Ground Game

A month after the US House passed it, what’s the deal with the health care bill?

President Donald Trump spoke with House Speaker Paul Ryan during a ceremony in the Rose Garden of the White House after the House pushed through a health care bill in May.
Evan Vucci/Associated Press
President Donald Trump spoke with House Speaker Paul Ryan during a ceremony in the Rose Garden of the White House after the House pushed through a health care bill in May.

President Trump began the week by taking to Twitter to criticize London's mayor, his own Justice Department, and the media. Headlines flew thick and fast. 

Meanwhile, there is an underlying fact that’s hard to ignore: Nearly six months into his presidency, he hasn’t had a single major legislative accomplishment.

The closest he might get to one is the potential repeal and replacement of Obamacare. When the House of Representatives passed their version of a replacement bill, Trump held a White House ceremony. But that was more than a month ago.


On Tuesday afternoon, Senate leaders are expected to both unveil their own version of the bill and give it an informal deadline: the Fourth of July holiday.

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Practically speaking, this means Senate Republicans have, at most, 19 working days to get something passed if they’re going to meet that cutoff. Politico reports that Senate Majority Leader Mitch McConnell appears more concerned with getting an up or down vote one way or the other than he is with actually passing a bill.

After all, McConnell knows that the longer health care is the top item on the agenda, the longer it will be until senators take up an infrastructure bill, immigration reform, or tax reform. Note how the White House has already moved the dates on tax reform. They said it would be taken up in the first 100 days, then by the spring, then by the August recess, and now they are talking about the fall. Any later than that and they’ll be in an election year where a thorny major tax reform bill becomes even harder to pass politically.

And if the Senate does get the necessary 51 votes to pass a health care repeal bill, it will probably then go to negotiations with the House, which could drag on for months — with the potential to be permanently stalled.

The political stakes are high. Ideally, Republican leaders want to have a repeal of Obamacare in place before the midterm elections. That’s because they’ve long promised their base they would repeal the health care law on “Day 1” — once they had a Republican president and Republican majorities in Congress. If they don’t pull it off, it will matter. History has shown how important the base of each party is to turnout in midterm elections, and Republicans already have a president in office with historically low approval ratings. The reason McConnell might be so open-minded about moving on after July 4 without a health care repeal is that the Senate is seen as more likely to stay in Republican hands than the House.


If McConnell is serious about a health care bill moving in the Senate this month, this means the Senate will find itself in the limelight. There will be drama in the push and pull between more-moderate and more-conservative members in shaping the bill. Whether and how Trump injects himself into the Senate debate could be the single biggest factor as to whether a bill passes quickly.

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