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What Went Down On Health Care This Week Filed under Health Care

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Nate Silver 2:17 AM Good Night!

And with that, this live blog is adjourned! Thank you for joining us over the past three days, and we’ll have much more analysis on the health care legislation in the days ahead.

Twitter 2:15 AM

Nate Silver 2:10 AM

Other than thinking that this is obviously a really big deal — both from a policy and a political perspective — I want to reserve some judgment until I see more reporting about what happened tonight. To what extent was this McConnell’s failure? Or Trump’s? Or Ryan’s? (Ryan could have been more reassuring to McCain and other holdouts.) To what extent was it a failure of the overall process, because the legislation was badly conceived? (Maybe the bill was lucky to get as close as it did?) Why did McCain vote “no”? I have more questions than answers, and we’re not in a position to answer very many of those questions yet.

There are a lot of questions about what happens next. But no matter what happens with the GOP legislation, there are a lot of immediate issues that need to be dealt with: Children’s Health Insurance Program reauthorization, dealing with payments to insurers in the private market, finalizing plans for the markets next year. At some point the GOP will have to make space to sort out those issues.

Harry Enten 2:07 AM

My closing thought: This was an absolute shocker. The conventional wisdom (as measured by the betting market PredictIt) gave it as high as a 90 percent chance of passing, as of Thursday. For comparison, PredictIt gave Hillary Clinton an 82 percent chance of winning on the eve of the 2016 presidential election.

Dan Hopkins 2:06 AM

The GOP was quite unified around the symbolic value of repeal but couldn’t translate that into a coherent set of policy proposals. That was evident in the last few days, when the party changed tacks quite markedly. It took a trio of GOP senators who are outliers (of different types) in their party to bring to a close this GOP attempt at that translation from symbol to policy.

Perry Bacon Jr. 2:03 AM

McCain’s role was interesting. But overall, much bigger deal: This was not a well-designed bill. Wonks on both sides hated it. There are conservative alternatives on health care that could work. Obamacare does have problems. But the failure of this bill is a really big policy story. Really big.

Perry Bacon Jr. 2:02 AM

I was wrong in predicting a few hours ago that this would pass. I think predictions are silly and try to stay away from them. In this case, I think having that prediction out there was useful. Senators don’t cast lonely votes like that. I was right about Heller, Capito and a bunch of others who I don’t think would have cast that vote. This was not a Trump-winning-in-2016-level surprise. But it was a surprise. McCain really was a maverick tonight — and on health care, an issue on which he is not usually a big voice. The conventional wisdom, as Nate said, was wrong.

Dan Hopkins 2:00 AM

To Perry’s point about this being a genuine surprise, does it speak to the possibility that observers have trouble assessing uncertainty? To me, the overall outcome isn’t nearly as surprising as the road that got us here.

Perry Bacon Jr. 1:59 AM

Just to emphasize how big of a surprise this was, it wasn’t just reporters like me who assumed the bill would pass. So did Senate aides from both parties. So did the Democratic senators, who were giving very angry speeches about this whole process, assuming the bill would be approved. McConnell assumed this would win; that’s why he brought it up earlier than expected. Pence was visibly surprised.

Nate Silver 1:58 AM

To echo Perry’s point — I was seeing some snark on Twitter earlier about how everyone will suddenly change their opinion about John McCain. To which my response is: well, shouldn’t this change people’s opinions? This was a huge deal. It’s not quite right to say he singlehandedly killed the GOP’s health care reform efforts — Collins and Murkowski were also important, obviously — but his choices made a huge difference in a bill that will affect a lot of people’s lives and a lot of his colleagues’ political fortunes. And he did so in dramatic fashion, in a way that will create a lot of embarrassment for McConnell and Trump. So it’s absolutely a big deal. It’s like if you had a quarterback who you always thought was overrated as a “clutch” performer and then that quarterback leads his team from 14 points down to win the Super Bowl. You have to give a lot of credit for that and not be too wedded to your priors going in.

Dan Hopkins 1:55 AM

Let’s say that this does indeed mark a turning point, and the ACA — or at least the Medicaid expansion — is here to stay. Will other states start to sign on? Maine voters will have a say on that in November. But what about states where the expansion has been an ongoing battle, like Virginia or Florida?

Perry Bacon Jr. 1:54 AM

McCain doesn’t seem to like or respect Trump. And two big hits at the president today: voting down this legislation and the passage of the Russian sanctions bill.

Harry Enten 1:54 AM

I don’t know if this is the end of the road, but the GOP made a lot of vulnerable members of Congress vote for some version of the Republican health care bill. It’s not just Heller and Flake in the Senate. It’s all those House members, too. The payoff seems minimal, unless something more occurs.

Perry Bacon Jr. 1:53 AM

Also, two of five female GOP senators voted against this. One of 47 men. Murkowski’s and Collins’s roles were big here. Maybe McConnell should have included them in the process from the beginning.

Perry Bacon Jr. 1:52 AM

If Obamacare repeal doesn’t happen, this will prove to be a big moment in McCain’s career. He’s done a lot of other big stuff. But this was a dramatic vote on a hugely important bill.

Nate Silver 1:51 AM

Another overlooked thing: The votes of red-state Democrats, especially Joe Manchin, were never in play.

Perry Bacon Jr. 1:50 AM

I haven’t seen McCain give his actual rationale for voting against this bill. He has never been a big leader on health care issues in the Senate, as I wrote earlier this week. I will be curious to see what he says.

The administration and Congress still need to deal with the private insurance markets for next year. There are a lot of decisions to be made there that are independent of this legislation.

Perry Bacon Jr. 1:49 AM

Is Trump sleeping? Where are the tweets?

Perry Bacon Jr. 1:49 AM

Schumer says that “it’s been a long, long road for both sides” and that “it’s time to turn the page.”

Nate Silver 1:48 AM

Still a lot of news to digest. But one small thing: It’s interesting, and a bit surprising, that Republicans didn’t give Heller a pass once they knew the bill was going down.

Perry Bacon Jr. 1:47 AM

“It’s time to move on,” McConnell says.

Dan Hopkins 1:47 AM

The GOP’s repeal efforts have come back from the dead more than once, so I’ll bet journalists are going to hesitate to write yet another round of repeal effort obituaries quite yet. But keep in mind that even if the legislative activities shift, or take a bipartisan turn, how the Trump administration oversees the insurance exchanges will have a pronounced impact on how the ACA works — or does not.

Harry Enten 1:46 AM

I don’t know the future of Republican efforts to repeal the ACA. What I do know is a lot of chickens came home to roost in this vote. Perhaps in the future it would be best for the president not to say that he prefers his war heroes not to be captured? Perhaps it would be better for the Interior Department not to threaten funding in Alaska? When you only have 52 votes in the Senate, maybe it’s better to treat each senator well. Otherwise, they may just vote against you in a key vote.

Nate Silver 1:45 AM

I mostly agree with that #hottake, Dan — there’s going to be a lot of political fallout from the failed vote tonight, but it’s still probably not going to be as bad as it would have been if Republicans had passed such an unpopular bill. With that said, let’s see the reaction from the White House and other quarters over the next few days. If there’s some sort of Trump tantrum against McCain, or Murkowski, or McConnell, that could offset a lot of the silver lining Republicans might get otherwise.

Perry Bacon Jr. 1:44 AM

McConnell is actually talking about seeking Democratic ideas. Who knows what that means? But that’s interesting. Will be curious if the administration still tries to tank Obamacare.

Dan Hopkins 1:43 AM

Earlier, Harry and I were trying to figure out the political rationale driving the Republicans’ fervor to repeal the ACA. It sure wasn’t driven by a desire to position themselves for the general election, and the case that it was helping them with their base was strained, too. So even though they voted against their party, it’s possible that the trio of Collins, McCain and Murkowski — one of them a former GOP presidential candidate — actually helped their party’s political prospects.

Perry Bacon Jr. 1:43 AM

If this is it for Obamacare repeal, this is a really big story. Really big. I’m not totally sure it is, since this bill seems like it will never die. I will be curious if Trump demands they try to keep pushing this. But McConnell sounds done.

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