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How Trumpcare Dies

Republicans' health care legislation is on the fritz. Here's what it'll take to grind it to a halt indefinitely.

Mark Wilson/Getty Images

One of the central challenges opponents of Trumpcare face is that they must constantly probe the bill for signs of life. Like a monster in a horror film, it predictably revives itself whenever the good guys let their guard down.

Long ebbs of legislative action—such as we saw last week, when Congress was on a weeklong holiday recess—are useful insofar as they mean the bill hasn’t become law and opposition has had time to harden, but they can easily be mistaken for a final demise, which in turn breeds complacency. We know Republicans are still trying to spring their health care bill on the Senate, and turn it into law before Democrats have time to regroup.

But to switch metaphors somewhat abruptly, it is probably more useful for observers to think of the bill as a widget working its way through a machine that Republicans are struggling to keep in working order. Republicans have defined themselves by their opposition to the Affordable Care Act for years; they are to a considerable degree unable to stop themselves from trying to destroy it, no matter how reckless or politically damaging it would be for them to pass Trumpcare. Simply by setting a legislative process in motion, they have committed themselves to passing it. It is in the nature of legislatures to produce legislation no less than it’s in the nature of a combustion engine to produce power and exhaust—so long as it is in working order.

Right now that engine is rattling badly, but Republican leaders are hard at work to stop it from seizing altogether.

To keep the machinery running, Republicans have deployed a key tool: outright lying. In an encounter with constituents last week, Senator Bob Corker of Tennessee said, “There is no attempt to do away with the pre-existing condition issue [in place under Obamacare]. There is an attempt right now to build up the subsidy level so that people who are lower income can actually purchase health care.”

Contrast these comments with what Senator Chuck Grassley of Iowa told his constituents around the same time: that an amendment proposed by Senator Ted Cruz meant to consolidate conservative support for Trumpcare is “subterfuge” that has the effect of “annihilating the pre-existing condition requirement.”

Being less honest about health care than Grassley, who once vouchsafed the “death panel” lie, is quite an accomplishment. But Grassley is right about this one, and Corker is not telling the truth.

As the former Affordable Care Act administrator Andy Slavitt noted, there is broad consensus among experts of all stripes that the impact of the Cruz amendment would be devastating. But for the moment, the Cruz amendment “annihilating” pre-existing conditions protections is an essential element of the machine. If it lives, the bill lives. The engine chugs along. Lying about the Cruz amendment helps the bill survive, but so too does the trading of other favors.

A key question at the moment is whether senators will accept ancillary goodies (like a few billion dollars in funding to fight the opioid crisis) as concessions for their votes on a bill that will throw millions of people off of their health insurance and gut protections for the infirm.

But the lying isn’t limited to individual senators discussing individual measures. It is the GOP’s fundamental method of persuasion for the entire bill. According to The Washington Post:

The White House and Senate Republican leaders are planning a final, urgent blitz to pressure reluctant GOP senators to pass an overhaul of the Affordable Care Act before their month-long August recess.

Aware that the next 14 days probably represent their last chance to salvage their flagging endeavor, President Trump, Vice President Pence and Senate Majority Leader Mitch McConnell (R-Ky.) intend to single out individual senators and escalate a broad defense of the evolving proposal, according to Republicans familiar with their plans.

When Trump returns from Europe, he plans to counter the nonpartisan Congressional Budget Office’s analysis of the legislation — which shows that 22 million fewer people would have insurance coverage by 2026 than under the current law — with figures and analyses from conservative groups and Republicans that show more benefits and less disruption, should the bill pass, according to a White House official familiar with the strategy.

There is one neutral, in-house scorekeeper, run at the moment by a Republican economist, who was hand-picked by Trump’s own health and human services secretary, and it found that Trumpcare will leave tens of millions of Americans uninsured relative to current law. The gainsaying of CBO’s findings with dressed-up right-wing propaganda is, like the Cruz amendment deceptions, an attempt to lie Trumpcare into law. To the extent that 50 Republican senators play up the false view that Trumpcare won’t leave millions of uninsured, citing bogus think tank “studies,” or hyping opioid slush fund dollars, or pretending their bill won’t gut pre-existing conditions protections, it is a sign that movement toward passage of the bill continues.

The good news is these last-ditch efforts to muscle the GOP health care bill into law are beginning to flag and work against each other. The same Post story notes that Senate Majority Leader Mitch McConnell will task Cruz himself with pitching his amendment to the rest of the GOP conference. It will be up to Cruz in some sense, then, to stop Republicans from breaking ranks. The Post notes that Alaska Senator Lisa Murkowski and Maine Senator Susan Collins have been in contact with Democrats “to see whether they might be more willing partners in fixing the health-care system.”

The importance of these developments can’t be overstated. Cruz is one of the most hated members of the Senate, even within the GOP conference. “If you killed Ted Cruz on the floor of the Senate,” Republican Lindsey Graham once said, “and the trial was in the Senate, nobody would convict you.” Cruz is the worst possible salesman for any piece of legislation, let alone a hideously unpopular one that will gut pre-existing conditions protections. If the linchpin of the Trumpcare blitz is the persuasive powers of Cruz, Obamacare supporters have something to celebrate.

Because if the Cruz amendment fails, and bipartisan backchannels expand, the process will freeze up. The hope is that a combination of Cruz’s toxicity, public pressure, and Democratic outreach will draw at least one more Republican into league with Collins and Murkowski. On Fox News Sunday, Republican Senator Bill Cassidy of Louisiana said the plan he drafted with Collins earlier this year—one that would leave the ACA’s taxes and coverage goals in place—“is the only way we can go forward.” On that basis, he could be the third apostate, but any Republican would do.

If at least three Republicans disappear into negotiations with Democrats over an Obamacare stabilization bill, ACA supporters will have succeeded in grinding the legislative machinery to a halt, and Trumpcare will be stuck in the cogs indefinitely. But to assume that such an outcome is inevitable is to underestimate the Republicans’ dedication to gutting Obamacare—or at least being able to claim that they did.