Mitch McConnell needs 50 of the 52 Senate Republicans to vote for his health care bill. That’s a 96 percent success rate. That was never going to be easy, and it hasn’t been made any easier by the competing and sometimes contradictory demands from the right and center wings of his conference.
If the majority leader pulls the health care legislation toward one side, he risks alienating the other end of the spectrum. The two posses are tugging the bill in opposite directions on the bill’s Medicaid cuts. More moderate senators want to keep some Obamacare taxes; conservatives say they ran on repealing all of the law’s taxes. Conservatives want to roll back all of the law’s insurance regulations; moderates are more skittish about unwinding the popular protections for people with preexisting medical conditions.
This is the Rubik’s cube, as McConnell is said to describe it, that the majority leader must solve.
It doesn’t help that McConnell drafted an overwhelmingly unpopular plan. One that cuts Medicaid spending by $772 billion over the next 10 years, versus current law, reduces the financial aid available to middle-class Americans who buy private coverage, and would result in an estimated 22 million fewer Americans having health insurance by 2026 compared with Obamacare.
McConnell suffered an embarrassing setback last week, forced to postpone an expected procedural vote on the legislation because he didn’t have 50 votes yet. Conservatives say they currently oppose the plan because it doesn’t do enough to unwind Obamacare’s insurance regulations. Moderates are blanching at the plan’s Medicaid cuts and its repeal of taxes on the wealthy at the expense of insurance for poor and middle-class Americans. Other contentious issues like Planned Parenthood funding have further complicated the debate.
Many senators are ambivalent at this point. They just want to get it done.
“If that’s what it takes to get an agreement, that’s what we’ll have to do,” Sen. Chuck Grassley (R-IA) said last week of keeping some Obamacare taxes.
Three dozen Republican senators would vote for any bill McConnell put forward. But satisfying the most conservative and most moderate members is the key to passage.
Senate Republican leaders hoped to have a new compromise ready by the end of last week. But they still seem to be at least another week away from consensus. The path is there, but it will require a delicate balance.