Killing Obamacare without a replacement doesn't appeal to McConnell

Key Points
  • Senate Republican leaders know that chances of passing their health bill are slim.
  • Majority Leader Mitch McConnell is unlikely to allow debate to extend past July 21, according to a GOP strategist.
  • Nevada Republican Dean Heller remains a potential key to the bill's fate.
Trump tweets that GOP should repeal Obamacare now and replace later

Senate Republican leaders know that chances of passing their health bill are slim, that they depend on preserving some Obamacare tax hikes, and that they probably require flipping the vote of vulnerable Nevada Sen. Dean Heller.

Those assessments, from a GOP strategist familiar with Majority Leader Mitch McConnell's thinking, show how narrow a path awaits Senate Republicans when they return July 10 after a holiday week off. McConnell hasn't given up, the strategist said, but is unlikely to allow debate to extend past July 21.

"The odds for them getting 51 votes might be at best one in five," the strategist said, even allowing for McConnell's tactical skills. "There are limits to what he can do. He is not turning water into wine."

The leadership can afford to lose just two of the GOP caucus' 52 members, which would then allow Vice President Mike Pence to cast the tie-breaking 51st vote in favor. Calculations begin with the assumption that Rand Paul, the leader's Kentucky colleague, is virtually certain to vote no.

The libertarian-minded Paul, echoing Nebraska Sen. Ben Sasse and President Donald Trump, suggested Friday that lawmakers first pass a simple repeal of Obamacare, then, after that, legislation to replace it. Senate leaders reject that option out of hand.

"For better or worse, that ship has sailed," the strategist familiar with McConnell's thinking said.

A repeal-first strategy was considered and rejected by GOP leaders and Trump himself early this year. Among other things, returning to it now would probably preclude action on tax reform until 2019.

Senate GOP may look to Democrats to help fix Obamacare if McConnell can't strike a deal

That's because repealing Obamacare could only be done using expedited, filibuster-proof "reconciliation" budget procedures. Such a repeal would, in turn, ensure Democrats would not cooperate on a replacement bill, forcing Republicans to use those same procedures again for their replacement.

Odds are against success even then, since "replace becomes a huge tax-and-spending bill," the strategist said. And because budget laws make those procedures available just twice this year, the GOP's planned tax bill couldn't use them, which almost certainly means "giving up on tax reform until after mid-term elections."

For now, leaders believe hopes of passing the Better Care Reconciliation Act rest on preserving some Obamacare tax increases. That money could then be used to increase spending on opioid addiction treatment and reduce the amounts Republicans initially planned to cut from Medicaid. Keeping the 3.8% tax hike on net investment income and the .9% Medicare tax hike for households earning more than $200,000, for example, could generate $230-billion over 10 years.

Another source of cash could be accelerating imposition of Obamacare's "Cadillac tax" on high-cost insurance plans, which the Senate would delay until 2026.

With enough extra money, GOP leaders believe, they may be able to lure holdouts such as Rob Portman of Ohio and Shelley Moore Capito of West Virginia. They would then dare outspoken conservatives such as Mike Lee of Utah and Ted Cruz of Texas to stand in the way of their last best chance to overhaul the law they have excoriated for seven years.

If those gambits work, leaders expect the most moderate Republican senator, Susan Collins of Maine, to remain opposed like Paul. In that event, victory or defeat could rest with Heller. The Nevada Republican, who faces a tough re-election fight next year, recently joined Nevada Gov. Brian Sandoval in opposing the Senate bill. But leaders believe softening the bill's Medicaid cuts might yet win him over.

In any event, the strategist familiar with McConnell's thinking predicted that the week of July 17 is the last one the GOP leader will devote to the health care debate. With a majority or without, he intends to call a vote.

"You might lose badly," the strategist said. "You might only get 20 or 30 votes."

Then the final decision for McConnell would be whether to flip his own vote to no – a parliamentary tactic that would permit him to keep trying and bring the bill back to the floor for reconsideration.

"If he doesn't flip his vote," the strategist concluded, "that'll tell us they're done."

Health care bill stuck on three key issues: Medicaid, regulations and opioids