We don’t know if the Republican health care bill will pass the Senate. It’s struggling right now, but remember that the House’s health care bill seemed dead too, before it was revived and approved. One question we have a better chance of answering is whether the elected officials directly involved in the health care vote should want it to pass.
That may seem like a simple question, but there are two dimensions that senators and other party officials need to keep an eye on when making their decision: How the bill’s passage or defeat will affect policy and how it is likely to affect politics. One outcome may be in line with a politician’s policy preferences, for instance, but that same outcome could spell electoral disaster for him or her. So we mapped out these possible outcomes for key players in the health care debate. Predicting the political fallout of something that hasn’t happened yet is a dangerous game, so instead we’ll simply the weigh the pros and cons of each potential outcome for each person or group.
If the Republicans pass some version of the legislation that the Senate is considering and President Trump signs it, it’s not clear that Trump actually gains much. Policywise, he doesn’t really seem to care what America’s health care system looks like. He has argued for a single-payer system at times, he held a Rose Garden celebration of the House’s vote to repeal of Obamacare, and he then later called the bill “mean.” Both the House and Senate bills leave most of Trump’s campaign promises on health care unfulfilled. The one promise they do keep, of course, is Trump’s pledge to repeal Obamacare. Indeed, about the only thing we can be positive about when it comes to Trump’s health care stance is that he clearly doesn’t like Obama and he would count passing a new health care bill as a win against the former president’s legacy.
Electorally, passing the bill could be an outright disaster for Trump. Far more Americans dislike the bill than support it. Moreover, strong disapproval of the bill far outruns strong approval of it. In other words, enthusiasm — one driver of turnout in the 2018 midterms — will likely be running against the bill. Obama signed a somewhat unpopular health care bill into law in 2010, and then watched his party’s House majority get wiped out a few months later, in part because of that health care vote. And the GOP bill is more unpopular than Obamacare was at the time of its passage.
But what if the bill doesn’t pass? Some conservative commentators (radio talk show host Hugh Hewitt, for example) are arguing that a failure on health care would be a political disaster, angering the party base, depressing turnout and dooming the GOP in next year’s midterms.
We are skeptical of this take. The Obamacare repeal effort, while a major goal of party leaders and conservative groups like Heritage Action, isn’t a big priority or even particularly popular among rank-and-file Republican voters. So Trump might suffer some ill effects from a high-profile legislative “loss,” but in the long term, it’s hard to see GOP voters rebelling against the party for failing to pass a repeal, especially since many of them wouldn’t even blame their party for that failure.
Verdict: Polling suggests that Trump would be better off politically if this bill failed, and he might be better off in terms of policy too.
Senate Majority Leader Mitch McConnell and Senate Republicans
Policywise, McConnell is not known as a particularly ideological figure. It’s not clear if he has very defined views on Medicaid funding or how pre-existing conditions should be covered, for example. In addition, many Republican senators have actually been worried about Medicaid cuts, which means that at least some members of the GOP caucus dislike at least some elements of this legislation.
More generally, however, the Senate bill is heavy on tax cuts. In fact, you could argue that it’s mostly a tax cut disguised as a health care overhaul. McConnell has pushed for tax cuts throughout his career, and other Senate Republicans are big fans of tax cuts too. So the Senate legislation would at least advance that policy goal.
In terms of politics, one thing to remember is that there are only two GOP senators up for re-election next year in states that Hillary Clinton won or narrowly lost. So pass or fail, the electoral politics of this legislation will be muted as far as McConnell and Senate Republicans are concerned. The only Republican senator up for re-election in 2018 in a state won by Clinton, Nevada’s Dean Heller, has all but pledged not to vote for the bill, so whether it passes or not may not make much difference to his re-election chances.
A larger, less immediate concern for McConnell and Senate Republicans is whether senators in swing states up for re-election in 2020, like Colorado’s Cory Gardner, would be hurt if they voted for the bill. Of course, 2020 is still three years away.
We don’t know how much McConnell cares about this, but a failure of this bill could dent his image. McConnell, unlike Trump, has a “reputation as a master tactician” as the New York Times put it this week. Were the bill to die in the Senate, it would indicate that McConnell doesn’t have as much control of his flock as some thought.
Verdict: McConnell wants to pass the bill, for political and policy reasons. As for other Senate Republicans … it depends on the senator. Most Senate Republicans would be unlikely to see major political fallout if this bill passes, and they’d advance their party’s policy goals by curtailing the government’s role in health care and passing big tax cuts. So on political and policy grounds, most Senate Republicans will likely be supporting this bill if it comes up for a vote. But there are probably a few key exceptions — Heller, Susan Collins in Maine, Rand Paul in Kentucky and perhaps others.
House Speaker Paul Ryan
Ryan has to love this bill from a policy perspective. He has been dreaming of major Medicaid cuts for years, and the Senate bill does exactly that. The House Republican caucus is also further to the right than the Senate’s, and much of the initial resistance to the House bill stemmed from a feeling that it didn’t wipe away enough of Obamacare, which it now does more of.
But the political incentives are somewhat less clear for Ryan and House Republicans than they are for McConnell and Senate Republicans. On the one hand, Ryan’s House already passed a highly unpopular health care bill. Vulnerable House Republicans, like Florida’s Carlos Curbelo, are already on record voting for the bill, so they may be penalized in the next election no matter what the Senate does.
On the other hand, Ryan and House Republicans may not get any political benefit if the Senate passes the bill and will probably see a major fallout. Unlike McConnell, Ryan has proven he can get a controversial piece of legislation through his caucus. Further, since every single House member is running for re-election in 2018, Republican representatives must campaign in districts where this bill is likely unpopular. We’ve already seen Democratic voters display a lot of enthusiasm in special elections so far. Democrats mostly lost those races, but they outperformed their showings from previous years. Ryan’s party is in danger of losing 24 seats and control of the House, and the Senate passing a deeply unpopular bill is unlikely to help change that.
Verdict: On policy, Ryan and House Republicans are rooting for the Senate to pass a bill. But on the politics side, where all they stand to gain for passing the bill is a potential boost from their base, they should probably hope the bill fails.
Reverse the section for Ryan and House Republicans. It would a huge policy defeat for the Democrats to watch parts of Obamacare get repealed. Expanding health insurance has been a defining goal of the party for decades. The beneficiaries of Obamacare, moreover, are disproportionately low-income, which fits with the broader Democratic goal of pushing programs to help fight inequality.
But politically, if the bill passes, it could help Democrats tremendously in the midterm elections. In that scenario, the Republicans would have adopted a very unpopular bill estimated to leave millions more people without health insurance and drive up the cost of insurance for many others. The problems America’s health care system faces, including rising premiums, could now be blamed on Republicans. The bill would likely help drive up Democratic enthusiasm ahead of the midterms, which could give Democrats the boost they need to take back the House.
Verdict: Democrats will fight to stop the repeal of Obamacare, even though it passing would help them win the House next year and perhaps even the Senate. The policy stakes are huge, and Democrats may be able to use the bill’s unpopularity against Republican candidates in 2018 even if it doesn’t become law.