Health-Care Bill Puts Senate in Uncharted Waters

(Bloomberg View) -- The Senate health-care bill is finally out. What is it? This is as good a summary as any:

Or, to be more specific, it's smaller/cheaper/worse Obamacare combined with slashing Medicaid and eliminating the taxes that Democrats passed to pay for the Affordable Care Act. Conservative health-care journalist Philip Klein (and bitter Obamacare opponent) has a different perspective: He considers the bill more of a "rescue" than a repeal.

Will it pass? The dominant attitude on Thursday (at least in my Twitter feed) was that Mitch McConnell is a master legislator who had carefully maneuvered the bill past various obstacles. Yes, many Republicans have expressed doubts about it, but surely they could be brought on board with amendments that allow them to claim credit back home. That's what happened in the House when their version of the bill looked dead. Moderates and those in states where it would be a tough vote -- Maine's Susan Collins, Alaska's Lisa Murkowski, Ohio's Rob Portman, Nevada's Dean Heller -- will fold, as that wing of the party always does. Those who feel the bill doesn't go far enough -- including Kentucky's Rand Paul, Utah's Mike Lee, Wisconsin's Ron Johnson, and Ted Cruz of Texas -- surely care about passing something, and the rest of the Republicans will likely give them what they need to vote yes.

Plausible? Absolutely.

Certain? I don't see it. To begin with, I'm not sure why we should believe in McConnell's legislative skills. He's certainly been very good at opposition, but his ability to pass bills into law, especially from his current position, is still unproven. The rejectionist crew might be pacified, but they've traditionally been motivated by separating themselves from mainstream conservatives. Do they care enough about what's in this bill to switch to a constructive role?

As for the other end of the Republican conference? It's very hard to compare this to any previous situation. There's never been a major bill that has polled this badly as it reached the Senate floor. I'm tempted to say that it's rare for any bill to have promised so much harm; I'm sure the bill's advocates would disagree, but it's hard to see how that isn't the case. And speaking of those advocates: I don't recall any major bill reaching this stage with so few members of Congress willing to speak in favor of it. 

Against all that is the imperative of doing what they promised to do after years of running on repealing and replacing Obamacare. Perhaps that's enough; perhaps many Republican senators really do care about the policy choices involved. I'll agree with the done-deal crowd that if Republicans really want to pass a bill, they will. 

On the other hand, I do think it's very likely most Republican senators just don't care very much one way or another. Very few Republicans enter politics because they care about health care: They may be passionate about taxes, or some aspect of foreign policy, or about immigration, but health care? Nah. And I remain skeptical that most of their constituents care very much, either: They hated Obamacare because of their dislike of Barack Obama, not because the provisions of the law were so offensive to them. 

If that's correct -- and what really matters is what Republican senators think their constituents care about, not what they want -- then it's probably not a done deal at all. And if that's the case, then supporters and opponents of this bill should really let their senators know their views over the next several days. 

1. H. Richard Friman at the Monkey Cage on Donald Trump's travel ban. 

2. John Hudak, Elaine Kamarck and Christine Stenglein at Brookings on Trump's immigration policies.

3. I think Amy Walter is more right than wrong about Nancy Pelosi after Georgia's special election. The wrong-ish part? I believe Republicans think Pelosi is a magic gun they can use against Democrats, but that doesn't prove using her in ads is actually better for them than just talking about the national Democratic Party (or replacing her with someone else). 

4. See also Jeer Heet's case for Pelosi. 

5. Jennifer Bendery and Alissa Scheller on Trump's opportunity to put plenty of judges on the federal bench. 

6. My Bloomberg View colleague Al Hunt talks to Bill Ruckelshaus about Watergate and Trump. 

7. And Robert Farley explains why the Vietnam War wasn't really winnable for the U.S. 

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Jonathan Bernstein is a Bloomberg View columnist. He taught political science at the University of Texas at San Antonio and DePauw University and wrote A Plain Blog About Politics.

To contact the author of this story: Jonathan Bernstein at jbernstein62@bloomberg.net.

To contact the editor responsible for this story: Brooke Sample at bsample1@bloomberg.net.

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