McConnell’s “Skinny” ACA Repeal Strategy – Destabilize and Blame Democrats

CBO Report Page 072717This post was written on July 27, 2017 (before defeat of the Senate’s “skinny” ACA repeal plan on July 28, 2017 by a 51-49 vote):

Crafting the final legal rendering of a bill passed by the Senate—prior to its advancement to the President for signature—has historically occurred in a U.S. Congress Conference on only rare occasions. Yet, Mitch McConnell (Republican Senate Majority Leader) is offering conferencing to Senate Republicans as a “carrot” to gain votes for a repeal of specific ACA provisions, following the recent bill defeat of the BCRA (H.R. 1628) and then the ACA repeal-only plan (S.A. 667).

Not accepting “game over”, McConnell is now pressuring Senate Republicans to en masse support the Health Care Freedom Act (“skinny” ACA repeal), targeting a subset of ACA provisions.

The Latest McConnell Strategy – Law by Committee

Similar to military options in combat, McConnell has attempted a new strategy, which is the manipulation of conferencing to achieve his goal of full ACA repeal. This shifts the bargaining and decision-making to a level of secrecy that is unusual even in congressional history. In other words, only a small number of individuals will be involved in the final rendering of the bill. Meanwhile, McConnell has promised conservative Republican senators (in exchange for their support) that the “skinny” ACA repeal bill will transform into a full repeal bill in the prospective Conference.

Playing Poker with Senate Votes – McConnell’s Ace

Political maneuvering to bargain for support is not a recent Legislative Branch strategy. However, McConnell—considered one of the savviest legislators in terms of secret deal-making—has raised it to an art form. He has now chosen to to call a Conference to press forward with a healthcare reform bill that is widely recognized as destabilizing to the U.S. healthcare delivery system as a whole. (The Congressional Budget Office [CB0] reported that it would result in a 20 percent increase in federal exchange premiums for each year between 2018-2026; it would also result in increasing the number of still uninsured people in the U.S. to 15 million in 2018.)

McConnell most likely understands that military bluffing has sometimes resulted against all odds in a victory. Despite an awareness of the “skinny” repeal bill’s destructive potential, McConnell is still pressing forward with it—even though many Republicans (as well as all Democrats) in Congress are against this bill (and against any ACA repeal without replacement). Indeed, seven Republican senators and all Democrats voted against ACA repeal without replacement. On the other hand, the frightening reality is that conferencing could enable the resurrection of full ACA repeal, even without the support of most members of Congress.

Danger to Legislative Process

McConnell’s latest strategy for harnessing Republican support of an ACA repeal bill is not only dangerous to the U.S. healthcare delivery system, but also dangerous to our particular system of government. The main reason is that it is a complete negation of the ideals of bipartisan decision-making and public congressional debate (that the framers of the Constitution conceived as essential elements). On the other hand, it is doubtful that even McConnell wants to impede forever the functional ability of both Houses of Congress to craft (and pass) legislation.

McConnell’s Priorities – The Importance of Partisanship

McConnell’s decision to manipulate the conferencing format strongly suggests that his first loyalty is to his Party, rather than to supporting a functional Legislative Branch. Moreover, McConnell (as the leading Republican Senator) wants to demonstrate to its voting “base” that a Republican-controlled Congress can do as promised. Maintaining his role as Senator is paramount. Therefore, he will utilize any available means to maintain his own position as an elected legislator and, also, as Senate Majority Leader.

Consequence of Choosing Conferencing

Besides saddling the nation with a law guaranteed to destabilize the U.S. health delivery system and wreak havoc on hospitals, McConnell clearly does not care if he has to bypass normal legislative channels to do it; engagement of this secretive conferencing can thus be normalized.

Addendum on 7/28/17: Thank you to all 48 Senate Democrats and the 3 Senate Republicans (Susan Collins, Lisa Murkowski, and John McCain) who defeated this Republican-sponsored bill (that not even the majority of Republicans in the 115th Congress wanted to become enacted)!