A feeling of pessimism is settling over Senate Republicans as they head into a weeklong Memorial Day recess with deeply uncertain prospects for their push to repeal Obamacare.
Senators reported that they’ve made little progress on the party’s most intractable problems this week, such as how to scale back Obamacare’s Medicaid expansion and overall Medicaid spending. Republicans are near agreement on making tax credits for low-income, elderly Americans more generous, but that might be the simplest matter at hand.
Republicans have started writing the very basics of their repeal legislation, even though they’ve made few decisions about what it will say. Staffers will work on the bill over the break to try to increase the pace of negotiations, as well as haggle with the Senate parliamentarian over whether the chamber can even consider the bill because of procedural reasons.
But in the meantime, frustrations are rising and confidence is diminishing.
“We talk about it every goddamn day,” said one GOP senator, who did not want to be quoted criticizing his own party. “But we haven’t done anything about it.”
Senators privately reported being surprised by Senate Majority Leader Mitch McConnell’s assessment on Wednesday that he doesn’t know how the party gets the requisite 50 of the party’s 52 members on board. Though aides said McConnell was restating the challenge of passing a bill in a sharply divided conference, senators said they also did not take the calculating majority leader’s words as a vote of confidence.
“He doesn’t do much that’s not purposeful. So is he sending a message here of: ‘Don’t anybody think this is likely to happen?’” said a second Republican senator. “If I had to bet my house, I’d bet we don’t get it done.”
They tried to shrug off a Congressional Budget Office score showing that 23 million fewer people will have insurance under the House GOP’s plan and that premiums would rise for two years before beginning to fall. But Senate Republicans also aren’t sure how much they can improve on a score that, in their view, fell far short of an acceptable outcome.
The nonpartisan assessment of the House’s bill “makes everything harder,” said Sen. Dean Heller (R-Nev.), the most vulnerable GOP senator in next year’s midterm elections.
“The point is, we should have a better CBO score. But I can’t guarantee it,” said Senate Finance Chairman Orrin Hatch (R-Utah), acknowledging that broad coverage losses cast a long shadow over the Republicans who may be skittish about repeal. "Of course it does … on the other hand, it’s an estimate and it doesn’t mean it’s accurate. That’s something that would worry anybody."
Yet Sen. Susan Collins of Maine said the Senate “absolutely” has to surpass the CBO’s assessment of the House effort. One of two true GOP moderates in the chamber, Collins is urging her colleagues to tilt the bill toward the center rather than to the right.
“There is no way that I can personally support a bill that is going to result in 23 million Americans losing their health insurance coverage, that will cause an 850 percent premium increase of a low-income adult aged 64, of which there are many in my state, and that does nothing to ultimately bend the cost curve of health care,” Collins said in an interview.
The GOP spent much of Thursday distancing itself from the House bill’s CBO score, attacking the organization as unreliable for its inaccurate estimates of Obamacare’s effectiveness. That left the question open of how Republicans’ will measure the success of the bill they are crafting, but GOP senators insisted their target isn’t to produce a bill that the CBO looks on charitably.
“Our goal is not to please the CBO,” said Sen. Dan Sullivan (R-Alaska).
Budget Committee Chairman Mike Enzi said he has started writing the bill, along with leadership and Sens. Lamar Alexander (R-Tenn.) and Hatch. He said he would “hope” to have a bill after the Memorial Day recess but wouldn’t put a deadline on the legislation.
Enzi said the GOP has made enough policy decisions “in some areas” of the bill to start writing. Sen. Ron Johnson (R-Wis.) said his conference has "really fleshed out the issues, what the fault lines are."
But Senate Republicans’ opaque repeal strategy has annoyed some rank-and-file members. Republicans are having three lunches a week to chew over Obamacare repeal in addition to two weekly working group meetings. All are behind closed doors, and McConnell and his leadership team have been careful to keep details from leaking out.
That’s kept outside groups and House members from criticizing any particulars of the health care plan, but it’s also viewed by some Republicans as poor optics.
“It would aid the process to have public hearings where this could be debated publicly. It would help bring the public along,” Sen. Bob Corker (R-Tenn.) told reporters Thursday. “The meetings themselves are of substance. I do think it’s always best to have [the media] opine as we’re moving along.”
There are limits to how much the Senate can really juke the numbers of the CBO score to make a bill more palatable to the public. Senators cannot write a bill that saves fewer than the $119 billion in savings from the House bill, which could restrict just how much room Republicans have to produce better coverage numbers or lower premiums.
And there is some concern among Republicans that they will have a hard time besting the House score on coverage or premiums, even though senators are wary of absorbing the political beating that the House took over the CBO’s assessment. If anything, the political fallout of the CBO score made clear that the Senate won’t eliminate Obamacare’s pre-existing conditions coverage requirement after the House allowed states to opt out. CBO said Wednesday that doing so would destabilize markets and in some places, drive up premiums.
The House still hasn’t sent the bill to the Senate and aides say they’re still not completely sure it adheres to all the rules of budget reconciliation. During next week’s recess, Republican and Democratic staff are expected to meet with the Senate parliamentarian, Elizabeth MacDonough, to start litigating the House bill. Democrats will hope to find fatal flaws that will end the reconciliation process and open the bill up to a Senate filibuster.
Assuming there are no major errors, Republicans will then start testing the waters of what legislation is allowed into the Senate bill, such as whether the GOP can automatically enroll people in insurance plans, allow states to opt out of Obamacare provisions or defund Planned Parenthood.
Aides working on the bill are slightly more upbeat about the prospect of repeal than senators themselves, believing that Republicans may have some room to maneuver. One option under consideration: Delaying repeal of Obamacare’s taxes to produce more money to shore up Medicaid coffers and reduce premiums in the short term.
But Republicans said they haven’t gotten that far yet, and are mainly stuck over how quickly to wind down Obamacare’s more generous Medicaid benefits and preventing millions of low-income people from losing insurance. That doesn’t mean Republicans are giving up on Obamacare repeal, but it does mean that after a month of talk, the GOP has made few real decisions on a path forward.
“There is no consensus yet,” said Senate Majority Whip John Cornyn (R-Texas). But he added: “Doing nothing is not an option. We’re doing the best we can.”