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Repeal & Replace Watch

Podcast: What The Health? What A Week!

Clockwise from left, Julie Rovner of Kaiser Health News, Mary Agnes Carey of KHN, Joanne Kenen of Politico and Sarah Kliff of team up in KHN's studio to record the latest episode of “What the Health?” (Lynne Shallcross/KHN)

Here’s one thing both sides in the national health care debate might agree upon: It’s been dramatic.

The Senate effort to overhaul the Affordable Care Act nearly died and came back to life several times in recent weeks, culminating in the middle-of-the-night collapse on the Senate floor on Friday.

It could be perplexing even for political junkies: the intricate twists and turns, the arcane rules, the odd contention by some GOP senators that they were voting for a bill they ultimately didn’t want to pass. We asked experienced Washington health care journalists to try to make sense of it all.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of and Mary Agnes Carey of Kaiser Health News deconstruct the drama and discuss what may be the GOP’s next move on health care.

The transcript below has been condensed and edited for clarity.

ROVNER: So it appears the zombie health bill is dead, again, for now, which is not to say it won’t re-emerge at some point. But, in case you hadn’t heard or didn’t stay up until the wee hours watching C-SPAN 2 as we all did, the Senate [Friday] night failed to advance a last-ditch, stripped-down health bill. …. [A]fter realizing they couldn’t pass any of their more comprehensive proposals, Senate Republican leaders hoped they could cobble together something, anything, that would at least get them into negotiations with the House. But it was not to be. Arizona Republican Sen. John McCain, who surprisingly returned after his brain cancer diagnosis and voted to launch the debate, then turned around and basically ended it, joining holdouts Susan Collins of Maine and Lisa Murkowski of Alaska in denying Republicans the 50 votes they needed.

So let’s try to reconstruct the week a little bit, shall we? When we left off last [time] … the bill looked pretty dead. How did it temporarily come back to life?

KENEN:  It looked really dead. … [But] McCain came back. They twisted some arms … some of the undecideds. I mean, McConnell’s pitch to them was, “I’m not asking you to vote for final passage right now. I’m just asking you to vote to get [the bill]  to the floor so we can debate it … and you can change it and we can discuss it. But get it off the floor. Otherwise we’re leaving Obamacare intact.” And he squeaked through with that message … including with McCain’s dramatic — but not as dramatic as later —  appearance. Welcome back to Washington!

KLIFF: It really was a fraught process from the start. … We figured, you know, if we got the vote to debate it, the votes to at least pass it, it would have succeeded. But there are a lot of … senators who got cold feet at the last minute who were never enthusiastic about this particular bill or the Health Care Freedom Act or “skinny bill,” as it has [variously] been called. One of the bizarre dynamics that began to develop … senators were saying we will only vote for this bill if the House promises not to pass it. … It seemed crazy and it turns out it was a little too crazy — that they could not pass a bill they did not want the other chamber to pass.

CAREY: It was just an amazing day of twists and turns. … [T]hat amazing press conference about 5:15 [p.m.] with [Sens.] McCain, Ron Johnson [of Wisconsin],  Lindsey Graham [of South Carolina] and I think Bill Cassidy [of Louisiana] came later basically saying, “[House] Speaker [Paul] Ryan, will you promise us that you’ll have a conference, a real conference, otherwise we’re not going to vote for this.” Ryan put out his statement. For three folks it was enough. John McCain said it wasn’t. It was just an amazing … this idea we’ll pass this piece of legislation as long as you promise it doesn’t become law.

KENEN: You know, “We can’t kill it because we’ll get in trouble. So can you kill it for us.” Yeah, that’s basically what happened. And then McCain killed it.

ROVNER: … Let’s talk a little bit about what was in that skinny bill …

KLIFF: So this bill had a very short life and death, introduced around 10 p.m. on Thursday, voted down around 1:30 a.m. on Friday. We got inklings throughout the week of what would be in it. It would focus on an individual mandate repeal, [there were] reports that it might repeal that medical device tax [and] it turns out it repealed that for three years [and] defunded Planned Parenthood for one year. But this is a bill we just did not have much time with. … And it is a bill that [the Congressional Budget Office] estimated would cause 16 million Americans to lose coverage — a lot of that as a result of getting rid of the individual mandate. CBO expects that the individual market would see people quit. Premiums would rise by 20 percent as healthy people exit the market [and] sicker people stick around. They also expect … that Medicaid enrollment would decline as well, as Americans got the message that you don’t need to purchase coverage. … And one of the kind of interesting things to watch was both Democrats and Republicans agreed this was bad policy. They agreed that this would be bad for the individual market. Lindsey Graham in that press conference we talked about, he said something along the lines of, “Well we know this bill would be a policy disaster.”

Then [he] made the case they have to pass it to continue the debate, but it was not like Republicans were offering this defense of “Here’s why this is a good bill and this is good policy.” Everyone agreed: If that became law it would be a very bad situation.

ROVNER: So why did McConnell proceed with this when he didn’t know he had the votes? Was this a show-me-the-body vote, where he had to prove that they couldn’t do it?

CAREY: I think, yes, he did definitely check the box that they had the vote on it, and secondly, sometimes when you put that bill on the floor, you put pressure on folks to flip their votes and go the way you want. … We talked about John McCain — let’s not forget about Susan Collins and Lisa Murkowski who you mentioned in your intro. Those ladies paved the way for this. They held firm. They got pressured from the White House, Murkowski in particular. So I think that he just wanted to push it. … But let’s not forget … just because it’s off the calendar now doesn’t mean it may not come back at some other point.

ROVNER: And I don’t want to gloss over this Lisa Murkowski thing. … Like I’ve said in a number of interviews, I’ve been doing this 30 years. I have never seen a week like this. But the Secretary of the Interior [Ryan Zinke] basically threatened Lisa Murkowski.

KLIFF: But it felt like they were threatening the wrong person. I think one of the reasons Murkowski has been able to stand so strong in this, and Collins — these are not the type of Republican senators who rely on the national party infrastructure, who need help fundraising, who need help with name recognition. …

… Collins is an institution in Maine. … These are not senators … like [Nevada’s] Dean Heller, for example, [a] new senator trying to show who he is … trying to work very closely with his governor. These are independent senators. And it … kind of seemed like a massive miscalculation for the Trump administration to call up Lisa Murkowski and say, “Watch out, we might retaliate against Alaska.”

ROVNER: She is the budget chairman of both the [Senate] Appropriations Subcommittee [on the Interior and the Environment] and the authorizing committee.

KENEN: But you know there’s the things that the administration can do. The administration can do big damaging things, they can do little erosion things. … They’re already doing that. … You could also do things to stabilize [the insurance market] … if the administration does things that really damage Obamacare … the voters aren’t really going to understand who did what, they’re just going to say, “Oh it imploded.” … I mean there’s multiple, multiple, multiple paths they can go [down]. … Each path has several paths, so none of us are ever going to be unemployed.

ROVNER: What are the chances that any of you think that this comes back to life this calendar year?

CAREY: I think it very well could. … Republicans ran on this in several elections. They’ve talked about it incessantly. And we have to remember [that] when Paul Ryan [pulled the House bill and] said, ”For the foreseeable future, Obamacare is the law of the land,” [the House] came back two months later and passed something. So it’s not over.

KENEN: It also depends on whether they get their act together on taxes. Because right now, they don’t. Once they move on to taxes, this reconciliation budget framework ceases to exist. … If they don’t have their act together on taxes, they don’t really want to draw attention to that. So you may still see some health care things happening. And then there’s also health care through the appropriations process. There’s health care legislation that could [be] put on other bills such as the Children’s Health Insurance Program that has to be renewed in September. There are other ways that we will be seeing health, whether it is in this form or another form. Obamacare does not suddenly become something that Congress ignores and forgets about tomorrow morning.

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This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.