Senate Health Care Debate: Continuing Coverage

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We’re still in the semi-dormant phase of the live blog, but a quick note on one of the many challenges the GOP will have to overcome over the next few days: the so-called “Byrd Rule.” Senate Majority Leader Mitch McConnell chose to use a process known as reconciliation to try to make good on the GOP’s seven-year promise to repeal and replace the ACA. The upside for the GOP is that it only needs 50 votes to pass (with Vice President Mike Pence as tiebreaker), so it can craft legislation that senators know won’t win any Democratic support. The downside is that the bill can include only provisions that change federal spending or revenue and whose budgetary effects are more than just “merely incidental” to a policy objective. If the Senate parliamentarian, the referee of sorts for the Senate’s complex rules, determines that a provision doesn’t comply with the Byrd Rule, then that provision needs 60 votes to pass.

The Senate parliamentarian just advised that a couple of proposed provisions don’t comply with those rules (this is in addition to an announcement she made last week — more on that in a second). One provision would allow insurers to charge older adults five times as much as they charge younger adults (insurers can currently charge only three times as much). The other would change regulations for small business health plans. The parliamentarian had already challenged several other provisions last week. Two are related to abortion — one would cut federal Medicaid funding to Planned Parenthood for a year and the other would prohibit federal subsidies from going to plans that cover abortions. But the parliamentarian also struck down a six-month waiting period for buying insurance that essentially would take the place of the individual mandate, in addition to a handful of other complicated but important provisions. These are some substantial roadblocks on an already bumpy path to repealing and replacing parts of the Affordable Care Act.

The Senate is now supposed to spend 20 hours, per its rules, debating health care. That’s 20 hours on the Senate floor, not in real time, so that will likely extend into Thursday or Friday. So this live blog will slow down until the action in the Senate heats back up (again, likely Thursday), although we’ll pop back in if there are important or interesting developments.

Once the 20 hours of debate is over, the Senate is expected to vote on a series of “amendments.” Some of these amendments are not really small changes, but entirely new bills, called “substitutes.”  Senate leaders are expected to vote on at least two substitutes for sure: the so-called full repeal legislation, which would repeal Obamacare but delay the replace for two years, creating a deadline for Congress to write new legislation. The Senate is also expected to vote on some version of the Better Care Reconciliation Act, the proposal for replacing Obamacare that McConnell has been writing. (This is the provision with the controversial cuts in Medicaid.)

Senators are also expected to make a number of other proposals through amendments. And another key factor to watch will be which provisions the Senate parliamentarian determines need 60 votes, because they don’t align with the rules for the reconciliation process that Senate Republicans are using right now.

Remember, a lot of the GOP senators today, such as John McCain, said they were voting to start a process but wanted to see changes to the underlying legislation. They may still vote for whatever bill party leadership comes up with. But Republicans still have to have 50 votes for something after these 20 hours pass.

Back in the Senate chamber, a bill that would repeal parts of the Affordable Care Act is being read in its entirety. A similar bill passed Congress in 2015 before being vetoed by President Barack Obama. This bill would repeal all of the taxes in the bill, eliminate subsidies to people buying health insurance on the private market, and end the Medicaid expansion that extended the program to everyone earning 138 percent of the federal poverty line (in states that chose to expand the program). It would also defund Planned Parenthood for a year. This is one of the bills that was going to be put to a vote last week before GOP Sens. Jerry Moran of Kansas and Mike Lee of Utah announced that they would not vote on a motion to proceed with the bill, and several other Republican senators have said they don’t support it. The Senate parliamentarian has also said the provision that would defund Planned Parenthood doesn’t conform with Senate rules and would need to come out.

Trump has been criticized for his role on health care — not knowing the details of the bill and seemingly not to help the legislative strategy. But he’s looking a little smarter now.

Remember how the president last week all but promised Nevada’s Dean Heller that Heller would lose his reelection campaign if he didn’t back this legislation? The senators in the room laughed but that seemed like a fairly direct threat from the president: Support this or the party won’t be supporting you in the future. Heller opted to vote “yes” on the motion to proceed. Appearing in West Virginia on the eve of the vote allowed the president to personally pressure Shelley Moore Capito, another swing vote on this legislation. Capito backed the motion as well. Trump overwhelmingly won in West Virginia in 2016.

Part of why McCain does what he does: There’s a generational and philosophical divide in how he’s covered by the press.

Among younger and less traditional reporters on Twitter — especially on the left but by no means exclusively so — a lot of people are pointing out McCain’s inconsistency in scolding McConnell’s process but nevertheless voting for the motion to proceed.

On CNN, however, the commentary about McCain’s speech was glowing. And the commentary has also been very warm in Twitter comments we’ve seen from older reporters at the major news networks and at newspapers like The Washington Post.

Longtime readers of FiveThirtyEight know that I have a lot of beefs with the establishment media. Moments like these, where they elevate style over substance, are a big part of why.

Vice President Mike Pence’s tie-breaking vote today was his fourth since taking office in January. His predecessor, Joe Biden, never cast a tie-breaking Senate vote.

Senate ties broken by vice presidents
VICE PRESIDENT FIRST YEAR OF TERM TIES BROKEN
John Adams 1789 29

John C. Calhoun 1825 28

George M. Dallas 1845 19

Schuyler Colfax 1869 17

Richard M. Johnson 1837 14

George Clinton 1805 12

John C. Breckinridge 1857 9

Dick Cheney 2001 8

Richard M. Nixon 1953 8

Alben W. Barkley 1949 8

Thomas R. Marshall 1913 8

George H.W. Bush 1981 7

Hannibal Hamlin 1861 7

William A. Wheeler 1877 6

Elbridge Gerry 1813 6

Mike Pence 2017 4

Al Gore 1993 4

Hubert H. Humphrey 1965 4

Henry A. Wallace 1941 4

James S. Sherman 1909 4

Levi P. Morton 1889 4

Martin Van Buren 1833 4

John Nance Garner 1933 3

Charles Curtis 1929 3

Chester A. Arthur 1881 3

Millard Fillmore 1849 3

Daniel D. Tompkins 1817 3

Aaron Burr 1801 3

Thomas Jefferson 1797 3

Spiro T. Agnew 1969 2

Charles G. Dawes 1925 2

Adlai E. Stevenson 1893 2

Walter Mondale 1977 1

Harry S. Truman 1945 1

Garret A. Hobart 1897 1

Henry Wilson 1873 1

Joe Biden 2009 0
Dan Quayle 1989 0
Nelson A. Rockefeller 1974 0
Gerald R. Ford 1973 0
Lyndon B. Johnson 1961 0
Calvin Coolidge 1921 0
Charles W. Fairbanks 1905 0
Theodore Roosevelt 1901 0
Thomas A. Hendricks 1885 0
Andrew Johnson 1865 0
William Rufus King 1853 0
John Tyler 1841 0

Source: Senate Historical Office

We’re all focused on health care, and with good reason. But the first question in Trump’s post-vote press conference was about Trump’s recent criticism of Attorney General Jeff Sessions. Trump didn’t say whether he would fire Sessions or call for him to resign, but he repeated his previous comments that he wouldn’t have appointed Sessions if he had known Sessions would recuse himself from the Russia investigation.

Heavens no, I don’t think McConnell is in danger. If they were so opposed to this process, they could make him use the committee process on this bill. They don’t care that much about regular order.

Clare stole my line. I agree. I don’t know if he is in any danger, but you’d need to find someone who could cobble together enough votes from either the left or the right. Does that exist?

I think all things are possible. Though my question is, who would step in?

Question for the group: Given McCain’s speech today and other recent griping from Republican senators, does anyone think McConnell in any danger as majority leader?

As Nate mentioned, we updated FiveThirtyEight’s Trump Score, which compares votes by members of Congress with Trump’s vote margin in their state or district — basically, how we would expect members to vote on bills if they voted in line with Trump’s 2016 performance in their state. By calculating the probability of each member’s vote, we can see which members’ positions on each vote are most surprising.

Here are the results of today’s motion to proceed on the health care bill, along with the predicted probability based on Trump’s vote in each senator’s state.

How Republican senators voted on the MTP
SENATOR STATE VOTE PREDICTED PROBABILITY TRUMP PLUS-MINUS
Gardner CO 24.11% +75.89
Heller NV 29.21% +70.79
Toomey PA 36.28% +63.72
Johnson WI 36.37% +63.63
Rubio FL 37.39% +62.61
Flake AZ 43.06% +56.94
McCain AZ 43.06% +56.94
Burr NC 43.33% +56.67
Tillis NC 43.33% +56.67
Isakson GA 47.05% +52.95
Perdue GA 47.05% +52.95
Portman OH 54.44% +45.56
Cornyn TX 56.59% +43.41
Cruz TX 56.59% +43.41
Ernst IA 57.59% +42.41
Grassley IA 57.59% +42.41
Graham SC 68.97% +31.03
Scott SC 68.97% +31.03
Sullivan AK 69.98% +30.02
Cochran MS 76.34% +23.66
Wicker MS 76.34% +23.66
Hatch UT 76.83% +23.17
Lee UT 76.83% +23.17
Blunt MO 77.87% +22.13
Young IN 78.84% +21.16
Cassidy LA 79.69% +20.31
Kennedy LA 79.69% +20.31
Daines MT 81.04% +18.96
Moran KS 81.35% +18.65
Roberts KS 81.35% +18.65
Fischer NE 87.87% +12.13
Sasse NE 87.87% +12.13
Alexander TN 89.03% +10.97
Corker TN 89.03% +10.97
Boozman AR 90.07% +9.93
Cotton AR 90.07% +9.93
Shelby AL 90.92% +9.08
Strange AL 90.92% +9.08
Rounds SD 92.85% +7.15
Thune SD 92.85% +7.15
McConnell KY 92.89% +7.11
Paul KY 92.89% +7.11
Crapo ID 94.39% +5.61
Risch ID 94.39% +5.61
Hoeven ND 96.68% +3.32
Inhofe OK 96.97% +3.03
Lankford OK 96.97% +3.03
Capito WV 98.74% +1.26
Barrasso WY 99.37% +0.63
Enzi WY 99.37% +0.63
Collins ME 28.05% -28.05
Murkowski AK 69.98% -69.98

Trump, at a news conference in the White House Rose Garden with the prime minister of Lebanon, praised McCain for returning to Washington and voting for the motion to proceed on health policy. McCain just a gave speech on the Senate floor full of shots at Trump and seems to strongly disapprove of the president’s foreign policy. So this is a moment where McCain’s general tendency to back the party led him right into being embraced by a president with whom he often disagrees.

In some ways, this vote matched an old pattern. While many have referred to McCain as a “maverick,” he’s actually had a fairly conservative voting record during his career. So his vote to proceed isn’t surprising from a historical perspective. Meanwhile, Collins, who voted against the motion to proceed, has voted against her party about 40 percent of the time on party-line votes during her Senate career. She is, from an ideological perspective, the true maverick of the Senate.

I have to say, this McCain speech is not soaring rhetoric. For those hoping for that, what we’ve gotten is an homage to the rules and traditions of the Senate, which have certainly corroded over the years, and McCain admits his part in all this. He also had a line about the need for senators not to listen to bombastic voices on the internet.

But it’s difficult to make a heartfelt speech about the importance of procedure when you’ve just voted “yes” to allow a very unusual Senate procedure happen. By the way, the general thrust of his stance still seems to be that he dislikes the health care bill.

We’ve added the motion to proceed vote to our Trump Score tracker. Collins, who voted against the bill, has a Trump Score of 84.1 percent, meaning that she’s voted with Trump 84.1 percent of the time, the lowest ratio of any Republican senator. Murkowski, the other “no” vote, has voted with Trump 90.7 percent of the time, tied for third least after Rand Paul.

McCain is unloading on the Senate process right now.

His surgery on his eye is visible. And he called the Senate the “most important job I’ve had in my life,” emphasizing that it is more significant than his military service.

But while McCain is giving a speech about returning comity and “humility” to the Senate, he just voted to proceed to a bill that didn’t go through regular order or the committee process.

“To hell with them,” McCain said of unnamed radio hosts. “Let’s return to regular order.”

One way you can tell this bill is not popular with the American public is how Democrats are voting. There wasn’t a single Democratic vote for the health insurance bill in the House, and there wasn’t a single Democrat who voted to proceed in the Senate. This includes many Senate Democrats who are in danger as they vie for re-election in 2018 — Democrats in states Trump easily won, including Joe Donnelly in Indiana, Heidi Heitkamp in North Dakota, Joe Manchin in West Virginia, Claire McCaskill in Missouri and Jon Tester in Montana. If the public polling is close to being correct, voting against the Republican health care bill could help their re-election bids.

So Democrats all waited to vote until Republicans were finished, adding to the drama. They’re voting as a group against the bill.

Also, the members are now all greeting McCain.

The motion to proceed has passed, but we don’t know what bill the Senate will be debating. Technically, it is the House bill, but what provisions they plan to include is still up in the air.

Looks like Johnson waited till McCain voted yes. That suggests to me that he didn’t want to kill the legislation personally, but might be a hard vote to get in subsequent votes.

McCain and Johnson just voted aye on the motion to proceed. The 48 Democrats and independents are expected to vote “no,” making for a 50-50 tie that will be broken in McConnell’s favor by Vice President Mike Pence.

We’re getting live shots now of McCain entering the Senate building. Looks like we’re pretty close to getting all the Republican votes in here — feels like a very dramatic last few minutes of a movie about … Senate votes. Imagine this with a staccato movie score and you’ve got the soundtrack to Senate reporters’ brains.

More on Ron Johnson. I have heard there is tension between him and McConnell because the party effectively wrote off Johnson in 2016, when he was running against a strong candidate (Russ Feingold, who had been the senator there before) in a state that everyone assumed Democrats would carry in a presidential year (Wisconsin). Trump won there, of course, but so did Johnson. This would be some revenge.

It appears that Johnson is a bit of a last-minute mystery vote here. He’s certainly been angry with McConnell of late. He recently told the Green Bay Press-Gazette that the way the leader was proceeding the health care bill was a “breach of trust.”

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