Deja vu: Four tea-party senators say they can't vote for new GOP health-care bill -- for now

Wasn’t there another example recently of a GOP health-care bill tanking because leadership couldn’t put enough on the table to attract conservative votes?

Meh. I think this is kabuki.

Sens. Ted Cruz (R-TX), Ron Johnson (R-WI), Mike Lee (R-UT), and Rand Paul (R-KY) issued the following statement Thursday responding to the release of the Better Care Reconciliation Act of 2017:

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.”

Cruz helped negotiate this deal and is up for reelection next year. He’s not going to be the 51st “no” vote on a bill backed by Trump. He might be the 52nd, but if it comes down to him, he’ll cave. Paul is a harder get but he and McConnell, the two senators from Kentucky, have coordinated for years. It’s hard to imagine Rand voting yes but it’s also hard to imagine him being the 51st vote that kills McConnell’s chances.

What’s really going on here? Partly, I think, this is a preemptive strike by the conservatives in the caucus to retain their bargaining leverage knowing that there are anxious moderate Republicans on the other side. Dean Heller, the most vulnerable Republican up for reelection next year, put out a statement of his own after the bill was released this morning:

“Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion. At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Governor Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. I will also post it to my website so that any Nevadans who wish to review it can do so. As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t.”

McConnell and Ryan will be under intense pressure to make the bill more salable to centrists before it lands on Trump’s desk and the conservative gang of four here know it. This is a shot across McConnell’s bow to not give too much to the Hellers and Murkowskis or else it’s game over.

That’s one possibility. The other possibility is that McConnell and Paul aren’t at cross purposes on this but rather are quietly coordinating, essentially playing a game of good cop/bad cop. McConnell may believe that compromise on health care within the caucus is impossible right now but there’s no way he can say that and declare defeat without at least putting something on the floor. So maybe he wrote the bill fully intending to make it unpalatable to the Rand/Ted wing of the caucus, knowing that Paul and Cruz can sell a “no” vote to their constituents if need be as a stand on principle. David Frum advanced the theory a few months ago that for all his talk about repeal and replace, Paul was actually following a strategy of “denounce and preserve”: He would badmouth the House health-care bill publicly, calling it a sellout of conservative principles that he could never support, knowing all the while that more than 400,000 people in his home state had gained coverage under ObamaCare. By opposing all Republican bills as weak tea, Paul could protect his conservative cred while also ensuring the continuation of O-Care in Kentucky. Maybe he and McConnell are up to something similar here. Mitch offers a replacement bill, Rand pronounces it a betrayal of the right, the bill goes down, both shrug and say “oh well,” and the Senate moves on to less challenging priorities.

Actually, as noted earlier, there’s a third possibility. Maybe McConnell deliberately left some conservative goodies out of the bill so that the Pauls and Cruzes can enjoy a “victory” this week by successfully amending it. The more their fingerprints are on it, the more likely they are to vote for it.

Here’s Rand noting that the new bill is very far from being a repeal of ObamaCare, which of course is correct. Big question for the gang of four here: Would they be willing to vote yes on a subpar bill purely for the sake of advancing the ball and getting to a conference committee with the House on health care? If they pass something and then the conference committee falls apart because they can’t reach a deal, both houses share blame. If they pass nothing, it’s all on McConnell and the Senate. Cruz has already floated an amendment that would improve a final bill’s chances of winning conservative votes in the House, but it’s not essential that that amendment pass now. It could always be introduced later in the conference committee. Again, that’s the central question — is this an earnest attempt to pass a bill that’ll replace ObamaCare or is it a matter of checking a box so that McConnell and his team can say “we tried” after the bill tanks?