When House Republicans tried to pass an Obamacare replacement plan back in March, it failed thanks to the resistance of the far-right House Freedom Caucus. Two months later, Speaker Paul D. Ryan, R-Wis., made a different bet: If you satisfy the right, enough moderates will cave to pull the bill across the finish line. That gamble paid off, with the measure passing 217-213. Now Senate Majority Leader Mitch McConnell, R-Ky., is making a similar wager on Senate Republicans’ spinelessness. Unfortunately, so far it seems to be working, with McConnell pulling together 50 votes to move forward on repealing Obamacare.
During McConnell’s doomed initial push for an Obamacare replacement, the GOP leader was trapped between skeptics on both ends of the caucus. The right, including Sens. Rand Paul, Ky., Ted Cruz, Texas, and Mike Lee, Utah, wanted to rip up Obamacare root and branch. The moderates, including Sens. Shelley Moore Capito, W.Va., Rob Portman, Ohio, and Dean Heller, Nev., opposed steep cuts to Medicaid and opioid addiction treatment.
With the resurrection of Obamacare replacement, GOP leaders had to decide what the latest version of the bill would look like. Because they opted to forgo a Congressional Budget Office score, this version would need 60 votes. Since that would be impossible to reach, this version would be more of a symbolic gesture. But it would set the terms for the intra-party debate the rest of the week as GOP leaders hashed out a final iteration behind closed doors. On Saturday, conservatives got a commitment to include Cruz and Lee’s amendment to allow insurance companies to sell plans that don’t comply with Obamacare’s mandate. (That would send the exchanges into a “death spiral,” but never you mind.) Paul also got what he wanted: a vote on a clean repeal of Obamacare.
What did the moderates get for their votes to proceed? A Portman amendment to the bill restoring “a small portion of the Medicaid cuts” to go with previously added and similarly pitiful funding to treat opioid addicts. Both were token gestures, yet Portman voted yes. A month ago, Heller said he would not vote for the bill because of its steep Medicaid cuts. The cuts remained largely intact, yet Heller voted yes. A week ago, Capito said she would vote for the bill only if there was a replacement plan “that addresses my concerns.” No one knows whether there will be such a plan, yet Capito voted yes. (Heller, Capito and their defenders will say that it’s just a procedural vote to begin debate, not on the bill itself. But Heller and Capito both specifically said they would vote no on that motion.)
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Worse, simply by voting for the motion to proceed, the moderates have undercut their influence. McConnell’s new strategy heavily depends on the fallback option of “skinny repeal” – a bare-bones repeal of the mandate and a few other features of Obamacare. The bill would then go to a House-Senate conference committee, where it would be completely rewritten, and then it would go back to the Senate for an up-or-down vote. Make no mistake: The House Freedom Caucus and Senate conservatives will have far more influence over that committee than moderates in either chamber. And then the moderates would be told to vote for a bill that they didn’t like and barely influenced, for the good of the party.
Sen. Richard Burr, a GOP stalwart, was rightly ridiculed on Monday for saying, “I’ll vote for anything.” But at least he was being honest. Again and again, we’ve seen GOP moderates go through the motions of being “deeply concerned” about an Obamacare alternative – or a controversial nominee or the latest development in the Russia scandal – then vote with the party anyway as though nothing has happened. Soon they will be faced with a final bill, one that will rip health insurance away from millions. The question is whether they will cave yet again. Those that choose cowardice may hope that voters won’t judge them, but history will not be so kind.
The Washington Post