JULY 28, 2017
WASHINGTON — The
Republican Party’s seven-year dream of dismantling the Affordable Care Act came
to what seemed like a climactic end early Friday, punctured by the Senate’s
vote to reject a last-ditch proposal to repeal a few parts of the health law.
With the vote on a
“skinny” repeal bill, Republican leaders were trying what amounted to a
legislative Hail Mary pass. But they could afford to lose only two party
members, and three Republicans voted no: Susan Collins of Maine, Lisa Murkowski
of Alaska and John McCain of Arizona.
Here are some of the
key lessons from the evening:
The process matters.
Republicans grumbled
about the secretive manner in which the
majority leader, Senator Mitch McConnell of Kentucky, put together his repeal
bill. There were no public hearings or formal bill-drafting sessions, and
Republicans used a fast-track procedure meant for budget matters as they tried to enact complex health policy and
avoid a filibuster.
Mr. McCain was an
outspoken critic. In June, asked his comfort level with the process, he cut off
a reporter. “None,” he said.
The final hours of
the repeal effort seemed worse than ever: Republican leaders unveiled their
bill and then expected their members to vote for it hours later, and in the
middle of the night, no less.
President Trump was
no help.
Without the election
of Mr. Trump last year, putting a Republican in the White House, the repeal
effort would have been an academic exercise, ending in a certain veto. But Mr.
Trump did not prove persuasive in recent days.
In public, he did not
show much fluency in the basics of health policy, let alone the ability to
persuade Republicans on complicated issues like the growth rate of Medicaid payments. And he did himself no favors by
changing his demands about exactly what he wanted the Senate to do.
Bullying isn’t
effective.
After Ms. Murkowski
voted against beginning debate on health care, Mr. Trump went after her on Twitter. It was not a fair
fight: He has more than 34 million followers, and she has about 99,000.
Mr. Trump also
directed the interior secretary, Ryan Zinke, to call Ms. Murkowski and remind
her of the Alaska issues controlled by his department.
It wasn’t a subtle
move. But this time, Ms. Murkowski held the whip hand: She is chairwoman not
only of the Senate Energy and Natural Resources Committee, which has
jurisdiction over the Interior Department, but also of the appropriations
subcommittee that funds it. Ms. Murkowski voted no.
The abortion debate didn’t make things
easier.
The politically
difficult task of coming up with sweeping health legislation was made more
challenging by differing views of abortion, an issue that was at the periphery
of the Republican efforts but was a persistent complication.
The slimmed-down
bill, like the comprehensive Senate legislation before it, would have cut off
federal funds to Planned Parenthood for one year, a major demand of
conservatives and of anti-abortion groups like the Susan B. Anthony List. Ms.
Collins and Ms. Murkowski both opposed that provision. Just hours before the
vote, Ms. Collins said the bill “unfairly singles out Planned Parenthood.”
A slim majority has
its limits.
Senate leaders
ultimately could not overcome a fundamental problem: Ms. Collins has a very
different view of health policy than, say, Senator Rand Paul of Kentucky.
Such divergent views
might not be a problem if Republicans held a big majority in the Senate. But as
Republicans hold only 52 seats, their leaders have had to worry about pleasing
both the most conservative and the most moderate members. In an otherwise
disappointing year for the party, Democrats won Senate seats in Illinois and
New Hampshire in 2016, and their freshman senators, Tammy Duckworth of Illinois
and Maggie Hassan of New Hampshire, made all the difference.
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