The Republicans ruling Congress face an uncomfortable yet familiar choice: support a bill replacing the Affordable Care Act that is broadly unpopular, or oppose it and face the backlash from the base of the party.
It appears that enough have chosen the latter to destroy what may be Republicans’ last, best chance to “repeal and replace” the 2010 health care law this year, beset by deep divisions over ideology and tactics. By Monday evening, three Republican senators—Sens. John McCain of Arizona, Rand Paul of Kentucky, and Susan Collins of Maine—publicly opposed the latest Republican health care bill, which would provide just enough no votes to kill it.
The failure to pass their top priority in Congress could throw the Republicans into an identity crisis and exacerbate fraught tensions between conservative and moderate Republicans, while further damaging relations between President Trump and some dissenting members on Capitol Hill.
Republicans all acknowledge the political imperative of keeping their promise to voters, who elected them to take control of the House in 2010, the Senate in 2014, and the White House in 2016 on a pledge to repeal President Obama’s signature legislation.
“People aren’t going to vote for people who said they’d repeal and replace the Affordable Care Act if they fail to do what they said they would do,” said Sen. Cory Gardner, the chairman of the National Republican Senatorial Committee.
The latest attempt to replace Obamacare is the most radical. The bill would allow states to weaken consumer protections, and it would end the ACA’s Medicaid expansion and subsidies in favor of block grants. It is opposed by major hospital, patient, doctor, and insurance groups.
The opposition to the bill came both on policy and procedural grounds. On Monday, Paul and Collins announced that they’d oppose the bill from the right and the left; Paul thinks the block grants are too generous, while Collins expressed concern about the “devastating impact” on Medicaid recipients, weakened protections for people with pre-existing conditions, and higher premiums and reduced coverage for millions of Americans.
On Friday, McCain criticized the bill based on process, lamenting a departure from “regular order,” as the legislation was written and pushed largely behind closed doors and without much public debate. The one Senate hearing members held was dominated by public protesters.
On Monday, Trump took to the Rick & Bubba radio show to respond to McCain, who defeated a previous GOP health care bill in the summer after receiving a brain-cancer diagnosis.
“What McCain has done is a tremendous slap in the face to the Republican Party,” Trump said. “Without John McCain, we already have the health care.”
Some Republicans still hold on to hope that they can pass the bill by the end of the week, when time runs out on using a process that allows them to pass legislation with only a majority, rather than a 60-vote threshold. And others in the GOP are mulling the possibility of using the fiscal 2018 budget resolution to give them yet another shot at repealing Obamacare with just 51 votes.
Either way, some Republicans are worried about the political consequences.
“A lot of this is about electoral politics,” Paul said in a press conference. “Republicans believe they are going to be punished if they don’t do something.
“But really, it should be about whether it’s going to work,” he added. “I have a strong feeling that in 2018, everything is still going to be in disarray even if you pass this. And that disarray—who will be blamed for it? The people who now own health care, which will be the Republicans.”
On the House side, the ideological split within the GOP Conference was on display Monday evening, as leaders of the party’s moderate and conservative factions differed on what the next steps should be.
Republican Study Committee Chairman Mark Walker and members of his group have a press conference planned for Tuesday to announce their support for Graham-Cassidy. So he said he is holding out hope Senate Republicans can still pass it.
If not, he said he wouldn’t be opposed to shoehorning health care reconciliation instructions into a fiscal 2018 budget, along with instructions regarding changes to the tax system. Walker added that he wouldn’t be opposed to a bipartisan deal, either, depending on its contents.
“We cannot sit there and fold this tent up and say, ‘OK, maybe sometime next year,’” he said. “We’ve got to back to it next week and the week after, coming up with legislation that may be fine-tuned or woven that we can get enough people engaged on it.”
But Rep. Charlie Dent, a key centrist, said the Problem Solvers Caucus will be sending a letter to leaders this week asking that, in the wake of Graham-Cassidy’s failure, they take up the group’s five-point, bipartisan health care legislation. He also said he hopes Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander will resume bipartisan talks.
“We should work this legislation from the center out,” Dent said. “We haven’t whipped this, but I bet there would be 218 votes to pass this.”
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