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Republicans' health care process is 'starting to feel incoherent'

How big a mess is the Republican health care gambit? A GOP senator said, "Things are starting to feel incoherent." This has the benefit of being true.
Without mentioning Donald Trump by name, Senate Majority Leader Mitch McConnell, R-Ky., denounced Trump's recent remarks about restricting Muslim travel during a news conference at the Capitol in Washington, Dec. 8, 2015. (Photo by J. Scott Applewhite/AP)
Without mentioning Donald Trump by name, Senate Majority Leader Mitch McConnell, R-Ky., denounced Trump's recent remarks about restricting Muslim travel during a news conference at the Capitol in Washington, Dec. 8, 2015.

To appreciate the scope of the Republicans' mess on health care, consider this quote from a high-profile GOP senator -- who happens to support his party's regressive plans.

"Things are starting to feel incoherent," said Senator Bob Corker, Republican of Tennessee, reflecting on the health care efforts, which have turned many Republican senators against one another as efforts to negotiate the future of the Medicaid program have caused large rifts.With no small measure of understatement, Mr. Corker conceded, "There's just not a lot of progress happening."

"Things are starting to feel incoherent" is a fair and accurate summary, though I'm inclined to take issue with the "starting to" qualifier. The Republicans' health care gambit has felt incoherent for quite a while.

I've heard from more than a few readers with questions about where things stand, so let's dive in with a Q&A.

Everyone said the Republican effort was dead. Then everyone said it's alive. I no longer know what to think.

And neither does anyone else. The original Senate Republican plan, unveiled last month, failed. Mitch McConnell then tweaked his proposal last week, only to discover this week that it didn't have the votes, either. The Majority Leader then said he'd bring an even-more-radical "repeal and delay" plan to the floor, and more than enough GOP senators almost immediately balked.

So health care advocates can breathe easy.

Not exactly. On Wednesday night, some Republican critics of their party's plans renewed their negotiations, hoping to work something out.

Did they reach some kind of agreement? Did any "no" votes flip to "yes"?

So far, the answer to both questions is no. Substantively, nothing has changed.

So I'm back to thinking I can breathe easy again.

That's understandable, but this is a volatile and unpredictable situation. The fact that conversations are ongoing suggest GOP senators, in theory, could still work something out. What's more, McConnell and the Republican leadership team are going to move forward with health care floor votes on Tuesday.

What will the Senate vote on?

That's a surprisingly difficult question to answer. In fact, Senate Republicans themselves concede that they have no idea what bill (or bills) will be considered when the floor votes begin in four days. Asked yesterday if his own members have been notified of what overhaul legislation they'll consider early next week, Senate Majority Whip John Cornyn (R-Texas) told reporters yesterday, "That's a luxury we don't have."

What does that mean?

I'm not altogether sure, but I think Cornyn's point was that he and the rest of the GOP leadership team are so lost right now, they can't offer anyone, including their own members, any guidance.

It sounds crazy to think the Senate will vote in four days on overhauling one-sixth of the United States economy, and they don't yet know what bill will be considered.


How many possible options are we talking about here?

It depends on how you count the bills. There's McConnell's original plan, McConnell's tweaked plan, McConnell's tweaked plan minus the Cruz Amendment, the "repeal and delay" plan (also known as the "Obamacare Repeal Reconciliation Act"), and even some plans pushed by individual members, such as the Graham/Cassidy plan.

Do any of these bills have the support of 50 senators?

At least for now, it doesn't look like it.

How significant is John McCain's absence?

Very. We don't yet have any idea when the Arizona Republican will return to Capitol Hill, but his absence will make it that much more difficult for the GOP to pull together 50 votes for a far-right bill. We've all talked for several weeks about the magic number of three -- if three or more Republicans fail to vote "yes" on the party's health care bill, it dies -- but McCain would count as one of the three.

In other words, if McCain is unavailable to vote on Tuesday, it would only take two GOP senators to derail any legislation by breaking ranks.

So what happens on Tuesday?

McConnell will bring the House bill to the Senate floor for a procedural vote called a "motion to proceed." If it fails to get 50 votes, it's game over. If it gets 50 or more votes, McConnell will then offer an amendment to replace the entirety of the House bill with ... something. No one can say with any confidence what that would be.

Will they clear the motion-to-proceed hurdle?

Maybe. Sen. Susan Collins (R-Maine) appears to be a hard "no," and if McCain is unavailable, that leaves GOP leaders will no room for error. Sen. Rand Paul (R-Ky.) was a hard "no," but he said yesterday he'd vote with his party on this procedural step if he's guaranteed a vote on his own right-wing proposal.

Anything else?

Republican leaders haven't stopped trying to buy off on-the-fence members, with McConnell reportedly dangling $200 billion in additional spending to help curry favor with his more moderate members. That wouldn't make much of a substantive difference, but the Majority Leader is apparently hoping these members are bad at math.

Watch this space.