House Republican leaders scrambling to buck up wavering members had portrayed the vote as the only shot to eliminate the GOP’s longtime boogeyman — and as an essential show of support for President Donald Trump.
But in fact, they have several options to salvage the repeal effort after they couldn’t muster 215 votes on Thursday. Here are a half dozen:
Delay the vote longer
The most straightforward thing is for leaders to punt. The vote has already been delayed at least until Friday and it could be put off longer.
A delay isn’t necessarily costly, beyond the bad optics and robbing the GOP of the opportunity to strike a blow against Obamacare on the seventh anniversary of its passage. A postponement could buy Speaker Paul Ryan and the Trump administration some breathing room if they think they’re close to a deal with the two dozen or so House Freedom Caucus members still opposed to the bill — or with some moderates who could still be swayed into the “yes” column.
The caucus chairman, Mark Meadows, hinted Thursday that a compromise could still be in reach, even as the group continues pushing to scrap additional Obamacare insurance regulations in its zeal to repeal the entire law.
“We’ve made very reasonable requests and we’re hopeful that those reasonable requests will be listened to and ultimately agreed to,” Meadows said Thursday. “I hope we’ll negotiate in good faith and get to a vote by 7 p.m. today.”
Keep changing the bill
House Republicans swore they were done rewriting the repeal bill to buy off holdouts earlier this week. But they could open the process back up to eliminate Obamacare’s provision requiring health plans to cover minimum benefits — a concession aimed at winning over members on the right.
Doing so could encourage the Freedom Caucus to press for even bigger concessions — say, stripping out additional consumer protections, including the hugely popular one requiring insurers to cover individuals with preexisting conditions.
Overhauling the bill would be a risky play, both politically and procedurally. Moving the bill further right would further alienate the 50 or so members of the centrist Tuesday Group, already rattled about the prospect of leaving millions more Americans uninsured. Roughly a dozen more moderate lawmakers have already committed to opposing the bill.
And then, there’s the Senate’s pesky Byrd rule, which limits what Republicans can stuff into a reconciliation bill and still comply with that chamber’s tough procedural requirements. GOP leaders warn they can’t kill more of Obamacare without violating those standards and sacrificing their chance to pass repeal with a simple majority. Even stripping out the essential health benefits might not make it past the Senate’s parliamentarian, who makes the ultimate call on whether a provision is permissible.
“Senate Democrats were told in 2010 they couldn’t amend essential benefits or insurance regulations in reconciliation,” said Edward Lorenzen, a senior adviser at the Center for a Responsible Federal Budget.
Even if such changes make it through, there’s no guarantee they’ll survive on the Senate floor. Democrats have pledged to challenge every provision they think might violate the Byrd rule in a bid to force Republicans to remove it from the legislation.
“They’ve been told it’s not going to be fatal,” Lorenzen said of Republicans’ plan to strip out Obamacare’s essential health benefits. “I think it’s much less clear whether it would survive a Byrd rule challenge.”
Force a showdown
Nothing focuses the mind more than a pressure-packed vote. Especially a lengthy one. Republican leaders could exercise the ultimate power play on their unruly members and call for a vote, betting enough of the wavering lawmakers will crumble. The high-stakes move would force the naysayers to back up their bluster or risk being seen as an impediment to the president’s first-term agenda.
“This is the most important vote we’ll ever cast,” Chris Collins (R-N.Y.) said. “If this goes down, we don’t get tax reform — we can’t move forward. We don’t get infrastructure. We got nothing.”
The White House is delivering the same message, threatening skeptics with the prospect of a primary challenge in 2018. And key Republican leaders are confident that pressure will eventually weaken the holdouts. Old-timers recall the 2003 vote on the Medicare prescription drug benefit, during which leaders held open the vote for almost three hours while a whip team blocked all the exits from the House floor until they had twisted enough arms.
The problem is that there’s no readily available fallback plan if the leaders fail. And it would be difficult to reestablish credibility to push other pieces of Trump’s agenda after a humiliating loss.
Admit failure, go back to the drawing board
Tweaking the repeal bill to please both Republican moderates and conservatives could well prove too difficult a needle to thread — especially as the needle seems to keep moving. If that’s the case, GOP leaders may end up swallowing their pride and scrapping the legislation altogether.
That dramatic decision would effectively restart the legislative sausage-making and raise the prospect of a smaller, more manageable bill that could win broader support in both chambers — even if it doesn’t accomplish everything Republicans hoped.
The upside of that approach is it allows the GOP to move on to tax reform and other agenda items without totally blowing past the repeal of Obamacare. But it’s unclear whether that strategy would sit well with recalcitrant conservatives and their supporters. And it would almost certainly become a midterm campaign issue since Republicans have been promising voters to scrap Obamacare for so many years.
Do something bipartisan
This is, admittedly, the least likely option. But for years, Democrats said they’d be willing to work on bipartisan fixes to Obamacare. If the reconciliation route fails, Republicans could call them on that.
Yet the debate over the repeal bill is the latest sign that Republicans and Democrats are miles apart on health care, and there’s little indication the two parties can bridge that gap anytime soon. In a floor speech Thursday, Lloyd Doggett (D-Texas) trashed Republicans’ work on health care, calling their efforts not just a “crumbling and destruction of health care, but also a crumbling of our democracy.”
Do nothing and blame the Democrats
Trump said it himself just weeks ago: “I say to Republicans, if you really want to do something good, don’t do anything. … Let it be a disaster.”
Republicans could shelve their quest to overhaul the health care system, hope Obamacare premiums keep spiking and insurers keep fleeing marketplaces and bet they won’t pay the political price in 2018. Trump has already expressed his misgivings about taking ownership of health reform, and privately assured conservative groups that he can pin the whole mess on Democrats if the repeal effort fails.
That’d be a big gamble; Republicans would be giving up on reforming a system they’ve railed against for years. But if the GOP tries and fails to get legislation through the House, it may start to look like the best of their bad options.
Jennifer Haberkorn and Paul Demko contributed to this report.
Powered by WPeMatico