By most measures, Republicans face a nearly impossible task of finding enough votes to pass their long-promised repeal of the Affordable Care Act through a Senate that seems irreconcilably divided.
A core group of moderates and mainstream conservatives remain resistant to the Republican proposal that slashes Medicaid funding, while a small but critical bloc of conservatives keep pushing to move the bill further in their direction.
Yet, by one measure, Republicans have never been closer to actually repealing large chunks of what they dismiss as “Obamacare.” Within two short weeks, the GOP will likely either be reveling in their unexpected victory or mired in deep infighting over the party’s failure to live up to a pledge it has made over the last seven years.
Some Republicans remain optimistic — and Democrats fearful — that Senate Majority Leader Mitch McConnell (R-Ky.) can pull off the negotiating tricks necessary, but he still faces an uphill fight in winning the votes to pass the Better Care Reconciliation Act by his tentative deadline of Friday.
If McConnell can make it happen, House Republicans seem ready to quickly pass the Senate version of the legislation and send it to President Trump’s desk for his signature.
At least that’s the assessment of two key House negotiators, one from the conservative and one from the moderate flank.
“I have no doubt in my mind that if it passes the Senate – in something close to what it’s like now – that it will pass the House,” said Rep. Tom MacArthur (R-N.J.), a moderate who negotiated portions of the bill that passed the House in early May.
His conservative counterpart, Rep. Mark Meadows (R-N.C.), called the latest Senate version “a step in the right direction” and suggested it would “have to be a big move” away from the current draft to sink the bill in the House. Either way, he said, conservatives will not object if Speaker Paul D. Ryan (R-Wis.) takes the Senate bill and places it on the House floor in a take-it-or-leave-it moment.
“I realize the reality is, we’re not going to change it when it comes back here,” said Meadows, chairman of the House Freedom Caucus, the most conservative group in Congress.
Ryan has gone out of his way to avoid comment on specifics of the Senate version of legislation. But Ryan has informed the House to expect immediate consideration if the Senate can find the votes. “If Senate is going to give us a health-care bill, we’re going to stay and finish the health-care bill,” he told reporters Thursday.
This is a reversal of the standard operating procedure of the last six-and-a-half years of the GOP majority in the House. Time and again House Republicans pulled a legislative face-plant and relied on McConnell to clean up their mess. In 2011, the then-Senate minority leader had to step in after House Speaker John Boehner’s failed talks with President Obama left the nation on the brink of default, and in 2013, Boehner’s House GOP drove the strategy into a federal government shutdown, which only ended through McConnell’s dealmaking. But this time, the negotiating failure could be on McConnell.
If McConnell works his magic, there’s no guarantee Ryan can ram the Senate bill through the House, where the original bill passed by slimmest of margins, 217 to 213 in May. Some House conservatives are balking at the Senate’s refusal to repeal all of the taxes that were included by Democrats when they passed the 2010 law and some moderates are wary of a provision Sen. Ted Cruz (R-Texas) won that would allow insurers to sell low-cost plans in addition to those that meet higher standards imposed by the ACA.
But MacArthur and Meadows believe that in its current form, the Senate bill can probably pass the House — and if it does happen, it will pass quickly.
For several weeks they have provided a feedback loop to key Senate negotiators over what they think their allies in the House would accept without too much debate.
After votes ended Friday, Meadows stuck around Washington rather than making his usual eight-hour drive to western North Carolina. He had a call with Cruz, a key ally to the Freedom Caucus, and his schedule called for a White House meeting this weekend with people he would only identify as “senior administration officials” to discuss the Senate legislation.
MacArthur’s role negotiating with Meadows cost him his leadership role in the Tuesday Group, particularly because of their provision that would eliminate guaranteed coverage for some pre-existing conditions. The moderate caucus of House Republicans split ranks on the House vote, and shortly thereafter MacArthur stepped down as co-chairman of the Tuesday Group.
But he has remained in talks with the moderates who did support the House bill, and in recent weeks he has had extended talks with a half dozen Senate Republicans. MacArthur was particularly pleased that McConnell added a $45 billion fund to fight the opioid epidemic.
Overall, MacArthur thinks the emerging Senate bill is pretty similar to what the House already supported. The Cruz amendment is not that different from what he and Meadows were trying to do on the pre-existing condition issue.
“Their bill is on the framework that we sent them, they didn’t start from scratch. And so they’re making adjustments around the edges, but directionality they’re doing the same things we did,” he said.
Meadows’ biggest worry is that McConnell will yield to the Republicans from Medicaid-expansion states who believe the Senate version goes too far in cutting the entitlement program, even after adding about $115 billion to help with premium costs and fight opioids. “If it shifts hard to the left, it doesn’t get out of the Senate, and even if it does, it’s dead here,” he said.
MacArthur, who now has drawn several Democratic challengers for next year, has told colleagues that there is no political gain from switching their yes vote to a no vote. “If you voted the bill out of committee, if you voted for it on the floor, the ads are already written against you. And to try to change now, I think, gets you nothing. You know, it’s all the calories and half the flavor,” he said.
As he left the Capitol Friday, Meadows had to temper his optimism about the bill’s chances in the House — because he knows that McConnell still hasn’t locked down its passage in the Senate.
“We’re still not there, though, we’re still several senators short,” he said.