The Senate Health Care Bill Is Still Not Dead

Does any Republican want to just kill this thing?

WASHINGTON ― The Senate health care bill remains in a curious state of buoyancy ― without enough support to go anywhere, but lacking enough opposition to sink.

Simply put: The bill is not dead, despite Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) vowing to vote against it and a healthy coalition of more than a half-dozen Republicans who have “serious concerns,” according to Collins.

With Sen. John McCain (R-Ariz.) recovering from a surgery to remove a blood clot above his left eye, Senate Majority Leader Mitch McConnell (R-Ky.) officially does not have the votes to bring the GOP health care bill to the floor. Facing that reality, he delayed the vote yet again.

But there’s a lesson in that delay: McConnell believes he can actually pass this. If he didn’t, with the backlog of legislative items already keeping senators in session into their August break, he could just take a failed vote and clear the measure from his calendar. He’s not doing that ― at least not yet.

At this point, any one Republican senator could cast serious doubt on the passage of this bill if he or she were to announce firm opposition to it. No one has taken that opportunity.

There are a number of potential reasons Republicans with concerns about the bill haven’t stepped up. No one wants to be the senator who sinks the GOP’s chances of its long-promised repeal of Obamacare, otherwise known as the Affordable Care Act. The bill is still being tinkered with. There isn’t a Congressional Budget Office score of the revised legislation. Senators may even want to blindside McConnell.

The truth on Capitol Hill is that even if a third Republican were to announce his or her opposition, hardly anyone would believe the legislation is dead until McConnell says so. Depending on how the CBO score comes back, the majority leader most likely still has more than $100 billion he can dole out to sweeten the deal for reluctant lawmakers.

If Sen. Dean Heller (R-Nev.) is as opposed to the bill as he was in late June because of Medicaid cuts, maybe McConnell can figure out something just for Nevada. If Lisa Murkowski (R-Alaska) isn’t pleased with the carve-outs for Alaska already in the bill, maybe the majority leader has something else he can offer.

Majority Whip John Cornyn (R-Texas) said Sunday he believed Republicans would only vote once McCain gets back, suggesting this is something that McConnell is still trying to pass, not just get off his plate.

McCain’s recovery and the bill’s delay may throw another wrinkle into the health care dynamics. Conventional wisdom holds that the longer this bill hangs out there, with an approval rating hovering around 20 percent, the worse McConnell’s chances are of convincing Republicans to go along. But the delay only hurts McConnell if you believe he had the votes to pass the bill this week.

If he never finds the support, McCain’s surgery is just another delaying of the inevitable. But it could also provide McConnell with the time he needs to work out a deal.

There’s a growing sense in the Senate that McConnell won’t stop adjusting the bill until he has the votes. In an effort to win over Republican senators, McConnell has accepted changes he didn’t want to make. He’s kept more of the Obamacare taxes ― bolstering premium assistance for certain individuals ― and he has undermined Affordable Care Act regulations, most notably the protections for people with pre-existing conditions.

Sen. Ted Cruz (R-Texas) insisted that he wouldn’t vote for the legislation unless it includes his amendment, which allows insurers to offer insurance plans that don’t cover essential health benefits and to charge exorbitantly more for people with medical issues so long as those insurers also offer one plan that does comply with the old Obamacare rules. Insurers insist that amendment is “simply unworkable in any form,” and would cause premiums to skyrocket on people with pre-existing conditions. McConnell included it anyway.

Now the majority leader has more time to work through issues and potentially make deals with holdouts. And the holdouts appear willing to talk.

Senators are still waiting on a CBO score, which has also been delayed. The CBO was expected to release a partial analysis of the revised bill on Monday, but Senate aides said that timeline was being pushed back. They didn’t offer an explanation for the delay.

While McCain’s recovery will give the CBO more time to score the legislation before senators vote, it’s still unlikely that the delay will provide enough time to score Cruz’s proposal. The CBO has said analyzing the effects of that amendment could take more than a month.

In the absence of an updated CBO score, Republicans look apt to accept an upcoming partisan analysis from the Department of Health and Human Services instead.

Again, any one Republican senator could put an end to these sorts of charades. With Collins and Paul promising to vote no, any one Republican could insist on a hearing for the bill. And any one Republican could insist on a full CBO score.

The best sign for McConnell is that no one else has spoken up.

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