Tom Brenner / The New York Times
The U.S. Capitol in Washington, on the morning of July 27, 2017. A day before, the Senate rejected a measure that would repeal major parts of the Affordable Care Act without replacing it. Senate Republicans have been trying to push through a repeal by using special budget rules that limit debate to 20 hours. That time is expected to be exhausted on Thursday.
Saturday, July 29, 2017 | 2 a.m.
WASHINGTON — The Republican Party’s seven-year dream of dismantling the Affordable Care Act came to what seemed like a climactic end early Friday, punctured by the Senate’s vote to reject a last-ditch proposal to repeal a few parts of the health law.
With the vote on a “skinny” repeal bill, Republican leaders were trying what amounted to a legislative Hail Mary pass. But they could afford to lose only two party members, and three Republicans voted no: Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona.
Here are some of the key lessons from the evening:
The process matters.
Republicans grumbled about the secretive manner in which the majority leader, Sen. Mitch McConnell, R-Ky., put together his repeal bill. There were no public hearings or formal bill-drafting sessions, and Republicans used a fast-track procedure meant for budget matters as they tried to enact complex health policy and avoid a filibuster.
McCain was an outspoken critic. In June, asked his comfort level with the process, he cut off a reporter. “None,” he said.
The final hours of the repeal effort seemed worse than ever: Republican leaders unveiled their bill and then expected their members to vote for it hours later, and in the middle of the night, no less.
President Trump was no help.
Without the election of Donald Trump last year, putting a Republican in the White House, the repeal effort would have been an academic exercise, ending in a certain veto. But Trump did not prove persuasive in recent days.
In public, he did not show much fluency in the basics of health policy, let alone the ability to persuade Republicans on complicated issues like the growth rate of Medicaid payments. And he did himself no favors by changing his demands about exactly what he wanted the Senate to do.
Bullying isn’t effective.
After Murkowski voted against beginning debate on health care, Trump went after her on Twitter. It was not a fair fight: He has more than 34 million followers, and she has about 99,000.
Trump also directed the interior secretary, Ryan Zinke, to call Murkowski and remind her of the Alaska issues controlled by his department.
It wasn’t a subtle move. But this time, Murkowski held the whip hand: She is chairwoman not only of the Senate Energy and Natural Resources Committee, which has jurisdiction over the Interior Department, but also of the appropriations subcommittee that funds it. Murkowski voted no.
The abortion debate didn’t make things easier.
The politically difficult task of coming up with sweeping health legislation was made more challenging by differing views of abortion, an issue that was at the periphery of the Republican efforts but was a persistent complication.
The slimmed-down bill, like the comprehensive Senate legislation before it, would have cut off federal funds to Planned Parenthood for one year, a major demand of conservatives and of anti-abortion groups like the Susan B. Anthony List. Collins and Murkowski both opposed that provision. Just hours before the vote, Collins said the bill “unfairly singles out Planned Parenthood.”
A slim majority has its limits.
Senate leaders ultimately could not overcome a fundamental problem: Collins has a very different view of health policy than, say, Sen. Rand Paul, R-Ky.
Such divergent views might not be a problem if Republicans held a big majority in the Senate. But as Republicans hold only 52 seats, their leaders have had to worry about pleasing both the most conservative and the most moderate members. In an otherwise disappointing year for the party, Democrats won Senate seats in Illinois and New Hampshire in 2016, and their freshman senators, Tammy Duckworth of Illinois and Maggie Hassan of New Hampshire, made all the difference.
