In a day filled with high drama, confusion and behind-the-scenes maneuvering, Mitch McConnell got a key win on Tuesday as the Senate voted to begin debate on replacing Obamacare.
Now the Kentucky Republican faces an even harder test — getting something passed.
The Senate faces several days of heated debate and tough votes, with the final outcome in doubt. Can Republicans actually repeal and replace Obamacare? Or simply repeal it? Can they roll back the expansion of Medicaid under the Affordable Care Act, which resulted in millions of more enrollees? What about eliminating Obamacare taxes? And defunding Planned Parenthood? What about a “skinny repeal” bill that would get rid of the employer and individual mandates under Obamacare while leaving almost all the rest of the legislation in place? All this is still up in the air.
There’s no guarantee McConnell can pull an Obamacare repeal rabbit out of his hat by the end of this week. But at least the show has finally started after nearly two months of delays.
“Not many people could have pulled that off given what [McConnell] pulled it off from,” quipped Sen. Johnny Isakson (R-Ga.).
Last week, as Sen. John McCain (R-Ariz.) shocked the Senate by announcing he had a brain tumor and needed to undergo treatment, McConnell’s chances of getting even this procedural accomplishment looked bleak. McCain’s health crisis meant McConnell lost a reliable vote to begin the health care slugfest, one he badly needed.
Moderate Republicans including Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Dean Heller (Nev.) and Lisa Murkowski (Alaska) were upset about rolling back the Medicaid expansion. Murkowski and Sen. Susan Collins (R-Maine) didn’t want to defund Planned Parenthood.
Hard-line GOP conservatives like Sens. Mike Lee of Utah and Ted Cruz of Texas didn’t think McConnell’s “Better Care Reconciliation Act” went far enough in dismantling the 2010 health law. Even his Kentucky colleague, Sen. Rand Paul, didn’t want to support a move to begin debate. Paul wanted a straight-up repeal vote, and he vowed to oppose anything short of that.
Sen. Ron Johnson (R-Wis.) railed at McConnell for a “breach of trust” over the Medicaid issue, and wouldn’t say whether he still supported McConnell for GOP leader, a stunning public rebuke.
McConnell was forced to delay the vote on the motion to proceed last week, an embarrassing setback for him and one that angered President Donald Trump, who may not grasp the intricacies of the Senate but does know that failure to repeal Obamacare would be a huge political defeat for his already struggling administration.
With all this on the line, McConnell did what McConnell always does — he ground down the opposition.
Using a combination of hardball politics, personal persuasion and lots of money — hundreds of billions of dollars were available to pay for more add-ons to the bill in order to get some votes — the Kentucky Republican scrambled to round up 50 Republicans to support the motion to proceed to the bill.
McConnell played good cop-bad cop by himself. He met privately with Portman on Monday night to woo him and other GOP moderates, promising Portman a vote on his proposal to add $100 billion in funding for those low-income Medicaid enrollees who may lose coverage. Portman kept saying he was undecided publicly on whether he would support the motion to proceed, but Majority Whip John Cornyn (R-Texas) said it was clear on Monday night that Portman, Capito and Heller were leaning leadership’s way.
McConnell stayed on message in public and private, relentlessly pounding home the theme that voting to begin debate wasn’t the same as voting for the bill on final passage. If Republicans don’t act, Obamacare remains the law of the land and they own it. Their constituents back home would remember that when they had a chance to get rid of Obamacare — something Republicans had vowed to do for seven years — they balked. McConnell gave his senators no place else to go.
“I hope everyone will seize this moment. I certainly will,” McConnell said on the Senate floor Tuesday before the vote. "Only then can we open up a robust debate process. Only then will senators have the opportunity to offer additional ideas on health care. Inaction will do nothing to solve Obamacare’s problems or bring relief to those who need it.”
McConnell added: “I’d like to reiterate what the president said yesterday. ‘Any senator who votes against starting debate,’ he said, ‘is telling America that you are fine with the Obamacare nightmare…’”
The other huge shot in the arm for McConnell and the White House came Monday night with the announcement that McCain would return to the Senate for the procedural vote. It quickly became clear the Arizona Republican would only be coming back if McConnell thought he could win the vote.
It didn’t matter if McCain’s floor speech immediately after bashed McConnell; McConnell had McCain’s vote, and he still had a chance of winning.
“I know many of you will have to see the bill changed substantially for you to support it,” McCain said. “We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end. And it probably shouldn’t.”
Yet there was one final moment of nervousness for McConnell.
Johnson came to the floor as the 50th vote. Collins and Murkowski were already opposed, so if Johnson voted no, it was over. John complained again to McConnell about the process for crafting the bill. McConnell stood quietly with his hands by his side during the conversation. And then Johnson voted for the motion to proceed, giving McConnell the support he needed. A 50-50 tie, with Vice President Mike Pence casting the deciding vote.
McConnell was still in the game, at least for now.
"Mitch is great about reaching out to members who have concerns and meeting with them one on one," noted Sen. Thom Tillis (R-N.C.). McConnell proved that he was willing to alter the GOP proposal based on member feedback, Tillis said, pointing to $45 billion McConnell added to the package for fighting opioid addiction.
"He’s also got the credibility of having listened to and acted on a lot of suggestions,” Tillis said.
“I think his blood pressure’s about 90 over 50, with about a 40 pulse, OK? He’s very calm through the storm,” said Sen. John Kennedy (R-La.). “And even when people yelled at him and a number did… I never saw him change expression, but he answered everybody.”
Seung Min Kim and Jennifer Haberkorn contributed to this report.