Column: Uh-oh, the GOP has no choice but to work with Democrats on healthcare reform

The sudden collapse of Kentucky Sen. Mitch McConnell’s healthcare bill on Monday was much more than a tactical setback for the Senate Republican leader once considered an unbeatable legislative wizard. It was a catastrophic failure for the GOP’s attempt to make one-party government work. It’s one thing to produce gridlock when control of Congress is divided. When one party manages to produce gridlock all by itself, something is seriously wrong. The setback means that Obamacare will almost certainly survive for the foreseeable future, despite seven years of GOP promises to repeal it.

McConnell and his allies clearly overestimated the cohesion of their fragile 52-seat majority in the Senate — a majority so small that any three defections meant defeat. Moderate-conservative Republicans wanted to protect the expansion of Medicaid, the health insurance plan for low-income families, especially in their home states. Hard-line conservatives wanted, above all, to shrink Medicaid and reverse the expansion.

There’s no easy way to compromise between those two positions. McConnell promised some senators that the bill would shrink Medicaid, but privately assured others that the shrinkage might never happen. That gambit backfired.

In his attempts to appeal to both pragmatists and hard-liners, McConnell produced an incoherent bill that became less attractive to each camp, not more.

Nor did he succeed in selling the bill to voters; several polls found less than one-fourth of the public liked the legislation. Bills normally go through a long process of public hearings and debate that, with luck, build popular support; that didn’t happen this time. And McConnell got little help on that score from a president who seemed jarringly unaware of the details of the bill.

Worst of all, from the GOP point of view, the debate inadvertently built new constituencies for Obamacare. The long battle over repeal educated millions of voters on what the law has actually delivered, especially through Medicaid expansion.

Before the House and Senate Republicans drafted proposals to replace Obamacare, the choice voters confronted was between a flawed status quo and an undefined alternative that Trump promised would be “beautiful.” Not surprisingly, many chose “beautiful.”

Once the legislation was unveiled, the choice changed. Now it was between Obamacare and a plan that reduced future spending on Medicaid, weakened the guarantee to cover preexisting conditions, and threatened to close rural hospitals.

Given that alternative, a majority rallied to Obamacare. The long-derided law is now more popular than President Trump, 53% to 38% in recent Gallup polls.

That helps explain why McConnell’s Monday night fallback plan to repeal Obamacare without a replacement (although the repeal would not take effect for two years) didn’t survive past lunchtime on Tuesday.

Three pragmatic Republican senators — Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska — rejected the idea almost instantly, saying it would throw insurance markets into chaos.

“I did not come to Washington to hurt people,” Capito explained with spare eloquence.

McConnell said he would still seek a vote on repeal, but the defections appeared to doom his plan.

The healthcare debate isn’t over, of course. Obamacare still needs short-term support and long-term fixes, which the president isn’t eager to provide.

Trump said Tuesday he will now revert to a messy solution he has long proposed: standing back and letting the federal health law fail on its own.

“We’ll let Obamacare fail and then the Democrats are going to come to us, and they’re going to say, ‘How do we fix it?’”

“I’m not going to own it,” he added. “I can tell you, the Republicans are not going to own it.”

Except he already does, in the eyes of many voters. A Kaiser Family Foundation poll last month found that 59% of Americans think the Trump administration now bears responsibility for making Obamacare work — including 56% of Republicans. Translation: Voters expect the governing party to fix problems whether it wants to or not.

Some Senate Republicans have accepted that burden already. Lamar Alexander of Tennessee, chairman of the Senate Health Committee, said he’s getting to work to “stabilize the individual [insurance] market.” John McCain of Arizona, hospitalized in his home state, said it’s time to draft new legislation with “input from members of both parties.”

With the collapse of McConnell’s effort, the GOP appears to have lost its chance to pass a bill in the Senate through reconciliation, the arcane budget process that requires a majority of only 50 votes. Any future healthcare bill will need 60 votes instead of 50 — which requires winning support from at least eight Democrats.

If they want to repeal, replace or merely fix Obamacare, Senate Republicans now have no choice but to try to legislate piecemeal changes the old-fashioned way — with hearings, open debate and even a measure of bipartisanship.

That’s probably too optimistic. But as McConnell warned a few weeks ago, they may have no alternative. They’ve tried everything else and failed.

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doyle.mcmanus@latimes.com

Twitter: @DoyleMcManus

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