Saturday, July 1, 2017

McConnell rejects calls from Trump, Paul and others to repeal Obamacare now and replace it later; making deals to get votes

Sen. Mitch McConnell spoke at Elizabethtown's State
Theater. (Courier-Journal photo by Alton Strupp)
Kentucky Health News

Senate Majority Leader Mitch McConnell has reportedly started making deals to get the necessary votes for his health bill, rejecting suggestions by President Trump and strongly conservative Republican senators – including Kentucky seatmate Rand Paul – that Republicans try to repeal Obamacare now and worry about replacing it later.

"Trump tweeted that if Republicans could not reach a consensus on health insurance they "should immediately REPEAL, and then REPLACE at a later date!" Paul "has been saying the same thing," notes Chief Correspondent Dan Balz of The Washington Post.

McConnell, speaking to reporters Friday evening after a Republican dinner in Elizabethtown, said "We are going to stick with that path," which calls for making changes in the bill that he released eight days earlier and seemed to lose more Republican senators' support with each passing day.

Protesters stood across the street. (C-J photo by Alton Strupp)
"Failure has to be possible or you can't have success," McConnell told the crowd at the Hardin County Lincoln Dinner. He did a riff on Trump's campaign slogan, asking, "It's not easy making America great again, is it?"

He alluded to his reported deal-making, which requires pleasing both Republican conservatives and moderates: "I'm sitting there with a Rubik's Cube, trying to figure out how to twist the dials to get to 50" votes, at which point Vice President Mike Pence would break the tie to pass the bill.

McConnell has added "$45 billion in spending to fight opioid abuse and to allow health savings accounts to be used to toward premiums, according to a source familiar with the matter," the Washington Examiner reports. "The HSA change is expected to reduce revenues by about $60 billion over the next decade." McConnell is able to make such changes because the Congressional Budget Office estimated that the bill would save almost $200 billion more over 10 years than the bill the House passed in early May.

$200 billion is enough "to make deals with as many as a dozen senators who oppose his draft bill," reports Michael McAuliff of Kaiser Health News. Matt Salo, the executive director of the National Association of Medicaid Directors, told McAuliff, “There’s clearly a path to do this. McConnell has enough candy to do it, and enough time.

Vox, an online news outlet that specializes in analysis of
public policy, says this is the Rubik's cube McConnell has.
Paul, a deficit hawk, doesn't like such dealing. "The bill is just being lit up like a Christmas tree full of billion-dollar ornaments, and it's not repeal," he said on "Fox News Sunday."

Paul has "sounded open" to the idea of keeping the 3.8 percent net investment tax on families earning more than $250,000, McAuliff reports. "Sen. Bob Corker, a Tennessee Republican, said that based on a meeting he had with McConnell late Wednesday, he expects the party’s Senate leaders will scrap their effort to repeal that tax," Bloomberg News reports. Corker said, “The initial draft bill really didn’t provide an opportunity for low-income citizens to buy health care that actually covered them, so that equation is going to change.”

That could blunt partisan opposition to the bill. "Democrats are united around a single political message, that the bill will give tax breaks to the rich while taking healthcare away coverage for the poor," The Hill reports. "The money saved from preserving the tax could allow Republicans to increase the financial assistance for lower-income people."

The prospect of losing a tax cut did not please conservative groups, which are "targeting individual senators and threatening political consequences if the GOP falls short of fully repealing Obamacare," reports Adam Cancryn of Politico.

"After seven years of promising to repeal and replace former President Barack Obama's law, they risk political disaster if they don't deliver," writes Erica Werner, chief congressional reporter for The Associated Press. Columnist Michael Cohen of The Boston Globe says the bill is in trouble due to McConnell's "strategic failures" and "the resoluteness of Republican moderates." He adds, "Doing things in the Senate is a heck of a lot more difficult than stopping them. Indeed, McConnell’s strategy of writing the bill in secret has badly backfired."

McAuliff writes, "There are some other levers McConnell has, but they are issues unrelated to the health bill. McConnell and senators would have to act as if it is not quid pro quo," Latin for "this for that."

In what amounts to an updated profile of McConnell, Washington Post Senior Editor Marc Fisher and reporter Sean Sullivan write, "Fueled by a lifelong quest for tactical advantage rather than by any enduring ideological flame, McConnell had long hoped for this chance, finally, well into his fourth decade in the Senate, to make big things happen, just like his role model, Mike Mansfield, the 1960s and ’70s leader who presided over a generation of Democratic policy initiatives that reshaped the nation.

"But now, after many years of goal-line stands, McConnell is under pressure to put some points on the board on big-ticket issues such as health, tax reform and infrastructure. Whether he can do that will depend on his ability to pivot from blocking to building. For decades, McConnell has been celebrated (and bashed) as an obstructionist, a leader who was effective at derailing the other side’s initiatives, without much of a track record in achieving big things for his own team."

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