Legislative tactical skill can’t solve everything

Okay, the Senate health bill is not dead, but it looks a lot worse off than it did a week ago.  As Sarah Kliff writes, there are still strong imperatives for Republicans to pass something:

The lessons I took from the House debate were threefold.

First, Republican legislators are really motivated to deliver on the bigpicture goal of Obamacare repeal even if it doesn’t tackle the issues they purport to have with the health law. Case in point: Republicans have lamented the Affordable Care Act’s too-high deductibles as unaffordable. They passed a bill that would raise deductibles. The key thing seemed to be passing something called Obamacare repeal even if it didn’t address the specific problems legislators had raised about the law.

Second, Republican legislators are not deterred by a lack of outside validators. We saw groups ranging from the American Medical Association to the American Hospital Association oppose the House health care bill. Conservative academics who are no fans of Obamacare joined the pile-on, too. Still, Republicans pressed forward undeterred. The conventional wisdom that a health bill needs widespread buy-in to move forward in Washington was seriously undercut.

Third, coming around to this point of view does take time. It took Republicans in the House a month and a half to wrap their minds around a major piece of legislation, make some changes, and decide to pass it. Part of this was about making substantive policy changes, but part of it also seemed to be having a few weeks to think about the alternative to this bill — which was likely passing no Obamacare repeal bill at all. Many members decided that simply wasn’t an option.

That said, no matter how much a master Senate tactician he is, McConnell is nonetheless human and trying to balance the very-much opposed of Senate conservatives and “moderates” is no easy task.  They all want to vote for a “repeal” but the conservatives want an actual repeal that truly guts Obamacare and the “moderates” seem to have at least some genuine modicum of concern for real people and their health.  That said, we saw how easy some House “moderates” were bought off with a tiny fig leaf and I worry about a similar dynamic in the Senate.  From a nice Vox discussion:

The topline from the CBO was bad news — 22 million fewer Americans having insurance — but there was a silver lining for McConnell. For reasons I won’t go into, CBO showed that he has about $200 billion to play with and still meet the savings targets he must under the procedural shortcut Republicans are using to pass the bill without any Democrats.

$200 billion is a lot of money! Especially when crucial swing votes like Rob Portman and Shelley Moore Capito have asked for nearly $50 billion in opioids funding and the bill currently contains only $2 billion.

Money might not solve all problems, especially for conservatives who want to undo more of Obamacare’s insurance regulations. But that is a lot of dough for McConnell to throw around as he ramps up the pressure.

538 had a really interesting discussions that rated how likely each supposedly opposition Republican Senator is to actually come around.  The key may be Rand Paul staying true to his libertarian principles.  I think they quite rightly point out that Ted Cruz is a completely non-credible opportunist.

And, back to the title of the post, nice NYT article on what McConnell tried and how it has not thus far worked:

WASHINGTON — Senator Mitch McConnell of Kentucky, the majority leader, has long enjoyed a reputation as a master tactician. But when it comes to repealing the Affordable Care Act, he seems to have miscalculated in the first round of play.

He assumed that his conservative and moderate colleagues would come together to make good on their seven-year promise to repeal the health care law, and quickly.

But when he assembled a group of senators to cobble together a health care bill last month, he seemed to go out of his way to exclude some of the most knowledgeable members and moderate voices on health care, like Senators Bill Cassidy of Louisiana, a doctor, and Susan Collins of Maine, an insurance expert and one of the few women in the Senate Republican conference. Views outside of Mr. McConnell’s on health care did not receive extensive consideration. [emphasis mine]

When Republicans from states that had expanded their Medicaid programs quickly found themselves at odds with more conservative members who wanted a large rollback of Medicaid, Mr. McConnell did little to allay those worries. Conservatives generally wanted to rein in costs while moderate members wanted to increase spending, particularly in states where health care costs are high and opioid addiction is escalating.

Perhaps this was, indeed, a tactical mistake by McConnell operating under the belief that “moderates always cave.”  I’m still not sure that’s not true.  At least you can now say, “moderates don’t always cave… right away.”

That said, I think the fact that the vote has been delayed till after the recess is potentially a big, big deal.  There’s a reason McConnell wanted to rush this– to make it that much harder for his caucus to face opposition back in their states.  Now they are going to and, hopefully, that opposition will be metaphorically loud and well-organized.  Drum:

In any case, the summer recess will now be an opportunity for Republican senators to find out just how dangerous a Yes vote really is. The progressive community needs to make sure they find out. And don’t forget to recruit your moderate conservative friends too. They probably have more influence with your local GOP senator than you do.

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About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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