Senate Republicans Don't Really Care About The Loathed AHCA Process

But they might care about health care enough to vote this bill down. Or not.
Sen. Ted Cruz (R-Texas) says his central focus on the Obamacare repeal bill is lower premiums.
Sen. Ted Cruz (R-Texas) says his central focus on the Obamacare repeal bill is lower premiums.
Tom Williams via Getty Images

WASHINGTON ― Senate Republicans are speeding toward a vote next week on their Obamacare replacement bill, even as GOP lawmakers can’t answer simple questions about the legislation, express frustration with the brazenly secretive and closed process, and don’t appear to have the votes yet for passage.

Republicans expected to get more details on their Affordable Care Act rewrite during a closed-door meeting Tuesday with Health and Human Services Secretary Tom Price. Instead, they got more vague happy talk from Senate Majority Leader Mitch McConnell (R-Ky.) and a speech from Price on what HHS has been doing to rein in Obamacare.

With Senate Democrats badgering Republicans about how they’re ramming this bill through ― no hearings, no markups, hiding the bill from members ― some GOP lawmakers are now acknowledging that the process has been less than stellar.

When Sen. John McCain (R-Ariz.) was asked whether this bill should be a template for lawmaking in the future, he sarcastically answered that “this is exactly the kind of legislative process our Founding Fathers had in mind,” going on to explain that he was obviously concerned the Senate may be voting on a health care bill next week that members won’t have seen.

But when reminded that he could withhold his support for the legislation until the process had improved, McCain said he couldn’t “say no to something I haven’t seen.”

It was a similar story with Sen. Bob Corker (R-Tenn.), who told reporters that he’s advocated for an open process from day one. “But again,” Corker said, “when you’re dealing with things which are being done here in a totally partisan way ― which is understandable ― I mean, that’s the way reconciliation works.”

After all their complaints about the way in which Democrats passed a second part of the Affordable Care Act in 2010 ― the first part of the legislation passed with 60 votes and was the product of more than 100 hearings ― Republicans have turned around and proceeded to use a legislative process that the Senate historian says has not been so secretive nor so partisan since World War I.

And if any Republican actually cared that the Senate GOP was acting in this manner, the senator could stand up and refuse to vote for the bill until the process improves.

Conversely, part of the reason the Senate is in this procedural position is because Democrats have been clear that none of them will vote for this bill, and even with the brazen GOP attempts to shut them out of the process, Democrats have struggled to mount an effective response to the legislative railroading, resorting to stunts and dilatory tactics in hopes of blocking a bill they have not seen.

On Tuesday, Democratic Sens. Chris Murphy of Connecticut, Cory Booker of New Jersey and Brian Schatz of Hawaii took a cab to the Congressional Budget Office to search for the legislation. They ended up, as they expected, empty-handed.

At a late-night Senate session Monday, Democrats decried the process on C-SPAN2, but it seemed to do little to win over their Republican colleagues or whip up the kind of outrage Republicans managed in 2010. In fact, even as Senate Republicans acknowledged the poor process, they maintained that their process was still somehow better than the Democrats’ in 2010 ― a blatant mischaracterization of how Obamacare was actually passed.

But all the GOP congressional shenanigans will be for naught if McConnell can’t get the bill through his chamber. And if McConnell really is intent on a vote next week, he will have to work expeditiously to build a coalition of 50 votes ― a coalition he doesn’t appear to have at the moment among the Senate’s 52 Republicans.

McConnell faces vote problems from both conservatives and moderates. Sens. Rand Paul (R-Ky.), Mike Lee (R-Utah) and Ted Cruz (R-Texas) have all expressed frustration with a number of provisions that they deem insufficient toward repealing Obamacare. They want a quick phaseout of the Medicaid expansion, the removal of certain regulations (like the protections for people with pre-existing conditions) to lower premiums and the abolishment of the taxes created under the Affordable Care Act. Paul has also resisted the creation of new tax subsidies to help pay for health insurance, a signal that his vote may not ever be gettable, though he and his staff have worked hard to not be written off in the negotiations.

If the three conservatives stick together, they alone have the votes to sink the Senate’s chances of an Obamacare repeal. But giving in to those demands would jeopardize many more votes from other parts of the GOP conference, and McConnell has basically said the pre-existing condition protections will not be dropped from the Senate bill as they were in the House version ― a condition for the support of many Senate moderates.

McConnell is basically gambling that he can get Paul, Cruz and Lee (or at least one of them) to accept a partial repeal as a step in the right direction, and he may, at least partially, be right. None of those conservatives has taken a hard line on what he needs at a minimum to support the bill.

Cruz repeatedly told HuffPost on Tuesday that “the most important issue” with the health care bill is that it lower premiums. “That’s my No. 1 priority on Obamacare, because it’s the biggest reason that people are unhappy with Obamacare,” Cruz said. But asked repeatedly whether he would vote against a bill that didn’t lower premiums and kept those so-called community rating provisions that ensure sick people are charged the same as healthy people, Cruz dodged the question, again and again, coming up with new ways to restate that his central focus was on lowering premiums.

That unwillingness to take a firm stance on any issue could be gamesmanship, as conservatives seek to avoid marginalizing themselves, but it also may be a recognition that they ultimately won’t be the ones who derail an Obamacare repeal.

Asked if he would really stand up to President Donald Trump on this health care bill, Cruz returned to his central focus: “From the beginning, I have been very clear with the president, the vice president and with members of both houses that our focus has to be on lowering premiums.”

Cruz’s refusal to be tied down may be a reflection of the political reality. He is up for reelection in 2018, and, despite his popularity in Texas, he faces stiff competition in Rep. Beto O’Rourke (D-Texas), meaning he will need the Republican base’s support ― something that may have already been jeopardized with his up-and-down relationship with Trump.

Lee and Paul may have more latitude to vote against the president’s wishes, but they also may be withholding support just to force the legislation further to the right. As Cruz noted Tuesday, Senate GOP leadership hasn’t decided how much of the Obamacare taxes will be repealed, and it’s still in flux how fast the Medicaid expansion would be phased out. Senators desperately want a seat at the table as those questions are sorted out.

On the other side of the conference, some moderates may also be playing a similar game. From the beginning, Sen. Susan Collins (R-Maine) has looked like one of the toughest votes to win over, and yet she has seemed more amenable in recent weeks, narrowing some of her problems with the legislation to its cuts in Planned Parenthood funding and its quicker phaseout of the Medicaid expansion. Sen. Lisa Murkowski (R-Alaska) has also expressed similar reservations, along with some Alaska-specific issues, but she hasn’t ruled out voting for the bill.

“You don’t know until you see it, right?” Murkowski said Tuesday about specifics in the bill. “What we’re trying to do is get a health care system that’s not only good for Alaska, but it’s also good for the country.”

And then there are the concerns of other senators ― particularly the ones from states that greatly benefited from the Medicaid expansion. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio) have both shown willingness to end that expansion, but they want to do it over seven years, not the three that McConnell and conservatives favor.

Just how long they would go for, and whether a shorter timeline might cost McConnell their votes, is unknown, but they, too, want a seat at the table.

Which is all to say there are many Republican senators who could potentially vote no, especially if it’s clear McConnell doesn’t have the votes. Would Sen. Dean Heller (R-Nev.), perhaps the most vulnerable Republican up for reelection in 2018, really vote for the bill if it’s going down?

McConnell has said he will put the bill on the floor with or without the votes. But a failed vote would almost certainly make it more difficult for senators to change their votes later ― a fact that may cause McConnell to pull the bill at the last minute next week.

Part of the reason the House was successful in passing its health care bill was that Speaker Paul Ryan (R-Wis.) didn’t force members to go on the record until leaders were sure they had the votes. In fact, the bill may have gotten through the House because Democratic opposition let up after Republicans didn’t seem to have the votes, with leaders then able to speed the bill through the chamber once they had an agreement between conservatives and moderates.

In the end, that may be the real legislative template McConnell is using.

Jonathan Cohn contributed to this report.

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