Senate Republicans this week will try to prove they’re not slow-walking the remake of America’s health care system, a dicey approach under President Donald Trump and one that’s been causing considerable conservative angst.
To that end, Senate Republicans will get a status update during their weekly caucus luncheon Tuesday, during which they’ll learn about some options being considered for repealing the Affordable Care Act. They’ll hear about potential tax credits, a possible timeline for ending Medicaid expansion and considerations about state waivers.
And with dozens of reporters outside the meeting room, details will get out quickly, allowing Republicans to reassure constituents and interest groups through the press that they’re moving ahead on one of the Republican Party’s most high-profile campaign promises over the past seven years.
“Every day you get closer to an election is a day that it gets harder to do the tough stuff,” said Scott Jennings, a Republican political consultant in Kentucky who has worked for Senate Majority Leader Mitch McConnell. “And the risk in ultimately not getting something done is that you’re accused of breaking your campaign promises. Failure to act is a message to the voters that the status quo reigns in Washington, and that was absolutely what they didn’t want coming out of the November election.”
Failure to deliver would be lethal, said Andy Roth, vice president of government affairs at the Club for Growth.
“Republicans campaigned on full repeal of Obamacare not just this past November, but for multiple election cycles, and now they’ve been given the mandate and the White House to do it,” Roth said. “If they don’t they’re going to lose their majorities in 2018.
“The reason why voters voted for Trump is because they wanted to get something done. Republicans keep saying one thing and then not following through when they get elected,” Roth said.
The Senate prides itself on taking a cautious, deliberative approach to legislation. But that style poses risks, including that the demands of the legislative calendar means a health overhaul will bump up against must-do legislation, including raising the debt limit and writing the 2018 federal budget.
Pushing health care beyond Congress’ August recess could imperil the legislation and give Democrats an opportunity to spend the summer bashing the plan — just as conservative activists spent the summer of 2009 lambasting Democrats and the Obama administration for the Affordable Care Act.
Senators on a weeklong recess last week sounded pessimistic about the chances for progress, even as Senate staffers began putting some proposals to paper. Echoing several of his colleagues, Sen. Richard Burr, R-N.C. told a North Carolina TV station it was “unlikely” the Senate would reach a deal this year. Senate Majority Whip John Cornyn, R-Texas, insisted otherwise, telling a Texas radio station he was confident the Senate would act before leaving town for August.
“Oh, absolutely, we’ll get it done by the end of July at the latest,” Cornyn said.
Monday evening, Sen. John Thune, R-S.D., said the Senate leadership is narrowing its options, but that the Senate needed to hold a vote, trailing off as he said, “if we don’t pass something and we go into ’18 ….”
But he suggested that Republican supporters don’t yet have the votes. “In the end we’ll get to where we have something to vote on and I would hope that we get to where we have 50 votes plus the vice president because I think it’s really important for us to act on this and try to put a fix in place.”
Sen. Roy Blunt, R-Mo., said leadership is “optimistic and we’ll see how it goes in the next few days.” But he said the Senate at a certain point will need to move on: “I don’t think this gets better over time,” he said. “My personal view is we’ve got now until the Fourth of July to decide whether the votes are there or not.”
What’s the risk of not holding a vote?
“Oh, I won’t answer that,” Sen Bill Cassidy, R-La., said.
Health care has been the chief talking point at the weekly lunches for the Republican caucus for weeks. House and Senate Republican leaders also are expected to meet Tuesday with Trump at the White House and discuss health care.
The slow pace so far could prompt additional prodding from Trump, who didn’t hesitate to lash out at House conservatives when he blamed them for imperiling the legislation in the House.
“Oh, Mark, I’m gonna come after you big time,” Trump said at one point, singling out Rep. Mark Meadows, R-N.C., who at the time opposed the bill that Trump and House leaders wanted to pass.
For now, Trump has stuck to cajoling Republican senators, saying on Twitter that they are “good people” who could “hopefully” get a bill passed.
Vice President Mike Pence offered some pressure, telling a crowd in Iowa over the weekend that “this summer, this Congress must come together and heed the president’s leadership, and we must repeal and replace Obamacare.”
More moderate Senate Republicans and those from states that have expanded Medicaid under the 2010 law have voiced worries that the House plan would not provide stability for families in Medicaid expansion programs, which would be phased out under the bill. Conservatives, meanwhile, say the alternatives don’t go far enough to repeal what they consider overreaching provisions in the 2010 law.
Some conservative groups are pressing the Trump administration to move ahead dismantling the Affordable Care Act in the face of Senate inaction. Freedom Partners and Americans for Prosperity last week sent a letter to Health and Human Services Secretary Tom Price urging him not to wait for the Senate.
“We’re disappointed that the Senate is taking so long and that some senators are saying ‘Can this really be done this year?’” said Tim Phillips, president of Americans for Prosperity. “We certainly hope it can be done this year, but either way we’re encouraging Price to move now.”
Still, Freedom Partners noted that rushing legislation would be as much a risk as moving cautiously.
“Repealing is a top priority, but we want the best legislation possible,” said Nathan Nascimento, Freedom Partners’ vice president of policy. “From our point of view, we’ve always called on Congress to take a thoughtful, orderly and transparent approach.”
Senate Republicans have a tenuous path. They hold a narrow majority of 52 to 48 and can lose only a few votes, if Pence casts a tiebreaking vote. And divisions in the GOP there are just as stark as the differences between its factions in the House, which stymied the bill’s progress in that chamber.
Democrats are looking to 2018, believing they have a case to make, regardless of the outcome. Failing to pass the legislation opens Republicans to charges that they broke their promises, but Democrats point out that recent polls suggest Americans are recoiling at reports that millions of people could lose insurance under the Republican plan.
“This bill is as popular as a toxic waste dump so the longer it lingers, the more damage it will do to people who are carrying it,” said Jesse Ferguson, a Democratic strategist working with Protect Our Care, a coalition of liberal groups that have joined to fight repeal of the Affordable Care Act. “Yet even as we’ve seen a lot of Republicans who don’t want to own the damage of health care repeal, we’ve not seen a lot willing to stand up and stop it.”