What Went Down On Health Care This Week

The Senate will hold more votes on health care, many of them largely symbolic, on Wednesday night and into Thursday morning. But we have reached the point in the Senate’s health care debate when the most important action will be happening off of the Senate floor for awhile. The Senate’s main two Obamacare bills — “repeal and replace” and “repeal and delay” — have both been rejected. Republicans are working, behind closed doors, on some kind of limited repeal plan that they hope can pass (the so-called “skinny” repeal). Senators have suggested that that plan would roll back the individual mandate, the employer mandate and the medical device tax. But the contours of the “skinny” repeal are likely to change, depending on what senators will support and what follows the rules of the reconciliation process. I expect a Friday vote on whatever Senate Republican leaders come up with and determine has the support of at least 50 senators. So watch this space tonight and tomorrow for our take on wacky votes, but more importantly on the ideas that Senate leaders float for a bill that can get 50 votes, how rank and file GOP senators react to them (particularly Nevada’s Dean Heller, who seems like he is now the key swing vote) and if policy experts think these proposals are viable and will improve or hurt the U.S. healthcare system. (A “skinny” repeal seems like a political solution that has lots of policy problems.) Also, now that senators are openly talking about taking whatever they pass into a conference with the House, the reactions of House Republicans are worth watching as well — and we’ll be tracking them too.

Weeks ago, the conventional wisdom had been that the GOP did not want to drag out its work on health care reform. When the Senate took up health care reform in late June, for instance, there was talk that Paul Ryan would keep the House in session to pass whatever bill emerged from the Senate’s deliberations before July 4. The goal was to rip off the Band-Aid, so to speak, and move on to other items on the GOP agenda. Now, the talk is instead that the Senate just needs to pass a bill, any bill, to get to conference, meaning that the goalposts have moved substantially. But why would the Senate and House’s joint negotiators be able to thread a needle that has eluded Mitch McConnell for the past few months? It’s certainly possible that proximity to final passage will give the GOP momentum — and that once key members have cast a vote to repeal Obamacare, they’ll want to see the policy through to enactment. But it’s not a sure thing. Negotiations on the repeal efforts have been described as a Rubik’s Cube or a whack-a-mole game, where any one solution generates a new problem elsewhere. That dynamic is unlikely to get any easier during a negotiation across chambers. The GOP — both its leadership and key swing votes — has a strong incentive to bring these repeal efforts to a close. The fact that they are now talking about punting to a conference committee indicates both how committed they are to repeal and how hard coalescing around any specific proposal has become.

I’m multitasking or somesuch, watching CNN on TV, the U.S. Senate’s online feed on my computer and monitoring Twitter. At least among the people I follow on Twitter, which I acknowledge includes a lot of policy nerds, there’s a lot of chatter about what Trump is doing — particularly his new ban on transgender Americans serving in the military. But there’s also a lot of health care in my Twitter feed. Obviously, the Senate online feed is about health care. But CNN is full of Trump. The banner as of this writing is “WHITE HOUSE: TRUMP ‘VERY CLEAR’ ABOUT FEELINGS ABOUT SESSIONS.” I will leave it to others if they want to criticize CNN’s coverage decisions. (I think the Trump-Sessions-Russia dynamic is a big story, as is the health care bill vote, as is the transgender policy, and all deserve extensive coverage.) What I think this reflects is how Trump defines or redefines “news.” Think of the first three letters in the word “news.” It is highly unusual for the president to go on a public campaign trashing the attorney general. A messy congressional process on health care is not that unusual; it happened in 1993 and 1994 and again in 2009 and 2010. This bizarre health care process would have been THE STORY at almost any other time, as long as the U.S. was not at war. But Trump is doing so much — and so much that is kind of weird at times and alarming at others — that he even takes attention away from a hugely important health care policy bill that will affect millions.