A Quick Post Mortem on the Better Health Care Reconciliation Act (BCRA)

By Lambert Strether of Corrente

As readers know by now, the Senate Republican health care bill, the BCRA, went down to defeat last night as Senators Mike Lee (UT) and Jerry Moran (KS) simultaneously defected as firm “No” votes. In this brief post, I’ll do three things: Briefly document the defeat, briefly describe what could be coming next, and do a modest happy dance on method (developed in this post, here).

McConnell’s Defeat

After Paul Ryan’s AHCA debacle, McConnell took point in the Senate by rewriting the bill. But here’s Politico on McConnell’s defeat:

Trump blindsided by implosion of GOP health care bill

(The Financial Times also points the blame cannons at Trump: “Trump suffers stinging defeat as Obamacare overhaul collapses.” Such an account is at best incomplete; recall that major right wing forces weren’t threatening defectors with “outside money”; and that major donors like hospitals and the insurance companies came out against the bill.) More from Politico:

President Donald Trump convened a strategy session over steak and succotash at the White House with senators Monday night, trying to plot an uphill path to repealing Obamacare and replacing it with a GOP alternative.

He made an impassioned pitch on why Republicans needed to do it now — and the political peril they could face if they didn’t “repeal and replace” after promising to do it for years. He also vented about Democrats and the legislative process. “He basically said, if we don’t do this, we’re in trouble,” said one person briefed on the meeting. “That we have the Senate, House and White House, and we have to do it or we’re going to look terrible.”

And it does look terrible!

Meanwhile, two senators [Moran and Lee] — neither invited to the dinner — were simultaneously drafting statements saying that they couldn’t support the current Senate health care bill. They released the statements just after Trump’s White House meal concluded.

Trump had no idea the statements were coming, according to several White House and congressional officials. His top aides were taken aback, and the White House was soon on the phone with Senate Majority Leader Mitch McConnell.

Trump has privately wondered why legislators don’t seem to listen to him, and the blow from Moran and Lee illustrated the limits of the president’s capacity to master the art of the Washington deal.

Well, not to defend Trump — if I were a Senator, I wouldn’t listen to him either — but if a deal is not there to be had, there’s no blame to affix for not making it. And with the BCRA, my view is that what Yves calls a “solution space” did not exist. McConnell’s bill was crafted to appeal to the rich (taxes), youth (lower rates), and swing states (in the Rust Belt), plus whatever goodies McConnell could dole out. That wasn’t enough to overcome local and particular reasons for Senators to defect. Of course, if policy [cough] wonk Paul Ryan and the whackos in the Freedom Caucus, in their eight years of opposition, had managed to create a solution space and tee up a workable bill in the House, McConnell and/or Trump wouldn’t have been left holding the bag. But so it goes![1]

In summary, defeat has many fathers. I think the real story to watch is not Trump, or McConnell, or even the odious Paul Ryan, but structural factors within the Republican party. The Atlantic:

Republicans Aren’t Turning on Trump—They’re Turning on Each Other

The House is mad at the Senate. The Senate is mad at the House. Various factions in the House and Senate are mad at each other or mad at their leaders.

Republican lawmakers have yet to turn on President Trump in any meaningful way. But they’re starting to turn on each other.

On Monday, the Republicans’ tortured health-care effort hit a seemingly permanent snag. But that was only the latest blow; after half a year of consolidated GOP control, not a single major piece of legislation has been enacted. With other priorities similarly stalled, legislators’ frustration is mounting.

“We’re in charge, right? We have the House, the Senate, and the White House,” one GOP member of Congress told me. “Everyone’s still committed to making progress on big issues, but the more time goes by, the more difficult that becomes. And then the blame game starts.”

Meanwhile, many senators are annoyed with Majority Leader Mitch McConnell for the rushed, secretive process that produced the health-care bill, and for threatening to cancel their August vacation for a potentially fruitless legislative session. And everyone is annoyed with the House Freedom Caucus, which has also demanded that lawmakers spend next month in D.C.

But everyone is always mad at the Freedom Caucus. Divisions between Republican factions are nothing new; nor is friction between the House and Senate. In an oft-repeated fable, a new Republican member of Congress, eager to go after the “enemy” Democrats, is corrected by an old bull: “The Democrats are the opposition,” he says. “The Senate is the enemy.”

James Madison would be proud!

Still, some wonder whether the current sniping isn’t better directed to Pennsylvania Avenue, where the scandal-mired president creates new headaches with every passing day. “We’re a big-tent party, so of course there are divisions,” the member of Congress told me. “But the only thing that could unite the clans is consistent and engaged leadership from the president. And it’s fair to say we’ve gotten mixed signals.”

A House Republican staffer described the fractious mood on Capitol Hill as “Republican-on-Republican violence.” As for why lawmakers don’t train their ire on the real root of their problems, the staffer shrugged: “Maybe it’s just easier to attack people without 13 million Twitter followers.”

Pass the popcorn. Gridlock is our friend.

What Next on Health Care

Predictably, McConnell, having received the baby from Ryan, is passing the endiapered, squalling effluent — I mean the bill, not Ryan — to Trump. The Financial Times:

[McConnell] said he would adopt a strategy advocated by Mr Trump: moving to repeal Obamacare but with a two-year delay, which leaders hope would buy them time to come up with the replacement they have been unable to find thus far. 

They had eight years to figure it out in opposition; why will an additional two in power help?

The Senate passed similar legislation in 2015 when it knew Mr Obama would refuse to sign it.

Games people play… Anyhow, the latest is that McConnell tried that this morning, and it didn’t work. WaPo, at 10:52AM:

Senate Majority Leader Mitch McConnell (R-Ky.) opened the Senate on Tuesday morning touting his latest plan — to vote on a pure repeal, with a two-year delay, by taking up the House’s health-care bill. But while conservatives and Trump have been pushing for such a repeal as a last resort, it appeared unlikely that the vote would succeed.

Two Republican senators, Susan Collins (Maine) and Shelley Moore Capito (W.Va.), expressed opposition Tuesday to the repeal-only option, apparently burying it.

“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

Et tu, Shelley? So we’re in an overly dynamic situation[2]. Of course, Democrats have their own games to play. Matt Yglesias:

The thing that would really kill Obamacare repeal — and preserve its insurance coverage gains — is what McConnell has warned his fellow Republicans against: bipartisanship.

This would be a very achievable goal if a dozen or so Republicans decided they wanted to work with Democrats to make it happen. A stronger mandate, guaranteed cost-sharing reduction money, and a few simple tweaks like bringing back “risk corridors” and expanding reinsurance funding would set off a virtuous circle. Plans would become slightly cheaper, and going uninsured would become slightly more expensive, pushing healthier people at the margin into joining the exchanges. That, in turn, would lower average premiums and push even more healthy people into joining the exchanges, which would further lower costs — lather, rinse, repeat. The result wouldn’t be a health care utopia, but it would be an improvement over the status quo, which is what people want.

No. That’s not what people want. People want (even some Republican poeple want (and more people can be persuaded to want)) — #MedicareForAll, not some gussied-up version of ObamaCare that takes another decade of lathering, rinsing, repeating, and virtuous cycling (along with virtuous cycling’s twin sibling, virtue signaling).

As I keep saying, ObamaCare is the worst possible Republican bill.

On Method

And now I would like to do a modest happy dance on method (which is the most important part of this post, to me. This tweet from a Philadelphia Inquirer reporter:

OK, who had Mike Lee and Jerry Moran as the senators who would kill Obamacare repeal?

— Jonathan Tamari (@JonathanTamari) July 18, 2017

[Lambert blushes modestly]. As I wrote in “All Politics is Local: Why the Odds Are Against TrumpUncare (BCRA, BCRA + “Consumer Choice,” and AHCA)“:

Third, if you do the math and take each unique case into account, I read Heller as a solid “no,” since he’s bucking the leadership on everything else and he’s backed by his governor, I read Collins as a solid “no,” since not only does she — Lambert gets sentimental here — care about the constituents of her small, rural state, she wants to run for Governor, and I read Capito as a solid “no,” since $45 billion won’t buy her off; she wants more, but there’s no more to be had. McConnell can afford to lose two; that’s three. I’m pleasantly surprised by Moran, and he’s a bit like Collins, in that he too, seems to care about his rural constituents, and his state seems split, at the state level, between “too far,” and “not far enough” on issues like taxes. I rate Moran as a possible “no.” That’s four. I rate Portman as weak, so still four (depending on what pressure Kasich can bring to bear). And that’s before we get to Cruz, Lee, Johnson, and Paul. I might throw Paul in, since McConnell will not meet his price, bringing the number of defectors to five.

With a caveat that I’m relucant to make calls, the judgment:

With the caveat out of the way, passage of TrumpUncare as BCRA, as BCRA + “Consumer Choice”, or as a revised AHCA seems highly unlikely to me, as does the simple repeal of ObamaCare with no replacement. (Even if the repeal didn’t take effect until 2019, or even 2021, that would be a terrible look that proves Republicans are unfit to govern.)

(I suppose that, instead of “highly unlikely” I should have written “highly unconfident,” but it was late.) Anyhow, I got a refined set of names that included the right names, Moran and Lee (and today Capito) although my analysis was light on Lee. Note also that Collins and Capito didn’t flip back, despite McConnell’s inducements. And after ruling out a boatload of monocausal explanations, this was my method:

[The post is] designed to show that the drivers for TrumpUncare’s success or failure are predominately local (and as a corollary, that most of the coverage you read in the Beltway press is worthless)… by taking a look at the local state of play for each defector.

Others in retrospect agree. An ABC reporter:

Lee and Moran also make sense to pair together to be the 2 senators to halt the bill. Two very different sets of concerns.

— Ali Rogin (@AliABCNews) July 18, 2017

“Two very different sets of concerns.” And CNN has a long article (even longer than “All Politics is Local”) belatedly using the same method to make the same point. “Why Senate Republicans can’t agree to repeal Obamacare, in charts.” Their conclusion:

Senate Republicans have been trying to thread the needle on health care reform for weeks, but their latest efforts collapsed on Monday when it became clear they couldn’t rally the votes to pass the bill.

So why can’t they find agreement? Each senator has a different reason to oppose the legislation — from ideology to re-election concerns to the demographics and health nuances of individual states.

(Note that this method is very different from a simple whip count, no matter how checklist- and graphics-heavy, as here.)

Conclusion

As the chorus sings in The Music Man, on their train to River City, Iowa: “You gotta know the territory”[3]. There’s a lesson for the left here: If you want to take advantage of elite factional splits — and who doesn’t? See the Duc d’Orleans — you’ve got to know what those splits are, and why they exist.

NOTES

[1] No, McConnell has not been hospitalized; Andy Borowitz is what passes for a humorist at the sadly diminished New Yorker.

[2] It will be interesting to see if there’s a leadership crisis in the Senate. Lee and Moran held hands and jumped off the cliff together:

My colleague @JerryMoran and I will not support the MTP to this version of BCRA #HealthcareBill

— Mike Lee (@SenMikeLee) July 18, 2017

Moran and Lee didn’t give the leadership, or Trump, a heads-up; they also gave cover to Senators in trouble in purple states or tight districts, like Heller. Then today Capito, part of the leadership team, sticks the shiv in. And some Senators complain about McConnell’s secretive tactics. It will be interesting to see if McConnell is defenestrated. “When you play the game of thrones, you win or you die,” as Cersei Lannister says.

[3] An American patter song:

Only a con man doens’t know the territory….

APPENDIX: Against “Resistance” Triumphalism

We will no doubt see a good deal of triumphalist claims from “Resistance” types like Neera Tanden, et al., that protest was central to the defeat of the BCRA; that is only natural, since AstroTurf organizations need to show results to their funders. Others play along:

I'm delighted to see the disastrous Republican health care plan won't succeed – a victory for the millions who stood up and fought back.

— Bernie Sanders (@SenSanders) July 18, 2017

I believe such broad claims, though sometimes made in good faith, border on political malpractice. First, an account for the defeat of the BCRA can be made solely by examining internal contradictions in the Republican Party (after all, the BCRA was only and ever going to get 50 votes plus Pence in any case; that’s why “R” for “Reconciliation” is in the title of the bill). Occam’s Razor would dictate I stop now, but in reality events are driven by multiple causes, so I’ll go on. Second, there’s no contemporaneous evidence that protest affects legislative outcomes (which is an entirely separate question from whether legislators show up at Town Halls, and so forth). John Laurits:

Though observations by past protesters appeared to support the hypothesis that elected officials can be forced to change policies by organizing a protest big enough to prove the public wants it — the results they achieved have rarely been repeated since the ’60s. And when results are not repeatable, either the experiments are flawed — or the hypothesis is flawed. If large protests influence public officials & policies, then why do we observe that anti-nuclear protests in ’83 had less influence over policy while organizing more protesters than the two largest ’60s era protests combined? Sure, in this instance, you could say “it was an issue of national security” — but why, then, did public officials take 14 years just to start redressing the grievances of 1 million who protested for LGBT civil rights?

Demonstrations which result in partial change to public policy 14 – 23 years later cannot be called viable protests for the same reason food which takes a year to cook is not a viable option for tonight’s dinner.

Since protest demonstrations haven’t worked in forty years, it would certainly be strange that they had an instant effect in 2017. Why would anybody believe they did (other than wishful thinking or the post hoc fallacy)? I’m guessing that liberal Democrats and some of good faith on the left are trying to emulate the Tea Party, certainly with their focus on town halls. But the Tea Party is a flawed analogy: It was a rebellion by conservatives within their own party against its leadership; although its form was a protest, its content was electoral. Why would any elected Republican legislator pay the slightest attention to a bunch of people who would never vote for them anyhow, even if they are waving clever signage? The only Republican who would is one in a marginal district, like Dean Heller, and even there I’d want firm anecdotal evidence from an actor speaking against interest before I believed it. (Note, however, a proper analogy to the Tea Party: Single payer advocates, presumably or at least possibly voting Democrat, threatening Democrat legislators. That might work, which is doubtless why “Resistance” organizations like Indivisible take care to erase the idea.)

A caveat: I think other electorally focused tactics can be said to work: Letters to the editor, for example. But not “protest” as such. “When Feeling Good is Bad” shows how empty the calories of protest are.