal ingredients likely to be contained in the conference bill: Senators Lisa Murkowski and Susan Collins, of course – but also McCain himself, Lamar Alexander, Dean Heller, Bob Corker, Rob Portman, Shelley Moore Capito, Mike Lee, Jerry Moran, Rand Paul, Lindsay Graham, and Tom Cotton. A few ― Lee, Paul, Cotton, Corker ― might be satisfied with a conference bill that blended the House legislation with the original McConnell draft, although my guess is they are content with the collapse of the effort. The remainder would have to flip-flop to support any likely conference measure, and would end up having voted to defend Medicaid and then, under pressure from the leadership, to slash it, within a single week ― not healthy politics.
The most likely outcome of such a struggle ― that McConnell and Trump would bludgeon nine or ten of these fence-sitters into supporting the final bill, but would end up with a fatal three or four “No” votes, dooming the final product, would have been the worst possible outcome for the Republicans. If McCain had voted yes, unleashing this maelstrom, a quarter of the Republican caucus would have been hung out to dry for flip-flopping and threatening Medicaid for millions of their voters; virtually all House Republicans would have cast a similarly toxic vote for a second time; there would be no repeal or reform of Obamacare and thus no victory lap for the Republicans and Trump; and as result, conservative fury would have been unleashed at virtually the entire caucus for failing to deliver a repeal of Obamacare.
And if McConnell had cobbled together, barely, the fifty votes needed to enact a conference bill, it would require eleven Republican Senators to flip and vote to cut health care benefits for more than 20 million Americans. The prospects for continued Republican dominance in Congress would have become vanishingly dim, as those voters actually realized they might die as a result. How would Senators like Heller and Capito explain to their voters cutting them off from health care after promising to defend them?
So embattled as Trump, McConnell and Ryan feel today, a thumbs up from McCain would have exposed them to a far more catastrophic position a few weeks down the road.
How did Republicans get here? What where they thinking (politically, ignore the substance of their stance on health care)?
Right after the election, Congressman Tom McClintock effectively predicted the debacle to come: “We’d better be sure that we’re prepared to live with the market we’ve created [with repeal] …. That’s going to be called TrumpCare. Republicans will own that lock, stock, and barrel, and we’ll be judged in the election less than two years away.”
There was ample evidence of how politically dangerous it was to “own” the American health care market. Indeed, it was shockingly clear in January that Republicans lacked the raw political muscle to repeal Obamacare.
“Their only hope of holding onto their Congressional majority is to move beyond this folly..."”
Yes, Donald Trump was President, Mitch McConnell Majority leader, and Paul Ryan Speaker. But compare their political arithmetic with those of the last two Presidents to seek massive health care reform. Bill Clinton beat his Republican opponent by six percent, received 370 electoral votes, had 57 Democrats in the Senate and an 82 seat House margin. He didn’t have enough political capital to pass health care reform, and the effort cost him control of Congress. Barack Obama had a seven percent edge and 359 electoral votes, 59 (and eventually, 60) seats in the Senate, and a 79-seat margin in the House. Obama managed to get exactly the number of votes he needed in the Senate, and had only a seven-vote margin in the House. He too lost the Congress over his commitment to “own” the health care market.
Trump trailed Hilary Clinton by two percent in the popular vote, had only 304 electoral votes, a two-vote Republican Senator majority, and a 47-vote margin in the House.
Republicans had a tiny fraction of the political capital enjoyed by Clinton and Obama. The only possible reason for thinking that repeal of the Affordable Care Act was in sight was recent Republican congressional unity ― but that unity had flourished in pure opposition mode. And clearly, Republicans knew in January that ingredients like “defund Planned Parenthood” or “slash Medicaid,” which were “must-haves” for many of them, were poison pills for many others. The unity was a sham.
Looming over everything was the reality that the Republicans didn’t believe their own best instincts. They fought Obamacare viciously, in large part because they knew that once Americans embraced the idea and reality that health care was a right, democratic processes would never take that right away. But when they lost, they pretended that they could simply wait out Barack Obama, reverse history, and erase the idea of a right to health care as if it had never existed.
Their only hope of holding onto their Congressional majority is to move beyond this folly ― and John McCain, whatever his motivation, has given them the gift of being able to do so.
