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The GOP's Health Care Echo Chamber

How Mitch McConnell and other Republican leaders are trying to hone their message for the Senate's health care debate.

The grin on the face of Sen. Mitch McConnell, R-Ky., last week spoke volumes about the GOP's stance in the raging health care debate. His smile was a flash of pure delight, especially considering the Senate minority leader's fondness for unblinking self-control. "You'll note that all the angst is on the other side," McConnell said during a July 24 interview in his ornate Capitol office. "Who is the most queasy about this issue now, Democrats or Republicans? They have the votes to do what they want to in the House and Senate."

As he spoke in his gracious suite, easily as large as the Oval Office, McConnell kept close tabs on the latest media reports. That afternoon, House Democrats were still struggling to quell a revolt by their party's fiscally conservative Blue Dogs, who objected to the soaring costs of the reform effort. The fact that the majority party was splintering on President Obama's signature domestic policy initiative -- next to rescuing the economy -- was certainly good news for the Republicans.


The Senate GOP has always assumed, though, that House Democrats will eventually use their 256-178 majority to muscle a health care bill through their chamber. Since the beginning of Obama's term, McConnell and his allies have expected that the reform effort would rise or fall in the Senate. Even now that Senate Democrats have a nominal 60-seat majority -- a shaky advantage because of the illness of two senior senators and the unreliability of a handful of centrist Democrats -- Senate Republicans know they may be the last chance to stop the legislation this fall.

As they prepare for what may be their ultimate test, Senate Republicans are sticking with the game plan that has served them well this year. They are offering policy-based critiques and alternatives to Democratic health proposals. They are looking for openings that might undercut an inexperienced but popular new president, without getting too personal. And in the process, they are trying to rebuild a beleaguered Republican Party by leveling their arguments from the right. They are rallying around old-fashioned, conservative principles of smaller government, less spending, and reduced debt -- tenets that Republicans concede they abandoned when they controlled Congress.

"We have two parts to our strategy," explained Senate Republican Conference Chairman Lamar Alexander, R-Tenn., who handles messaging for his caucus. "One is to offer what we think should be done.... We have more Republican proposals for how to get where we need to go on health care than the president has put out, which is zero."


"And the second thing," Alexander said last week, "we thought we ought to point out the damage that a government-run program would do.... And I think we've been very successful with that.... I hope we've slowed down these unwise ideas that have come out. We haven't been as successful as I'd like us to be, so we're going to keep trying."

So far, however, the GOP's health care strategy has scored points primarily because the majority party has made unforced errors. A partial list: Several unfavorable cost estimates of Democratic proposals from the Congressional Budget Office; accumulated public sticker shock in a dour economy; glacial bipartisan negotiations on the Senate Finance Committee led by Chairman Max Baucus, D-Mont.; and continuing Democratic policy disagreements.

"I don't think it's so much that what we're doing is working, as much as it's the case that what they're doing is not working," a Senate GOP leadership aide acknowledged. "Democrats have two Mount Everest-sized obstacles to overcome. One is the price tag, and the other is convincing the American people that the people who brought you FEMA are now going to run your government health care plan. Good luck with that, guys."

Sen. Judd Gregg, R-N.H., the ranking member on the Senate Budget Committee, who helps his caucus interpret the budgetary implications of the Democrats' health proposals, was among those who said recently that it was unclear if the Republicans' strategy was having much impact. "I don't know that we are," Gregg said candidly, after offering a long description of the GOP's aims. "I wasn't arguing that we're making progress. I don't know."


But as Obama's August deadline on health care reform slipped last week, McConnell suggested that he and his colleagues were moving the needle. House Democrats sparred with one another instead of with the GOP, while Senate Democrats sniped at Baucus because he was compromising with Republicans. "I think our members have done a good job of focusing on the things that we do not like, and also underscoring the need for reform," McConnell told National Journal.

In particular, McConnell pointed to long-standing calls from many Democrats in the health care debate for a government-run public insurance option. Lately, demands for a public option have appeared to wilt under Republican comparisons to the socialized medicine of Canada and the United Kingdom. Some key Senate Democrats have instead floated a compromise system described as public cooperatives. "I think we've had an impact," McConnell said. "That [public option] was, earlier in the discussion, considered essential, and now it's considered negotiable."

Even as McConnell sees signs of success, he must contend with some freelancers in his ranks. Three Republicans -- Sens. Charles Grassley of Iowa, Olympia Snowe of Maine, and Michael Enzi of Wyoming -- have been participating in the Finance Committee's health care negotiations, making some others in their party nervous. And then there's hard-charging conservative Sen. Jim DeMint, R-S.C., who suggested during a July 17 telephone conference call with GOP activists that health care reform could become Obama's "Waterloo," his undoing. DeMint's remark clearly ran counter to the Republican script, which calls for assailing wrong-headed policy, not the president personally.

Obama, in turn, attacked Republicans for playing crass obstructionist politics, but DeMint was unapologetic. "I have no confidence that the president actually wants to make health insurance affordable and available to all Americans," DeMint said on the Senate floor on July 21. "I'm glad to see the president out taking shots at me for saying we have to stop him on this, because we have been on a rampage since he took office, passing one government program after another, expanding spending and debt at levels we have never imagined in this country."

McConnell, in the interview, said that every member of his caucus is free to express his or her opinion, "but my views are that it's not about the president, it's about the policy." Other Senate GOP leaders agreed. Alexander said that DeMint spoke his mind, although he noted, "I wouldn't say it that way."

Sen. John Thune, R-S.D., the new chairman of the Senate Republican Policy Committee, said during an interview in his office that he thinks "the most effective strategy is to focus on [the president's] policies, and not just be anti-Obama, or to appear to just want to block whatever the president wants to do. We have to have alternatives. It's got to be positive."

Thune was uncertain, however, whether Senate Republicans at this point could rally around one health care reform alternative, noting that several measures co-sponsored by Republicans are sitting in the CBO's in-box, waiting to be scored.

Setting The Tone

McConnell understands that voters last November overwhelmingly embraced Obama's pledge to cross party lines to solve America's biggest problems. But Senate Republicans rejected the idea that defying the president on specific legislation would pose much of a political risk. They decided that it was important to publicly embrace Obama's goal of bipartisanship, and then argue that it was impossible to achieve if the president could not, or would not, buck his party's liberal wing.

McConnell began to publicly lay out the GOP's arguments on health care in the spring by saying that Republicans stood ready to work with the president if Obama aimed at the "real" problems. "Reform is no longer just a good idea -- it's absolutely necessary," McConnell said in May, but he added in a frequently heard GOP refrain, "It's important to get it right."

"The prospect of a government takeover of health care is becoming more and more real," he warned. "Their plan would create a government-run insurance model that could limit patient choices.... It could soon lead to government bureaucrats denying and delaying care... [and] private-market health plans would become more and more expensive."

Although 46 million Americans are uninsured, most people have coverage of some type and say in surveys that they are satisfied with their plans and don't want drastic changes. Separately, a segment of the populace that includes many independent voters worries about the huge federal budget deficit. Republicans hope to appeal to both groups by advocating piecemeal market-based health care reforms.

"People want the government to do less when the economy is bad," said public opinion analyst Karlyn Bowman, a resident fellow with the American Enterprise Institute. "But when the economy is doing well, as it was in 2000 and 2001, Americans were much more generous with what they wanted government to do, much more generous with spending. We're deeply ambivalent."

Thune contends that Obama and congressional Democrats boxed themselves in. "Logic would dictate that in a recession, you wouldn't want to raise taxes, and when you're running deficits as far as the eye can see, that you wouldn't want to borrow more and pile up more debt," he said.

Amid the Democratic bill-drafting this summer, McConnell and other Senate GOP leaders have offered their interpretations of the direction that the majority party is headed. The Republican warnings were designed, with the help of pollsters and political communicators, to capitalize on voters' doubts. Americans seem perplexed by budgeteers' estimates that the Democratic health reform plans would cost at least $1 trillion but would save the government money over the long haul.

"It's as if every single American gets up in the morning, walks over to the window, and tosses $2 out into the wind, every day for the next 10 years," McConnell warned during a July 15 Senate floor speech. Obama picked up his megaphone to deliver a "what's in it for you" pitch during a July 22 prime-time news conference, but because of legislative delays in both chambers, the president was forced to champion generalities while GOP opponents filled in the blanks.

As Senate Republicans worked to hone their messages on health care the past seven months, they also gained some useful practice as the loyal opposition. In May, McConnell almost single-handedly forced Senate Democrats to deny Obama's request for $80 million to close the Guantanamo, Cuba, detention facility. And -- after watching Democrats in February peel off three GOP senators to enact the $787 billion economic stimulus package -- Republicans more recently have seized upon public impatience with the stimulus and the still-lagging economy.

"If the stimulus taught us anything, it's that Americans should be skeptical any time someone in Washington rushes them into a major purchase with taxpayer dollars," McConnell said in a July 7 Senate floor statement. "The American people don't want us to rush through a misguided plan that pushes them off of their health insurance and onto a government plan that denies, delays, and rations care. On the stimulus, Americans saw what happens when Democrats rush and spend."

Sen. Susan Collins of Maine, one of the three GOP supporters of the stimulus bill, said she didn't get the linkage. "The health care debate I do not see as connected to the stimulus debate in any way," she said in an interview. Collins said she shares her caucus's concerns about a government-run public health plan, the overall price tag for reform, and the consequences for quality of care and access to coverage. Maine's version of a public health plan has been expensive, she noted, inspiring her to avoid any headlong rush to pass a flawed measure.

"I do not regret my vote for the stimulus bill," Collins added. "I think it was the right vote, even though the bill was not perfect. We were faced with the greatest economic crisis since the Great Depression. To just say no fell far short of an answer."

Collins's moderate Maine colleague, Snowe, is one of the three Republicans at the table in the Finance Committee's health care negotiations. Snowe, who also voted for Obama's stimulus plan, says she doesn't want ambitions for universal, affordable health care coverage to slip away for another generation.

Enzi, an accountant by training, is also a party in the Finance talks. He is the ranking member on the Senate Health, Education, Labor, and Pensions Committee, which approved a liberal-leaning health care bill on July 15 that includes a public insurance option. Enzi has had nothing favorable to say about the health care bills drafted by House Democrats or the HELP Committee, and he regularly briefs his GOP colleagues about the status of the closed-door Finance talks.

Grassley, the Finance Committee's ranking member, is the influential wild card among Senate Republicans, and he covets his reputation for independence. McConnell stays in close touch with the folksy Midwesterner, eager to keep him in the GOP fold. Many congressional observers have decided that Grassley is negotiating in good faith with Democrats to see if he can help get a reasonable bill out of Finance, but these sources expect him to reject a conference report later this year if it moves too far left.

In an interview, Grassley contended that Republicans should be delighted that he's on the job. "If they wonder whether or not our being involved [in the Finance talks] is doing any good, wouldn't you rather have a conservative Republican at the table than have nobody at the table?" he asked. "And secondly, hasn't our party, plus the grassroots of America, been pleading for time to study [legislation]? And suppose I was not at the table: There would be debate on the floor of the Senate, not in the Finance Committee."

Grassley said that Republican leaders asked him to block any Democratic moves to ration health services or implement a public option, although he tentatively supports a public cooperative that is not government-run. "So, the two things that Republicans are most concerned about -- the public option and rationing -- ain't going to be in it," he concluded.

Asked about his balancing act with Grassley, McConnell said that his colleague has been "very open" with the caucus. "I think it's been just fine," McConnell said of the Finance discussions. "I do read that some of the Democrats may not be that happy with it. But I don't think I have felt, nor do I think most of my members have felt, that they were trying to hide the ball on us."

Watching The Polls

In the interview with NJ, McConnell resisted the temptation to handicap the politics of the health care debate. "You know, this is a long march, and it's really not about the 2010 election," he said. "The main thing is to get the policy right, and the politics will take care of itself a year and a half from now, when we have another election."

Although the Democrats' health care proposals are supposed to take effect over four years, plenty of political analysts believe that the outcome of the midterm election could hinge on this congressional debate. President Clinton and the Democrats were hammered in the 1994 elections after fumbling on health care, and Republicans long for a similarly dramatic reversal of fortune.

The conventional wisdom is that the party in power in the White House loses seats in a nonpresidential election year. But Presidents Franklin Roosevelt, Clinton, and George W. Bush managed to pick up seats in the midterms of 1934, 1998, and 2002, respectively. Roosevelt rode the New Deal. Clinton balanced budgets and "saved Social Security" with surpluses. And Bush and the GOP capitalized on their war on terrorism after 9/11. The trio enjoyed two important conditions, in the view of academics: Each president had a job-approval rating above 65 percent at the time of his midterm election, and as voters went to the polls, the growth of their real income was strong.

Obama's job-approval numbers six months into his presidency are high but dropping -- not unusual as his honeymoon wanes. U.S. personal income, which began declining in 2008 and continued sliding during the early months of 2009, showed improvement in April and May, thanks in part to the stimulus checks, according to the U.S. Bureau of Economic Analysis. Most economists expect the recession to end later this year, but some warn of a slow "jobless recovery."

"If the Democrats don't get health care, and the jobless rate is above 10 percent, it could be a big election for Republicans next year," predicted consultant John Feehery, who was a top aide to then-House Speaker Dennis Hastert, R-Ill.

Looking to fan the flames of dissent, the Republican National Committee has dubbed Obama's health reform effort a "risky experiment" and spread the word in broadcast ads. Rush Limbaugh, the president's conservative talk-radio nemesis, said on his July 20 program: "The same people that gave us the subprime debacle, which is at the root of today's economic malaise -- the same people and the same thinking and the same philosophy -- are behind this push for government-run health care. It is socialized medicine, I don't care what the term that you come up with. It's going to be nothing more than the subprime mortgage mess times 10."

McConnell's rhetoric on health care, variations of which he repeats on the floor almost daily, has been echoed by numerous other Senate Republicans in interviews, op-eds, town hall meetings, and speeches. The minority leader has turned the Senate's two physicians, Tom Coburn, R-Okla., and John Barrasso, R-Wyo., into TV talk-show hosts on a program presented on the Senate's website and YouTube. On Thursday afternoons, the two doctors tout the minority perspective as they answer viewer e-mails about health care reform.

Republican senators strategize about health care during their regular Tuesday policy luncheons and at meetings of McConnell's working group, which gathers every Wednesday afternoon just off the floor to discuss the issue. The working group has brought in outside advisers and opinion leaders, including the Lewin Group consulting firm, which is owned by health insurer UnitedHealth Group; several GOP pollsters; policy experts from the Heritage Foundation (a Lewin client) and AEI; and conservative luminaries such as former House Speaker Newt Gingrich, R-Ga., and former Sen. Phil Gramm, R-Texas.

Stuart Butler, Heritage's vice president for domestic and economic policy studies, said that congressional Republicans have been able to "break through" to the public with their concerns about Democrats' proposals and the costs, as well as the revenue measures required to cover those costs. "They are beginning to frame it better," he said, adding that the GOP traction is notable because "as a party, they haven't laid out a comprehensive alternative -- what it would look like if Republicans were running things."

Butler, who regularly confers with lawmakers and staff on both sides of the aisle, said that congressional Republicans were reluctant to "go first" with any alternative before House and Senate Democrats settled on a plan, because they didn't want the minority's ideas to become "the punching bag."

Senate Majority Whip Richard Durbin, D-Ill., said in an interview that Republicans "are trying to create a climate of concern and fear over change, and they continue on a daily basis to raise questions. It's interesting, though, that the public support for change is still there, overwhelmingly."

Recent polling supports Durbin's assessment. The Gallup Organization reported on July 24, after a telephone survey that followed Obama's news conference, that seven in 10 Americans would urge their representatives in Congress to pass a health care reform law. But nearly a third said it was unnecessary to get it done this year, and a quarter of Americans -- mostly Republicans -- would advise their lawmakers to oppose a reform bill at any time.

Durbin said that Republicans molded their messaging around focus-group-tested language aimed at "stopping the 'Washington takeover' of health care," as Frank Luntz, a GOP pollster and message consultant, put it in a 26-page memo that made the rounds on Capitol Hill this spring.

Before Senate Majority Leader Harry Reid, D-Nev., publicly conceded last week that his chamber would not be voting on health care reform before the August recess, Durbin was looking ahead to September and searching for the bright side. "I think we've played it to a standstill," he said. "McConnell's trying to rally his troops, and I'm sure he has most of his caucus behind him. But he doesn't have all of them."

This article appears in the August 8, 2009 edition of National Journal Magazine.

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