Health Bill’s Failure Poses New Challenges for McConnell

Like Paul Ryan, the Senate GOP Leader spent years promising to repeal and replace Obamacare. Now what?

Senate Majority Leader Mitch McConnell, joined by Sens. John Barrasso (left) and John Thune, takes questions from reporters about the Republican health care bill on March 21.
AP Photo/J. Scott Applewhite
March 27, 2017, 8:01 p.m.

On the eve of Pres­id­ent Obama sign­ing the Af­ford­able Care Act, an aide to then-Sen­ate Minor­ity Lead­er Mitch Mc­Con­nell came up with a new ral­ly­ing cry that would lead Re­pub­lic­ans back to power—“re­peal and re­place”—and wrote it down on a note­card. In the next sev­en years, the party won back the House, Sen­ate and White House on that core prom­ise, which has now gone up in flames.

In the af­ter­math, the fo­cus is on how Pres­id­ent Don­ald Trump can sal­vage his agenda, how he, “the closer” couldn’t close and how Speak­er Paul Ry­an, the wun­der­kind wonk, could so dis­astrously craft and sell the bill that his Re­pub­lic­an col­leagues re­jec­ted last week. Mc­Con­nell, though, has emerged re­l­at­ively un­scathed, as his Re­pub­lic­an sen­at­ors aver­ted the crisis of tak­ing a tough vote on what was de­scribed as Trump­Care or Ry­an­Care.

But re­peal­ing and re­pla­cing Obama­care is Mc­Con­nell’s prom­ise too—and he is acutely aware of how the fail­ure in the House makes every oth­er top agenda item even harder to do.

“If you’re just look­ing at the num­bers, you would con­clude there’s no pos­sible way [to pass it],” said Josh Holmes, Mc­Con­nell’s former chief of staff and the pro­gen­it­or of the Obama­care “re­peal and re­place” slo­gan, of the Amer­ic­an Health Care Act in an in­ter­view be­fore the bill died last week. “But what I keep com­ing back to is, there is no oth­er al­tern­at­ive. It has to pass. I don’t know what the timeline is on that, but it lit­er­ally has to pass be­cause if it doesn’t, it’s all over. There’s noth­ing to go to. There’s no agenda without it.”

Over the next few months, Con­gress will need to pass a gov­ern­ment fund­ing bill and raise its bor­row­ing au­thor­ity, which will re­quire bi­par­tis­an sup­port in the Sen­ate. In early April, Mc­Con­nell will de­liv­er con­ser­vat­ives their first ma­jor vic­tory in the Trump ad­min­is­tra­tion when the Sen­ate con­firms Judge Neil Gor­such to fill the Su­preme Court va­cancy—a win he paved the way for last year by tak­ing the un­pre­ced­en­ted step of re­fus­ing to even con­sider Obama’s nom­in­ee Mer­rick Gar­land. Mc­Con­nell has lately come to call it the most sig­ni­fic­ant one he’s made in his polit­ic­al ca­reer.

But for Mc­Con­nell to guide Re­pub­lic­ans from what Ry­an has called an “op­pos­i­tion party” to a “gov­ern­ing party,” he’ll have to en­sure that the party can pass ma­jor le­gis­la­tion too.

The White House, Ry­an and Mc­Con­nell had agreed to ad­dress Obama­care first not only be­cause it was the de­fin­ing cam­paign pledge of Re­pub­lic­ans every­where. It also made it easi­er to do their oth­er top pri­or­ity: com­pre­hens­ive tax re­form. The health care bill would have re­pealed taxes, lower­ing the baseline ne­ces­sary to achieve the goal of mak­ing the tax le­gis­la­tion “de­fi­cit neut­ral.”

Without fin­ish­ing the health care bill, Re­pub­lic­ans won’t be able to re­duce taxes as much as they’d like. Nor will they have any polit­ic­al mo­mentum; they’ve proven on a grand stage that mod­er­ates and con­ser­vat­ives can’t over­come their ideo­lo­gic­al di­vi­sions while in power.

“Passing any­thing in­to law is ex­tremely dif­fer­ent than stop­ping something from be­com­ing law,” Holmes said. “You’ve got a House con­fer­ence that is largely fo­cused on the lat­ter rather than the former, and that fever needs to break in or­der for us to be­come a gov­ern­ing party. That’s a prob­lem.

“If people think it’s easi­er to get tax re­form done than re­peal and re­place, I don’t think they’ve either seen a con­ver­sa­tion on Cap­it­ol Hill be­fore, or dis­cussed tax re­form,” he ad­ded.

Sen. John Thune, a mem­ber of the Re­pub­lic­an lead­er­ship team, said last week that tax re­form would be “equally hard” as health care re­form, not­ing that one ma­jor pro­vi­sion to help pay for it, the so-called bor­der-ad­just­ment tax, is deeply con­tro­ver­sial, es­pe­cially in the Sen­ate.

“None of this stuff is easy,” Thune said.

The Obama­care re­peal de­bacle will make it even harder.

Be­fore the bill spec­tac­u­larly faltered in the House, its pro­spects in the Sen­ate were dire.

“I don’t know why we led off with health care,” Sen. Lind­sey Gra­ham told Na­tion­al Journ­al two days be­fore the ef­fort fell apart. “That’s not my de­cision to make, but that would’ve made a lot more sense to me to do in­fra­struc­ture, taxes. But that ship has sailed.”

After the AHCA died, some Re­pub­lic­an sen­at­ors have en­cour­aged their lead­ers to not break their “re­peal and re­place” prom­ise and look at oth­er op­tions. Be­fore it did, former aides still close to Mc­Con­nell offered a range of views of what he’d do next, but there was little con­sensus. “If they can’t do a re­peal and re­place, at some point you fish or cut bait,” said one per­son. Oth­ers thought dif­fer­ently.

“If they fail this week, I don’t think it is the last time that this is­sue is be­fore the Con­gress,” said Ro­hit Ku­mar, a former seni­or policy aide to Mc­Con­nell now at PwC, in an in­ter­view be­fore the House pulled the House bill. “I think they will be mo­tiv­ated and de­term­ined to keep try­ing.”

Re­pub­lic­ans could have come up with a re­place­ment some­time in the past sev­en years that would have got­ten broad sup­port with­in their party. In­stead, they spent around three weeks try­ing to whip a bill that had little buy-in from ma­jor in­dustry play­ers or con­ser­vat­ive act­iv­ists and health care ex­perts. One former GOP aide to the Sen­ate Health, Edu­ca­tion, Labor, and Pen­sions com­mit­tee re­buffed cri­ti­cism that they should’ve come up with a plan soon­er.

“Why the hell would you agree on something back in 2009, 2010, ‘11, ‘12, ‘13, ‘14, ‘15, so that it can hang out there in the wind and be cri­ti­cized for po­ten­tially years un­til you ac­tu­ally come in­to power?” said the former aide. “It’s bet­ter to wait un­til you ac­tu­ally have the power and then to say, ‘Here’s what we’ll do.’”

But should they try again, Re­pub­lic­ans will have to con­front what the aide ad­mit­ted was a “nat­ur­al in­ab­il­ity” to come up with an agree­ment on a con­ser­vat­ive health care vis­ion, com­pared to lib­er­als who want to put Amer­ica on the course to­wards a single-pay­er sys­tem. On Monday, Ry­an re­portedly told donors that Re­pub­lic­ans would not “all of a sud­den aban­don health care and move on to the rest” of the agenda.

So does Mc­Con­nell have a bet­ter idea for how he and Ry­an can keep the prom­ises they made? If he does, he hasn’t shared it yet.

“He was rather good at fig­ur­ing out what was in the world of the doable and what wasn’t,” Ku­mar said, “and not spend­ing a lot of time try­ing to pur­sue that which wasn’t in the world of the doable.”

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