If you’re planning to watch Senate Majority Leader Mitch McConnell cajole a clutch of disaffected Republican colleagues into casting a “yes” vote for the moribund health care bill, arm yourself with a scorecard and calculator. With nearly $200 billion to allocate—assuming that effort doesn’t infuriate his more conservative colleagues—you can expect a blossoming of catchy catchphrases to describe the efforts of a wily negotiator whose capacity for pulling legislative rabbits out of hats should never be underestimated.
Remember the “Cornhusker Kickback,” the derisive term Republicans used in 2010 to describe the goodies that Democrats bestowed on Nebraska to win over their foot-dragging senator, Ben Nelson? Well, we’ve already seen the “Aleutian Advantage,” aimed at the high cost of medical care in Lisa Murkowski’s Alaska. Soon we may see the “Badger Bestowal” (for Wisconsin’s Ron Johnson), the “Buckeye Benefaction” (for Ohio’s Rob Portman), the “Pine Tree Premium” (for Maine’s Susan Collins) and the “Sunflower Subsidy” (for Pat Roberts and Jerry Moran of Kansas).
The run-up to the actual vote (assuming McConnell does not fold his cards and give up) is going to feature running tabs on every cable news channel and political website, along with daily prediction models and betting odds. With that kind of frenzied coverage, it’s hard to remember that there are some fundamental underpinnings to this fight that are worth keeping in the front of your mind:
1. The Vote Will Be Close, Because That’s the New Normal.
Once upon a time, major social legislation was the product of bipartisan consensus. In 1935, Social Security was passed by votes of 372-33 vote in the House and 77-6 in the Senate. Thirty years later, Medicare passed 313-115 in the House and 68-21 in the Senate; a plurality of House Republicans and 13 GOP senators voted “aye.” But over the past quarter-century, a very different pattern has emerged. President Bill Clinton’s tax and budget proposals passed by a single vote in the Senate—Vice President Al Gore broke a 50-50 tie—and with a 219-213 vote in the House. George W. Bush’s prescription drug plan passed 220-215 in the House, but only after GOP leaders held the vote open for hours. Barack Obama’s stimulus proposal won exactly 60 votes in the Senate—the bare minimum to avoid a filibuster—and his Affordable Health Care Act won the same 60-vote minimum. And the House’s bid to “repeal and replace Obamacare” passed earlier this year with 217 votes—one more than the bare minimum, due to vacancies. That bill was nearly defeated because of the polarization of the parties, and in particular the threat of primaries within the Republican Party by foes of anything that smacks of government regulation or taxes. Now, competing cross-pressures on Republican conservatives and moderates all but assure that McConnell will have almost no margin for error.
2. There’s Enormous Incentive Not to Let the President Lose a Key Vote
In every one of those key votes, the president prevailed. Why? Because, when the vote is that close, no member of Congress wants to be seen as the person who inflicted a poetical defeat on a president of his or her own party. Back in 1993, then-Senator Bob Kerrey—no fan of Clinton’s character or policies—decided at the last minute to support Clinton’s budget proposal, telling him: “I could not and should not cast a vote that brings down your presidency.” Further, these reluctant party members have often been rewarded with significant concessions. Clinton abandoned any effort at an energy tax to win over suburban Democrats; Obama’s health care plan bent heavily toward insurance companies to help win the support of Senator Joe Lieberman, whose state of Connecticut was home to many insurance companies. At Lieberman’s insistence, the bill also dropped the whole idea of a “public option,” a step toward a single-payer system dear to the hearts of more progressive Democrats.)
And in this case, concessions are even more likely because …
3. “Winning” Matters Way More Than What’s Actually in the Bill
There’s a story about a spectator at a bullfight who sees a vendor selling “Hot Meat Pies.” When he bites into one, it’s cold, doughy and meatless. When he complains, the vendor days: “No, no— ‘Hot Meat Pie’ is just the name of the pie.”
The is where the Republicans are today. They have spent seven years promising their base that they will “repeal and replace Obamacare.” At this point, that is all that matters. To quote political analyst Vince Lombardi, “Winning isn’t everything, it’s the only thing.” So, if it takes a substantial increase in Medicaid funding—if it takes firm protection for people with preexisting conditions—or, alternatively, if it takes letting states permit grossly inadequate insurance policies—that is what will be in the bill. The one likely invulnerable provision is the massive cut in taxes for the affluent; abandoning that would be akin to the Roman Catholic Church declaring that the Trinity is just a suggestion. You can see this mentality in a recent column by conservative radio host Hugh Hewitt, who chastised wayward Republican senators that “to vote ‘no’ on whatever compromise arrives is to express contempt for the Republican Party as a whole.”
Complicating the negotiating is something we have never seen before, namely …
4. The President Has No Idea What’s in the Bill and No Idea Whether He’d Back It If He Did Know
In every recent case, presidents were fully engaged in the struggles to shape these bills. Clinton and Obama were policy wonks; George W. Bush, while often painted as detached when it came to details, was a full partner in the struggle to get his prescription drug plan through the House. Trump, on the other hand, is on record as declaring that 2 plus 2 equals 5, or 7, or 86. By that I mean he has promised to fully protect Medicaid, lower premiums, decrease deductibles and increase benefits, all at a lower cost. His familiarity with the process can be gauged by the fact that he a) threw a victory party after the House passed the bill, and b) later declared the bill as “mean” and “a piece of s—.” During the first round of House negotiations, my colleague Tim Alberta reported, the president had trouble cutting a deal “because he lacked familiarity with the legislation itself”; this week, the New York Times reports that the president seems not to have understood that the Senate bill’s centerpiece is a massive tax cut.
It is not too much to say that if someone suggested he “repeal and replace Obamacare” by taking the Medicare law and striking “over 65” from it, Trump would embrace the idea with enthusiasm. The problem for McConnell and his colleagues, then, is that the only assurance they have that the president will not undercut whatever deal they strike is that he has the same focus on detail as Governor William J. Lepetomane in “Blazing Saddles.”
Taken together, these underlying realities suggest that, if you’re betting on history to repeat itself, McConnell will get 50 votes for his bill. But betting on history these past two years has proven to be a fool’s wager; if McConnell does manage to pass the bill, it will be the legislative equivalent of squaring a circle.