The Republicans’ “Seven-Year War” to repeal the Affordable Care Act appears dead. Last night, three GOP senators bucked their party and president, siding with Democrats to vote down a last-minute effort to repeal portions of the law. Here are three takeaways from last night’s vote.
1. It’s tough to govern with a fractured majority
As Mark Spindel and I wrote this spring, ideological disagreement among Senate Republicans has been on the rise for over a decade. To be sure, Republicans are less ideologically fractured than they were in the late 1970s. But unified party control of Congress and the White House — especially with a distracted president and a White House in chaos — can’t paper over a deep cleavage within the GOP conference. That gap seems particularly wide on health care, undermining Senate Marjority Leader Mitch McConnell’s efforts to cobble a deal that would appeal to both poles. In the wee hours of the morning, McConnell (R-Ky.) faced the reality that no Senate majority existed for his proposals to repeal or replace Obamacare.
2. The rules of the game matter
Expecting Democrats to oppose Trump’s agenda, Republicans choose a legislative route known as “reconciliation” that precluded the need for Democrats’ votes. Those budgetary rules allowed Republicans to legislate with a simple majority. But they also threw steep barriers in their way.
First, the Congressional Budget Act places strict limits on what can be included in a reconciliation bill in the Senate — unless 60 senators vote to waive the limits. With just 52 GOP senators and little hope of attracting Democratic support, Republicans had to closely comply with legal limits on reconciliation.
One key restriction required Republicans to match major cuts in Obamacare taxes with steep cuts in government spending — provoking opposition from GOP senators whose states rely on generous Medicaid funding through Obamacare. Another limit required every provision in the bill to directly change government revenue or outlays. That requirement precluded any policy changes with only incidental budgetary effects — further complicating leaders’ ability to cobble policy trade-offs in a deal.
Second, the decision to pursue repeal with only GOP votes took away a Senate majority’s key tool for covering their missteps: blaming the other party. McConnell tried to lay the blame at Democrats’ feet last night, but the accusation sounded hollow, given the GOP’s choice of a legislative vehicle that allowed them to circumvent the Senate’s supermajority rules.
3. Simple majority rules don’t turn the Senate into the House
Defenders of the Senate filibuster often argue that simple majority rule will turn the Senate into the House. But last night’s demise of the GOP repeal campaign suggests that more separates the chambers than their voting rules. Senators, of course, represent states, not narrow districts. Given the importance of states in managing health insurance under Obamacare, senators’ state-based electoral ties might have enhanced the influence of governors in Senate dealmaking. Pressures from governors who wanted to improve, not repeal, the act complicated McConnell’s search for a deal in the Senate, even after governors were nearly invisible when the House took up its bill earlier in the year.
McConnell had only two votes to spare, and he lost three. But it wasn’t the nay votes from the two centrists last night that were so remarkable: Susan Collins of Maine and Lisa Murkowski of Alaska had forecast their likely opposition to repeal, given how hard repeal proposals would hit their states. What Washington has been talking about Friday morning was John McCain’s last-minute opposition, highlighting objections from his home state’s governor.
McCain (R-Ariz.) had not been deeply involved in health care during his long career, was largely invisible during the months-long efforts to craft a deal, and appears to have surprised GOP leaders when he bucked his party. That degree of individualism — fueled in part by responsiveness to broader state interests — is unique to the Senate, and proved pivotal to the outcome. It may take more than simple majority rule to make the Senate behave like the House.
4. McConnell committed legislative malpractice
McConnell and his staff drafted this bill in secret, hoping to speed up the slow-moving Senate by avoiding public review. If negotiated in the open by committees, the party’s slim, divided majorities on key Senate panels would probably have doomed the bill. But centralized, secret bargaining that kept many senators in the dark for so long made matters worse for McConnell. Secret bill-writing continued until even after floor debate had already begun — meaning that senators were asked to vote on the fly for proposals affecting one-sixth of the economy. With so few votes to spare, it was a daredevil strategy for a majority leader.
Now what?
After this, it seems unlikely that Republicans will revive their legislative campaign against Obamacare. This fall’s schedule will be demanding. They need to write a budget that will allow them to advance tax reform before the 2018 elections; reach a bipartisan deal on government spending for the coming fiscal year; and raise the nation’s debt ceiling. That’s a heavy lift for a slim, fractured majority with little hope of leadership or political cover from their own party’s president across town.