In Hemingway’s The Sun Also Rises, a character asks the dissolute Scotsman Mike Campbell how he managed to go bankrupt. “Two ways,” Campbell replies. “Gradually and then suddenly.” It’s an answer Republican members of the Senate might find themselves giving in the years to come when they’re asked how they came to be supporters of repairing the Affordable Care Act rather that tearing it out, root and branch.
The GOP has been promising to repeal the ACA since before the ink dried on President Obama’s signature, and when they took control of the House in 2011 they began pushing for full repeal. Knowing that they had no chance of making it happen at that point, there was little political downside to voting to eliminate the law, even without a viable plan for replacing it.
Even after Republicans won the Senate in 2015, bills to repeal the ACA kept coming -- one even made it to the president’s desk -- because Republicans knew that Obama would veto anything that threatened his top domestic policy achievement.
But things began to change late last year, after Donald Trump’s election victory placed the GOP in unexpected control off all the levers of power in Washington. A few hardliners still called for total elimination of the ACA, but when actual legislation slowly started bubbling to the surface, the proposals that emerged looked less like full repeal than tinkering around the edges. This seemed to reflect the understanding among a large share of the party’s members that they would bear the blame if they destroyed the existing health insurance system without a viable replacement waiting in the wings.
That was the gradual part. The sudden part has come within the past 24 hours. With the Senate Republican leadership struggling to find the votes to advance its Better Care Reconciliation Act on Monday, Sens. Mike Lee of Utah and Jerry Moran of Kansas announced that they would not vote to allow the bill to come up for debate. Added to the two members who had already signaled the same intent, this tipped the balance, meaning that the Senate bill was effectively dead.
By Tuesday morning, Senate Majority Leader Mitch McConnell was promising that there would be a vote on a straight repeal of the ACA, with implementation delayed for two years to allow more time for an alternative to be formulated. By lunchtime, enough GOP Senators had lined up against allowing that measure to come to a vote that it appeared dead as well.
But at that point, the tone had already started to change. On Monday night, Arizona Sen. John McCain, at home recovering from serious surgery, said in a statement that it was time for Republicans to put aside partisanship and begin working with Democrats to help shore up the existing system rather than focusing exclusively on demolishing it. He urged a return to “regular order,” in which the committees with jurisdiction over health care issues would hold hearings and debate the bill in public.
On Tuesday Tennessee Sen. Lamar Alexander, like McCain a longtime veteran of the Senate, appeared to agree. “My main concern is doing all I can to help the 350,000 Tennesseans and 18 million Americans in the individual market who may literally have no options to purchase health insurance in 2018 and 2019.”
Alexander, who chairs the Senate’s Health, Education, Labor and Pensions Committee, is in a uniquely important position when it comes to this issue, given his committee’s jurisdiction.
“The Senate Health Committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market. I will consult with Senate leadership and then I will set those hearings after the Senate votes on the health care bill.” (Alexander’s statement came out before it became clear that McConnell may not even have the votes to bring a repeal vote to the floor.)
The Senate’s old guard, after watching the party’s leaders leadership flail their way toward legislative disaster over the past few weeks, may be moving to reassert its institutional authority. But one key ally who isn’t on board yet is President Trump, who on Tuesday called on Republicans in a tweet to “let Obamacare fail.” Later, speaking to reporters, he said “We’re not going to own it. I’m not going to own it.”
Another key partner, Democratic leader Chuck Schumer of New York, has repeatedly said that he is willing to work with Republicans to help repair parts of the ACA -- but he will extract a price to do so, both in terms of policy and politics.
On Tuesday, Schumer criticized Trump on the Senate floor, saying, “The president would not be ‘letting Obamacare collapse.’ He is actively, actively trying to undermine the health care system in this country, using millions of Americans as political pawns in a cynical game.”