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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