The Senate must go to a 51 vote majority instead of current 60 votes. Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!— Donald J. Trump (@realDonaldTrump) July 18, 2017
All the wise heads are muttering into their prematurely gray beards on the intertoobs that Mitch McConnell can still pull it off, can still repeal and replace Obamacare, because Mitch McConnell! What they cannot explain is how he will pull off this legislative miracle:
The idea has a certain logic. Republicans can quickly make good on their promise to repeal Obamacare and then get to the hard work of actually figuring out what should come next.The idea has "a certain logic" if you ignore the fact that such an idea has to go through the legislative process. It was considered and rejected by the GOP Senate earlier this year (January, to be precise), and it holds no incentive for those concerned about Medicaid cuts (part of Sen. Moran's reason to jump ship and scuttle McConnell's bill). It's also useless to McConnell, because it would create chaos in the insurance markets, and as I said before, leave the explosion until after the 2018 elections. That's supposed to help McConnell, but in the "what have you done for me lately?" world of U.S. politics, it's far too little far too late. And did I mention the chaos in the insurance markets repeal would unleash? Even Ted Cruz wouldn't vote for that.
And it has precedent. Congress passed a clean Obamacare repeal bill in 2015, which President Obama quickly vetoed. Senators could presumably return to that bill and pass it a second time — although this time, they’d expect Trump to turn the bill into law.
But here’s the problem: In practice, the act of repealing Obamacare, even with a two-year delay for a replacement, would set off a catastrophic reaction across the health care system. A successful repeal vote would drive insurers out of Obamacare’s exchanges, leading to collapsing marketplaces across the country, and Republicans would bear all the blame.
Matt Yglesias tells us that:
The real fate of American health care lies with five Republicans — Dean Heller (R-NV), Shelley Moore Capito (R-WV), Rob Portman (R-OH), John Hoeven (R-ND), and Lisa Murkowski (R-AK) — whose behavior since McConnell rolled out BCRA 2.0 has been strange.Well, sure; except the bill died on the announcements of the guy from Kansas and the guy from Utah. Moderates had nothing to do with it. Dylan Scott at least gets that much right:
Conservatives wanted to unwind as much of Obamacare as they could, whatever the consequences. Moderates were skittish about passing a plan that would lead to millions of people losing health coverage they gained under Obamacare, openly advocating to keep some of the most popular provisions of the 2010 health care law. The two ends of the ideological spectrum also struggled to agree on how deeply to cut Medicaid, both by ending Obamacare’s expansion and by putting a hard spending cap on the whole program.
Josh Marshall last night was still hedging his bets, going with the "if frogs had wings" defense beloved of political commentators who hate being proven solidly wrong:
In most respects, this is no different from what Democrats hoped would be a truism about major new programs. Once people get access to new benefits they’re really hard to take away, especially when tens of millions of people have them. Of course, none of this was foreordained and it’s far from guaranteed even now. It is quite possible that McConnell will still be able to pass a Trumpcare bill.
Of course, it's impossible now that McConnell will be able to pass a Trumpcare bill, because he's giving up on that. Even McConnell knows when he's licked, even if pundits refuse to accept what's in front of their eyes. And what's in front of their eyes is a legislative process nobody wants to pay attention to.
The vote that has now preemptively failed was a vote to take up the House bill and debate it. Without 50 votes to do that, McConnell can't move anything through the Senate. McConnell has already announced (though nobody but Jim Newell noticed it) a vote on what Newell labels a "test run" bill:
The "first amendment" McConnell is referring to is the "test run" bill that the House and Senate each passed in 2015 to see how much of Obamacare they could eliminate under reconciliation. (Coincidentally, while the test run bill eliminates as much of Obamacare's taxes and spending as possible, it does not touch any of the market regulations that so arouse conservatives' ire.)My understanding of reconciliation is that it can't be used to affect the market regulations Newell mentions there, so all it can do is eliminate taxes and spending (which affects the budget, and so can be handled with only 50 votes in the Senate). As Newell points out:
That bill, though, was passed when House and Senate Republicans knew that President Obama would veto it, and they wouldn't have to live with its consequences. When the Congressional Budget Office, at Democrats' request, rescored the 2015 legislation earlier this year, they found that it would increase the uninsured ranks by 32 million and double premiums over 10 years. It will be... quite difficult to pass that. McConnell may just be offering a sacrifice to conservatives (and the president).Yes, the hard-core crazies (like the Sen. from Oklahoma who was dining with Trump last night when news came the bill was dead in the Senate) want to just repeal Obamacare. As I say, did Ted Cruz offer an amendment to the Senate bill in order to kill it, or to save it? Is he going to stand fast for straight up repeal and chaos in the marketplace? Is he that sure he'll win in 2018? Probably not.
And if the GOP Senate can't repeal all of Obamacare through reconciliation, it won't really be "repeal," will it? The pundits and pooh-bahs may not know that, but the Senators do. McConnell is no more likely to repeal Obamacare with just 50 votes, than he is to get his bill passed. Does this sound like a Senator who's going to decide to just burn it all down, sow dragon's teeth, and reap the whirlwind?
“There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it. This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare’s rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one.
“We should not put our stamp of approval on bad policy. Furthermore, if we leave the federal government in control of everyday healthcare decisions, it is more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase. We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans.”
McConnell's bill was an act of severe moderation compared to simple repeal now, replace whenever. How he is going to make that palatable to 50 Senators, when it will only be partial repeal at best, anyway, is simply beyond me.
Adding: there is a very interesting analysis here, in tweets, about McConnell's rise to power and his failure on this bill. This final tweet sums it up (the rest are worth reading for details supporting the argument):
Their problem now is that the tactics McConnell employed to accrue power undercut their ability to get things done.— Adam Jentleson (@AJentleson) July 18, 2017
Earth, scorched. 11/
As I said: sow dragon's teeth, reap the whirlwind. The pursuit of power for its own sake inevitably ends with finding out you haven't grasped power; it has grasped you.