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The Republican health care gambit falls apart

The Republican plan to replace the Affordable Care Act is now dead. The broader GOP crusade to repeal "Obamacare" is not.
Senate Majority Leader Mitch McConnell (R-KY) bows his head in prayer during an event on Capitol Hill, Feb. 24, 2016 in Washington, D.C. (Photo by Drew Angerer/Getty)
Senate Majority Leader Mitch McConnell (R-KY) bows his head in prayer during an event on Capitol Hill, Feb. 24, 2016 in Washington, D.C.

Just 24 hours ago, Republicans were cautiously optimistic about their health care gambit. Two GOP senators -- Maine's Susan Collins and Kentucky's Rand Paul -- had announced their opposition to Senate Majority Leader Mitch McConnell's latest proposal, but other Republican skeptics were still holding their fire, leading some in the party to believe the bill still had a chance.

That didn't last. About 12 hours ago, two more GOP senators -- Kansas' Jerry Moran and Utah's Mike Lee -- said they'd vote against their party's legislation, bringing the total number of "no" votes to 52. Soon after, McConnell pulled the plug.

Senate Majority Leader Mitch McConnell acknowledged Monday night that he lacked the votes to pass the Senate health care bill after two more Republican senators came out against it, leaving the party short of a majority.Instead, he said the Senate would vote on a full repeal of Obamacare, with two years before the repeal goes into effect to allow time to create a new system. The new plan may appear to fulfill a seven-year GOP promise, but it faces extremely difficult odds after many moderate Republican senators have already come out against repeal without an immediate replacement.

This is a story with a lot of moving parts, so let's unpack the developments with some Q&A.

So, the Republican crusade is dead?

Sort of. The legislation Mitch McConnell unveiled last week clearly doesn't have the votes to pass and GOP leaders don't believe they're in a position to twist a few arms and change a few minds. That legislation, at least for now, is dead.

Now what?

McConnell is now planning to hold a vote -- "in the coming days," according to a written statement from his office -- on what's known as "repeal and delay." This entails repealing the Affordable Care Act now and creating a two-year window in which Congress would work on a Republican alternative.

This sounds familiar.

That's because it was the original Republican plan after last year's elections. GOP leaders settled on "repeal and delay" as the quickest and easiest way to achieve their political goals.

So why didn't it pass?

Largely because Donald Trump and his White House team rejected the approach, insisting that Congress kill "Obamacare" and replace it with a Republican model simultaneously.

If implemented, how bad would "repeal and delay" be?

We don't have to speculate: As regular readers may recall, the CBO found back in January that this approach would cause premiums to spike and would take health coverage from 32 million Americans over the next decade.

That sounds horrible. How worried should I be about this passing?

Not very. There's no reason to believe this bill can get 50 votes. The less conservative Republican senators will almost certainly balk, and Sen. Bill Cassidy (R-La.) said last week this tack is “a non-starter.”

So why is this McConnell's new plan?

A couple of reasons. First, the White House hasn't given him much of a choice. Donald Trump and Mike Pence have both publicly pushed this approach -- despite the White House saying the opposite earlier in the year -- and the president reiterated his support for this plan overnight. McConnell isn't in a position to blow off the wishes of his own party's White House.

Second, Senate Republicans voted to pass this same plan in 2015, when they knew it'd face a presidential veto. McConnell will effectively turn to his members and say, "Well, you voted for it two years ago, so you should vote for it again now."

So McConnell thinks it has a chance of success?

Not really. By all accounts, he wants to go through the motions, prove that he did his best, and move on. Members who voted for this in 2015 knew there'd be no consequences for their actions, making it a hollow political exercise. This time, it would count -- and the harm to Americans would be real.

I'm starting to feel a little better. Is it all right to exhale?

For now. I'd remind health care advocates that the Republican gambit collapsed in March, too, but the endeavor made a comeback two months later following some backroom negotiations. The desire among GOP officials to pass at least some kind of health care legislation hasn't changed and it won't go away anytime soon. There are some alternative Republican plans on the table -- a plan from Louisiana's Bill Cassidy and South Carolina's Lindsey Graham was unveiled last week, for example - -and with the collapse of McConnell's plan, it's likely some of these other proposals will get a fresh look.

In other words, the Senate Republican plan as we know it is dead, but the broader GOP crusade is not.