Is Senate Majority Leader Mitch McConnell planning to hold a vote on the Senate's version of the American Health Care Act (AHCA), which would rewrite Obamacare, next week?
If so, that would be quite remarkable, given that there is currently no bill available for either the public or Republican lawmakers to see. It is even more remarkable given that Republicans spent the last seven years criticizing Democrats for having rushed Obamacare into place, on a party line basis, without sufficient debate or clear public support.
Yet that appears to be exactly what McConnell is now planning for the AHCA. Politico and other outlets are now reporting that the GOP leader is barreling towards a vote on a bill that by all accounts isn't even fully drafted yet. That timeline matches earlier reports that McConnell hoped to hold a vote before the July 4 recess.
Although there is no bill to examine, and there are strong indications that the status of many of its particular provisions remains in flux even now, early reports indicate that it is likely to take much the same basic approach as the House version of the AHCA—except, perhaps, more expensive.
That framework was stunningly unpopular, polling at less than 20 percent back in March, a figure that makes Obamacare, which was unpopular for most of the previous administration, look positively beloved. As The New York Times noted last week, the plan is not popular in a single state. Presuming those numbers hold for whatever the Senate comes up with, every Senator who supported the plan would be voting against their home state majority.
No Senate Republican has stepped forward to defend the plan, whatever it is, at any length. There have been no public hearings, and all indications are that McConnell does not plan to hold any. When Senate Republicans are asked to explain their plan and its benefits, they respond with platitudes, at best.
As with the House bill, which Republicans defended on such glowing terms as "this is not the bill we wanted" (Rep. Dave Brat) and "this is the best we have today" (Rep. Jim Rennaci), it's not even clear that Republican lawmakers like what's brewing, or the rushed, opaque process that McConnell appears intent on using to pass the plan.
"I want to know exactly what's in the Senate bill. It's not a good process," Sen. Ron Johnson (R-Wisconsin) said last week. Sen. Mike Lee (R-Utah), who is part of the Senate working group that is working up the framework for the bill, said he has "grave concerns about what we're doing so far."
So far today I've heard GOP senators say they don't know what's in the health care bill, who's writing it or when they're going to see it
— Tierney Sneed (@Tierney_Megan) June 20, 2017
President Trump, meanwhile, has thrown a wrench into process by declaring that the House bill is "mean." Yes, he was referring to the same piece of legislation that he and his senior aides aggressively lobbied House Republicans to pass, and that President Trump, in a Rose Garden celebration following the bill's passage, called "a great plan" and "very, very, incredibly well crafted."
Nobody likes it. Nobody has read it. But Senate Republicans may vote on it next week anyway.
One question that comes to mind is, why? The only person who can answer that question definitively, of course, is Mitch McConnell. But since he's keeping quiet, here are five theories worth considering.
Keeping a Promise: The first is that Republicans simply feel they need to make good a promise to repeal Obamacare. Any legislation that looks roughly like the House bill would not exactly do that; the AHCA retains Obamacare's individual insurance market structure, keeping the health law's insurance regulations in place at the federal level while altering its insurance tax credit. But it would allow Republicans to claim that they have done so. This is one of the arguments that Speaker of the House Paul Ryan made on the day the House passed its bill. "This bill delivers on the promises that we have made to the American people," he said. "A lot of us have been waiting seven years to cast this vote."
It's A Marginal Improvement: A second reason why McConnell might be proceeding is that, although Republicans don't think a great bill, they believe it is at least somewhat better than Obamacare. This is basically the argument that Rep. Justin Amash (R-Michigan) made after casting a vote in favor of the AHCA despite having been one of the more outspoken GOP critics of the plan. "The proper analysis is not whether it makes the law good but rather whether it makes the law better," Amash wrote. "In this case, I felt comfortable advancing the bill to the Senate as a marginal improvement to the ACA."
The Health Care Hot Potato: Amash and most of the other members of the House Freedom Caucus voted for the AHCA even after spending weeks strongly criticizing the bill. Part of the reason why was the pressure applied by President Trump, who personally lobbied individual holdouts, as well as the Freedom Caucus as a group. Trump didn't just urge them to vote, however. He also called them out on his Twitter feed—and even hinted that he might back primary challengers: "The Freedom Caucus will hurt the entire Republican agenda if they don't get on the team, & fast. We must fight them, & Dems, in 2018!" As Reason's Matt Welch wrote, Trump appears "confident that he can similarly bully 50 of the Senate's 52 Republicans into line." So even though as few as three GOP senators could hold up the vote, or slow down the process, no one wants to be the target of an early morning Trump Twitter rant accusing them of being the holdout on Obamacare repeal.
It's a Setup For Tax Reform: Congressional Republicans haven't spent much time defending the AHCA framework on the health policy merits. But they have frequently described the bill as a helpful setup for tax reform, the next major item on their domestic policy agenda. There are only 52 Republicans in the Senate, so in order to pass a tax reform that permanently lowers tax rates with a simple majority, Republicans need to use the reconciliation process, which does not allow for deficit increases beyond the 10-year budget window. The GOP health care bill eliminates Obamacare's taxes and offsets them with Medicaid cuts, leading to a lower revenue baseline, which in turn makes it easier to design a tax code that slashes rates. That is why Republicans put Obamacare first on their agenda and have pushed to move it quickly.
This is not speculative. Republicans have been rather open about viewing the AHCA as a necessary prologue to permanent tax reform built around cuts to tax rates: "We want a very big tax cut, but cannot do that until we keep our promise to repeal and replace the disaster known as Obamacare," President Trump said earlier this year. At the Rose Garden ceremony celebrating the passage of the AHCA, Trump said the health care bill helps pave the way for a tax cut, and Rep. Kevin Brady, who chairs the tax-writing Ways and Means Committee, also declared the bill a victory for a tax policy, saying, "Make no mistake, today we have taken a giant step toward delivering bold tax reform."
"Show Them a Body": Finally, it's possible that McConnell wants the bill to fail—but needs to hold a vote first. This is the theory advanced by a Republican health care lobbyist to Vox reporter Dylan Scott earlier this month. "They have to be able to show the electorate a body, to say that they tried and failed," the lobbyist said. McConnell is a vote counter and strategist who has never been too focused on the particulars of the GOP's policy agenda, but he has always been a shrewd political operator. So he may have taken a look at the AHCA's poll numbers, and the dissent and disunity amongst Senate Republicans, and decided that the best course would be to hold a vote, let it fail, and move on.
McConnell can be difficult to read, but I wonder if there's something to this theory, although I would tweak it slightly. It may not be that McConnell actively wants the bill to fail; if he were determined to kill the bill, there are lots of ways he could do so—and perhaps even some steps he could take that would not let on that he was trying to strangle it.
Instead, I suspect that McConnell may not have a strong preference for the bill one way or another, and that he doesn't want to waste much time on it, regardless of the outcome. McConnell likes political victories, so he would be happy to bag a win on a kept promise, and he's a conventional enough Republican that he would probably be pleased to help set up a major tax reform. But he may not want to spend too much time on health care, especially since spending more time debating any plan that looks roughly like the House health care bill is virtually certain to make it less popular. (If Republicans felt they could make a winning case for the legislation, you would expect to see them doing so.) So, presuming the reports about the rapid vote timeline are accurate, McConnell is going to give his fellow Senate Republicans a chance, let the AHCA pass or fail, and then move on.
If that theory is right, it is yet another indication about the quality of the bill: Leadership not caring one way or another about the AHCA's passage is, to put it mildly, not much of an endorsement. But at this point, there's no reason to expect one. It's been clear for a while now that Republicans would rather vote on their health care bill and move on than take the time to explain it, make their case to the public, and defend it on the merits.