For weeks, insiders in Washington have been wondering: Is it possible that the Senate’s wily majority leader, Mitch McConnell of Kentucky, secretly wants his healthcare bill to fail?
That sounds unlikely, I know. McConnell prides himself on his prowess as a legislative strategist; he likes nothing better than crushing his opponents. Repealing Obamacare was one of the GOP’s core promises in 2016, and most conservatives (including McConnell, presumably) still believe in the cause. Equally important, McConnell and House Speaker Paul Ryan desperately wanted to pass a healthcare bill with a big tax cut at its center. That’s the core of the Republican economic agenda.
In a normal political universe, McConnell would want his bill to pass – and my guess is that he still does. But he may be reconsidering.
Passing the healthcare bill has turned out to be harder than the Kentuckian expected. On Tuesday, with negotiations at a stalemate, McConnell delayed the first vote on the bill until after July 4.
He has only 52 Republican senators; he can’t afford to lose more than two. That’s given individual senators plenty of leverage, and they’ve been using it. On the right, libertarians and tea party conservatives have demanded ever more radical changes, including yet more cuts in Medicaid, the program that provides health insurance to the very poor. On the center-right, senators from states that use Medicaid to fight the opioid epidemic have demanded more money to keep those programs alive.
The bill McConnell and his allies unveiled last week satisfied neither side. It didn’t repeal Obamacare. It didn’t replace it. It didn’t even fix it, in conservatives’ eyes, except around the edges. It mostly just cut the current program’s spending to pay for tax cuts aimed at people making more than $200,000 a year.
The bill would break almost every promise Donald Trump and his party made to voters during last year’s campaign.
“Our healthcare plan will lower premiums and deductibles,” Trump promised in May. Actually, CBO found that the bill will raise premiums and deductibles for many – especially older people, who arguably need health insurance most.
Republicans argued that the bill would push premiums down by allowing insurers to offer policies with less coverage – but that’s just selling less insurance for a lower price, the equivalent of shrinking the chocolate bar.
Example: a 64-year-old with an income of $57,000 would see her premium triple, from $6,800 to $20,500. Unless she opted for higher deductibles or less coverage, that is.
“I’m not going to cut Medicare or Medicaid,” Trump promised on the eve of his campaign. But the bill reduces Medicaid funding by almost $800 billion over 10 years compared with what would have been spent under Obamacare.
Here’s the problem McConnell will face if he succeeds: Once they’ve enacted a law that will inevitably become known as Trumpcare, Republicans will own every problem in the American healthcare system. If children with cancer can’t get coverage, Democrats will blame them for it. If older people can’t afford their rising premiums or deductibles, Democrats will blame them. If healthcare costs continue to rise, Democrats will blame them for that, too – just as the GOP blamed Obama, whether he deserved it or not.
All to pay for a tax cut that, as Democrats will point out, will go largely to the top 1 percent.
When McConnell and his lieutenants designed their bill, they hoped its complexity – and the fact that its biggest cuts to Medicaid won’t kick in for years – would obscure its cost to Americans who currently depend on Obamacare.
But this week’s CBO report made that strategy untenable. Under the Senate bill, CBO warned bluntly, higher premiums and deductibles would mean “few low-income people would purchase any plan.”
That’s why, after the CBO report, more Republicans began whispering that it might be better for McConnell to let the bill die.
“The CBO changed the narrative in a bad way,” a top GOP lobbyist told me. “It looks as if we will be sliding Obamacare back to the Democrats -- which is what Trump wanted from Day One.”
What he meant was: If Republicans give up and leave Obamacare in place, they can try to blame Democrats for any problems that ensue.
As the president tweeted on Monday: “Perhaps just let OCare crash & burn!”
It wouldn’t be good government. It’s probably not even good politics. There’s no reason to expect that anyone but unshakable Trump loyalists will blame Democrats for the consequences of a high-profile Republican failure.
And McConnell hates to fail.
But his chances of winning are eroding. According to some Republicans, he’s warming to the idea of taking a dive. It may be the only way he has to show Trump how difficult governing really is.