Mitch McConnell’s Obamacare Dilemma: Govern or Destroy?

The Senate majority leader wants to keep power. Throwing 20 million people off health insurance would probably hurt his chances—but the base doesn’t care about the repeal’s consequences. Which way will he go?

Photo Illustration by Elizabeth Brockway/The Daily Beast

NPR commissioned a poll this week showing that huge percentages of people know very little about the Affordable Care Act, a.k.a. Obamacare. Since it was passed, the survey asked people, has the ACA decreased or increased the number of uninsured? A plurality (49 percent) did give the correct answer of decreased, but even so, the combination of increased (24 percent), didn’t know (17) and stayed the same (10) beat the right answer out by 2 points.

In most of punditland, these numbers are taken as evidence that President Obama and his people did a terrible job of evangelizing the gospel. I say sure, they could have done better, but the lack of basic understanding of the law stems far more from the mis- and disinformation spread about it by its opponents from before the law even a bill. This begins (but by no means ends) with the very moniker Obamacare, which Republicans invented, not Democrats, and certainly did not intend as a compliment.

And now, is this the beginning of the end? Wednesday night, the Senate passed almost strictly along party lines (Republican Rand Paul joined Democrats) a budget resolution that greases the skids for ACA repeal. More specifically it instructs the body’s committees to begin taking up the work of repealing most chunks of the law. The House is going to take up the same resolution Friday and pass it quickly.

The politics of this can get really baroque and confusing, but it’s going to come down, I believe, to one simple question: Is the GOP as a party in power going to try to even pretend to be kind of responsible, or is it governed by its rabid extreme base that just wants to destroy all things Obama and doesn’t care anything about the consequences?

Here’s what I mean. Let’s start with the House. Obviously the House isn’t going to pretend anything. Oh, House Republicans will have to come up with some kind of fig-leaf replace language to try to say they’re not really throwing 20 million people off health care, but that isn’t what matters for them. For them, their very purpose in life is the destruction of this handiwork of Beelzebub. Paul Ryan is a total fanatic on the subject. And House Republicans are safe in their districts, by and large; it’s going to take months for constituents to realize that they lost their health coverage, and if Congressman X comes back to the district for a town-hall meeting in 10 months after having voted to take their insurance away and when confronted blames the whole thing on Obama again, 92 percent of the people in the room will believe him.

That’s the House—and the people who voted them in—these days. The House is so cocksure about its position that it passed a rule when this new Congress convened that will prevent the Congressional Budget Office from “scoring” whatever Obamacare repeal and/or replacement it passes. “Scoring” means estimating its impact on the deficit and such. Back in 2015, the CBO estimated that the repeal of the ACA proposed then by House Republicans would add to the deficit by $137 billion over 10 years. This by the way was after they had handpicked a CBO director to replace the earlier guy, who kept coming up with scores they didn’t like.

Now, House Republicans have found a beautiful solution to this whole problem. And it’s not, “Hmmm, let’s produce a more fiscally responsible plan so we get better scores.” It’s: “I know! Let’s just pass a rule to prevent the scorer from scoring!”

This brings us to the Senate, which is a somewhat trickier matter. Mitch McConnell is a man of very few actual political convictions. No restrictions on campaign spending is the only thing he really cares about, and maybe keeping unions at heel. His chief political conviction is keeping the word “Majority” in front of the word “Leader” in his title. He’ll do on Obamacare whatever he thinks will make that more likely to happen.

That could mean—especially with more than 400,000 Kentuckians at risk of losing their coverage gained under Obamacare—that McConnell will slow-walk the thing. He’ll see how Trump’s doing, the state of the economy. He’ll size up the 2018 races and figure out how many of his people seeking reelection need repeal and how many might be hurt by it (he’ll also make those calculations for the Democratic incumbents running). And he’ll do whatever he thinks will keep him in power.

Unless normal calculations on the matter of Obamacare prove impossible. It may just be that the small-ish but ideological intense base is so ravenous for repeal that McConnell won’t be permitted to act his normal cynical calculations.

Things are different for a party in power, which is why I put those words in italics up above. When you’re in the opposition, you can play to that base all you want. McConnell always had the comfort of knowing that whatever the Senate did or didn’t pass, Obama would veto it. He could say hey, we did our best, but we got blocked. There are no consequences for your actions.

But when you’re governing, there are consequences. The question is: does the base care? Or is ridding the nation of this scourge called Obamacare of such fundamental importance that consequences are irrelevant?

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That NPR asked people what should happen to the ACA. The biggest chunk, 38 percent, said keep it and expand it. Repeal and replace got 31 percent, and repeal only/the hell with it got 14 percent. This may be one of those times when, from where Ryan and McConnell are sitting, 14 is greater than 31.