The Daily 202: Senate Republicans still face narrow path to pass health-care bill after procedural victory

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WASHINGTON – Mitch McConnell is like a quarterback who has just converted on fourth and long. The Senate majority leader kept the drive to repeal Obamacare alive, but he’s still trailing by a touchdown, the game clock keeps ticking down and a win is not inevitable.

— He didn’t have a single vote to spare, but the Kentuckian demonstrated impressive legislative prowess by getting 50 Republican senators to vote for the motion to proceed to debate on the health-care bill. It was high political theater: John McCain, recovering from surgery and battling brain cancer, traveled 2,300 miles from Arizona. As police removed protesters yelling “kill the bill” from the gallery, Wisconsin’s Ron Johnson (who has been a holdout in recent weeks) held off on voting until he saw what the outcome was going to be. Vice President Mike Pence then cast a tiebreaking vote.

— But Tuesday night underscored what a tough row to hoe this remains. The rules of the body mean that any senator can now submit amendments that need to be voted on. This leads to what’s called a vote-o-rama, an often chaotic and sometimes unpredictable process.

The first item members took up Tuesday night was the Better Care Reconciliation Act. That is the carefully negotiated package that McConnell spent weeks crafting, with compromises to get conservatives like Ted Cruz, R-Texas, and moderates like Rob Portman, R-Ohio, on board. But nine Republicans broke ranks and voted no.

The diversity of those who opposed the measure underscored the ideological split within the Republican conference about the best path forward on health care. The group included moderates like Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, as well as conservative purists like Mike Lee, R-Utah, and Rand Paul, R-Ky. Also voting no were Bob Corker, R-Tenn., Tom Cotton, R-Ark., Lindsey Graham, R-S.C., Dean Heller, R-Nev., and Jerry Moran, R-Kan.

— President Donald Trump, who has stepped up his efforts in recent days to get a bill done, marveled Tuesday at the small margin for error. “It’s a very, very difficult situation,” he said in an interview with the Wall Street Journal, “because you move a little to the left, and you lose four guys. You move a little bit to the right, and all of a sudden you have a bloc of people who are gone. You have a one-inch road and it wheels through the middle of the valley.”

— Senators will next cast an up-or-down vote on whether to completely repeal Obamacare. The vote could come as early as Wednesday. It will fail. The only question is how many Republicans vote against it. Two years ago, all but one of them voted for the identical measure – when they knew that it was only for show and Barack Obama would veto it.

— It’s hard to overstate the degree to which White House officials and Senate GOP leaders just want to pass something – really, anything – to show the base that they are keeping their promise to roll back Obamacare. They would happily portray even most modest tweaks to the Affordable Care Act as major successes to save face. As far as they’re concerned, whatever gets passed will be the basis for negotiations with the House. So this is not even a final product.

That’s where what’s being called “skinny repeal” comes in. “The ‘skinny repeal’ option would repeal the ACA’s mandates that individuals buy plans and that employers with 50 or more employees provide coverage . . . as well as eliminate the law’s tax on medical device manufacturers,” The Post’s Sean Sullivan, Juliet Eilperin and Kelsey Snell explain. “This . . . strategy would keep the overhaul effort alive but amount to a tacit acknowledgment that broader efforts to revise or repeal the law cannot succeed … The conservative group Freedom Partners (backed by the Koch political network), urged senators to use the votes to partly repeal the law and then keep pushing for full repeal. . . . But one key way Senate leaders won Tuesday’s procedural vote was by assuring several centrist Republicans that they may end up with a modest bill.”

The devil is in the details.

“There has been a mismatch all along between many of the Republicans’ critiques of current law and the likely outcomes of their reforms,” Margot Sanger-Katz writes in the New York Times. “But earlier bills grappled with the issues by trying to deregulate insurance markets or provide stabilization funds, even if analyses suggested that the changes would still increase consumer costs and the number of Americans without insurance. A skinny repeal bill, instead, leaves those policy goals to the side in an effort to find a slender majority of votes.”

— Keep in mind: Opening floor debate may be a Pyrrhic victory for the GOP: Democrats are going to force Republicans to cast some uncomfortable votes in the coming days as part of the freewheeling amendment process. Regardless of whether a bill ultimately passes, and how they try to spin it, every senator who voted for the motion to proceed just gave years of fodder to Democratic admakers. “These votes, frankly, are a lot tougher for them than they are for us,” said Senate Minority Leader Chuck Schumer, D-N.Y. “They are squeezed in both directions.”

McConnell, for his part, warned his members that voters “expect us to tackle the big problems.” “So all we have to do today is to have the courage to begin the debate,” the GOP leader said in a floor speech. “Let the voting take us where it will.”

THE MAC IS BACK:

— “John McCain, maverick of the Senate, did not return to Capitol Hill and suddenly stop the progress of the Republican health-care effort. But the Arizona Republican, now battling an aggressive form of brain cancer, did use his moment in the spotlight Tuesday to deliver a sobering message to colleagues,” The Post’s Elise Viebeck, Paul Kane and Ed O’Keefe report. “The Senate might be known as the world’s greatest deliberative body, McCain said, but it is not clear it deserves that reputation today. The partisanship, the gridlock and the political subterfuge have dragged down the institution, he said. Senators’ work is ‘more partisan, more tribal more of the time than any other time I remember,’ McCain told a rapt audience on the Senate floor. ‘Our deliberations can still be important and useful, but I think we’d all agree they haven’t been overburdened by greatness lately. And right now, they aren’t producing much for the American people.'”

Even though he delivered a pivotal vote to move the health-care debate forward, the 2008 GOP presidential nominee publicly criticized his party’s leaders for their lack of transparency and suggested that a bill may not ultimately pass. “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,” McCain said. “I don’t think that’s going to work in the end, and it probably shouldn’t . . .

“Let’s trust each other,” he added. “Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires.”

HOW IT’S PLAYING BACK HOME:

— Arizona Republic: “It won’t take long to see whether McCain’s message dented the partisan stalemate on Republican efforts to overhaul the Affordable Care Act. Both sides are expected to wrangle for the rest of the week over competing versions of the health-care bill to see if any ideas can muster a majority.”

— Denver Post: “Cory Gardner votes to advance Senate GOP health care bill but circumspect on what comes next. Regardless, Colorado Republican plans to pitch idea involving private insurance for low-income residents.”

— Alaska Dispatch News: “Alaska’s senior Republican Sen. Lisa Murkowski said Tuesday that her decision to vote no on beginning debate on health care legislation was a last-minute decision. In the end, an allegiance to ‘the process’ won out.”

— Las Vegas Sun: “[Sen. Dean Heller] voted in support of a motion to push forward with efforts to roll back Obamacare. . . . He noted that his vote to proceed was not a vote in favor of the GOP bill. . . . Rep. Jacky Rosen, D-Nev., who is running against Heller next year, said in a statement after today’s vote that Heller folded under pressure from President Donald Trump and GOP leaders.”

— Charleston Gazette-Mail: “Following the roll call, [Sen. Shelley Moore] Capito said she expects that the final Senate version will put more money into combating the worsening opioid epidemic and beefing up the Patient and State Stability Fund, which would soften the blow of some of the lost federal funding.”

— Columbus Dispatch: “Despite his sharp criticisms of nearly every health-care bill pushed by Republican leadership this year, Ohio Sen. Rob Portman sided with party leaders Tuesday to keep alive the GOP effort to dismantle and replace Obamacare.”