McConnell facing biggest test as leader

Published 8:27 am Wednesday, July 19, 2017


Guest columnist

This column is on a less frequent schedule for the summer, but one of its favorite subjects has been especially busy since our last visit.

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In the last three weeks, Senate Majority Leader Mitch McConnell withdrew his health-insurance bill when he couldn’t get the votes for it; cut the Senate’s treasured August recess in half; produced a revised bill that still drew fire from ardent conservatives, including seatmate Rand Paul, for not really repealing Obamacare; drew heavy criticism from health-care industry and patient lobbies; got an implicit warning from President Trump demanding a bill; and drew three Pinocchios from The Washington Post for a “deeply misleading” remark about Medicaid. And a poll again ranked him the least popular senator in his own state, with a 41 percent approval rating in Kentucky between April 1and June 18.

That’s a pretty rough ride for a 75-year-old man who’s been in politics for 50 years, but he still seems comfortable in the saddle he long sought, leader of the Senate’s Republican majority. However, that majority is so thin (only two votes to spare), health insurance is so complicated, and health care is so important, that he’s still having trouble getting the 50 votes it needs.

Some people are beginning to wonder if McConnell really wants his own bill to pass, since polls show Republicans’ approach to be highly unpopular, and the bill would have a greater negative impact on his home state than perhaps any other (see my last column) – more than some states represented by moderate holdouts who oppose the bill’s long-term limits on Medicaid spending.

In this case, McConnell has acted as majority leader, not as a representative of Kentucky’s interests. He and Republicans have made the repeal of Obamacare their primary campaign promise for seven years, and failing to deliver would further split the party and weaken his own standing. So he cares a lot more about getting 50 Republican votes than the specifics of the bill, which are means to an end: getting the best bill that serves his purposes.

While his bill is not a true repeal, because it retains the Obamacare framework of subsidized insurance, its changes in Medicaid and other provisions of the 2010 law would be big enough that he and his party could claim victory.

And victory is being demanded by Trump, who said of McConnell Wednesday: “He’s gotta pull it off” or I’ll be “very angry.” At McConnell, he seemed to imply.

Trump has made no public pitch for the bill and seems not to know or care what’s in it. For him, it’s all about winning. Also, for political and procedural reasons, he and McConnell need to get health insurance out of the way before moving to tax reform.

The issue has proven to be McConnell’s greatest test as majority leader. As minority leader, he crafted several must-pass compromises with Democrats to keep the government going, but as majority leader, he wants only Republican votes because compromising with Democrats on Obamacare would be anathema to the party’s conservative base.

But this is a must-pass bill only for Republicans, and McConnell seems to be betting that in the end, the conservatives who think it doesn’t go far enough and the moderates who think it goes too far will see that their party can’t afford to not deliver on its promise.

McConnell has compared the process of getting 50 Republican votes to finding the solution to a Rubik’s cube – an apt analogy. He is a legislative mechanic who knows the “instruction manual” of Senate rules and precedents. They could prove decisive when the bill hits the Senate floor; that’s when we may see legislative sleight of hand.

To win conservatives, McConnell added to the bill a provision by Sen. Ted Cruz of Texas allowing insurance companies to sell the sort of low-cost, low-coverage policies that Obamacare outlawed. That would destabilize the insurance market by reducing the risk-sharing among healthy people and the not-so-healthy, insurance companies have warned.

McConnell may know, presume or think that the Senate parliamentarian will rule the Cruz provision out of order because it isn’t related closely enough to taxes and spending, a requirement of the budget-reconciliation rules that he is using to avoid a Democratic filibuster, which takes 60 votes to stop. Cruz could ask the Senate to overrule the parliamentarian, but that would be a battle between the Senate’s ultimate outsider and its greatest insider; McConnell would win.

In his redraft, McConnell reportedly used another form of political prestidigitation. Republicans such as Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia, states that used Obamacare to expand Medicaid like Kentucky did, don’t like the bill’s future limits on the program because it wouldn’t be able to keep up with health care inflation and states would have to cut it. The Washington Post says McConnell has told the senators that “The bill’s deepest cuts are far into the future, and they’ll never go into effect anyway” because a future Congress would block them. And remember, even the initial cuts, to Medicaid expansion funding, wouldn’t kick in until after the next two federal elections.

And McConnell could still add money to the bill to get votes. He will know exactly how much on Monday, when the Congressional Budget Office gives the bill a budget score. He’s not going to buy Paul’s vote, or that of ultimate Republican moderate Susan Collins of Maine, but he might get the rest.

And if he doesn’t? He has said the alternative would be a compromise with Democrats, simply to stabilize the health insurance markets. Some of the GOP moderates have already called for that, and that was the main sales pitch McConnell gave for the revised bill Thursday.

So, with the partisan imperative gone, there is a kernel of belief in a fundamental policy. McConnell and Trump could still call it a victory. So would the one in 3threeKentuckians on Medicaid. Here’s to bipartisanship.

Al Cross is director of the Institute for Rural Journalism and Community Issues and associate professor in the University of Kentucky School of Journalism and Media. His opinions are his own, not UK’s. This column originally appeared in the Courier-Journal.