The Republican health care bill is not dead yet, but the prognosis is far from positive.
If the GOP’s efforts to repeal Obamacare do fail, there’ll be plenty of reasons why. But over the last week, two surprising explanations stand out: the resoluteness of Republican moderates and the strategic failures of Senate majority leader Mitch McConnell.
Let’s start with the moderates, a vanishing breed that is generally seen as the group of Republicans most likely to cave. But on health care, it’s the moderates who have played perhaps the greatest role in stopping the momentum for repeal.
Senator Dean Heller of Nevada, the most endangered Republican incumbent in the Senate, fired the first shot, declaring last week that he could not support the GOP’s health care bill. His denunciation set the tone for the bill and quickly put McConnell and the Senate leadership on its heels.
Senator Susan Collins of Maine delivered a far worse blow. While conservatives like Rand Paul of Kentucky, Mike Lee of Utah, and Ron Johnson of Wisconsin also made clear their opposition to McConnell’s bill, Collins, by echoing many of Heller’s complaints about cuts to Medicaid, ensured that McConnell would now need to win over two of the more moderate members of his caucus while somehow also bringing on board all of the conservative holdouts.
The recalcitrance of moderate Republicans should not be that surprising. In the Obama years many moderates walked lock step with McConnell’s policy of constant obstructionism. But it was Collins — along with Olympia Snowe, also of Maine, and Arlen Specter of Pennsylvania — who got President Obama’s stimulus package past a GOP filibuster. Snowe delivered a crucial vote in the Finance Committee that helped pave the way for passage of Obamacare. Former Massachusetts senator Scott Brown was a “yes” vote for passage of Dodd-Frank and — along with Snowe, Collins, Lisa Murkowski of Alaska, and others — helped ensure that Don’t Ask, Don’t Tell was repealed.
Not all of these votes were made out of principle. Politics certainly plays a role. But we shouldn’t be surprised that GOP moderates were the firewall on Obamacare repeal.
The second myth burst by the Senate GOP’s near-term failure on health care is that of Mitch McConnell’s legislative wizardry. One of the arguments frequently heard over the past two weeks is that McConnell will make the tough legislative deals to ensure that repeal happens. It’s true that the Kentucky senator is a masterful tactician when it comes to obstruction, a skill that he honed to great effect over the past decade. But he has no real record of legislative accomplishment, and doing things in the Senate is a heck of a lot more difficult than stopping them.
Indeed, McConnell’s strategy of writing the bill in secret has badly backfired. Once it was released, few Republicans spoke positively about it, because none of them knew what was in it. Moreover, McConnell’s apparent strategy of putting out legislation that could be improved later — perhaps by adding money to stanch the Medicaid cuts or dealing with the opioid epidemic — ensured that when the bill dropped it would be easily and harshly caricatured by Democrats. Monday’s devastating CBO report, which showed that the bill would throw 22 million off the insurance rolls, only made matters worse. How McConnell didn’t see the CBO score coming — and get Republicans prepared for it — is hard to understand.
Finally, by failing to coordinate his effort with the White House, McConnell helped ensure that the president and congressional Republicans would not be on the same page — a problem highlighted by the threat from a Super PAC close to the White House to target Heller for his opposition to the bill.
For someone so well-versed in the moods and machinations of the Senate and its 100 members, McConnell appears to have sorely misjudged his own caucus.
It is of course still possible that moderate Republicans will cave and McConnell will pull a rabbit out of the hat. After the House repeal bill was revived in May, it would be a mistake to question the willingness of Republicans to bite the bullet and get in line.
But the chances of that happening are a heck of a lot slimmer than they were just one week ago — and for reasons that few people might have expected.
Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.