Wednesday, June 28, 2017

Not so easy when you can't obstruct


Mitch McConnell was considered a masterful parliamentary tactician when all he had to do was obstruct the black guy. It was easy to get his caucus to agree to that in whatever form he offered. Now that he actually has to produce something, in this case repeal and 'replace' Obamacare, he finds that not all his choir are singing from the same page.
Senator Mitch McConnell of Kentucky, the majority leader, has long enjoyed a reputation as a master tactician. But when it comes to repealing the Affordable Care Act, he seems to have miscalculated in the first round of play.

He assumed that his conservative and moderate colleagues would come together to make good on their seven-year promise to repeal the health care law, and quickly.

But when he assembled a group of senators to cobble together a health care bill last month, he seemed to go out of his way to exclude some of the most knowledgeable members and moderate voices on health care, like Senators Bill Cassidy of Louisiana, a doctor, and Susan Collins of Maine, an insurance expert and one of the few women in the Senate Republican conference. Views outside of Mr. McConnell’s on health care did not receive extensive consideration.

When Republicans from states that had expanded their Medicaid programs quickly found themselves at odds with more conservative members who wanted a large rollback of Medicaid, Mr. McConnell did little to allay those worries. Conservatives generally wanted to rein in costs while moderate members wanted to increase spending, particularly in states where health care costs are high and opioid addiction is escalating.

On those key issues, Mr. McConnell put his legislative thumb on the scale in favor of conservatives, quickly alienating many senators from states that had expanded Medicaid, such as Senator Lisa Murkowski of Alaska, as well as Ms. Collins, who became an early and vocal opponent of the bill.

Ms. Murkowski raised concerns on several levels. She expressed worries about soaring health care costs in rural areas, about women’s access to health care if Planned Parenthood were defunded, and about how the most vulnerable citizens, such as Alaska Natives, would get health care. Those concerns were largely unanswered.

Conservatives point out that, compared with the House bill, the Senate bill delayed the phaseout of the expansion of Medicaid as detailed in the Affordable Care Act, and that preserving protections for patients with pre-existing conditions was something that moderates wanted. But over all, the bill was similar to the House version in broad strokes that moderates disliked, and conservatives won out on the key issue of reining in the growth of Medicaid in the long term.

Mr. McConnell may have been betting that pressure from a majority of Republicans — who have been promising for the better part of a decade to unravel President Barack Obama’s signature domestic policy achievement — would get senators from Medicaid expansion states on board to do just that.

But the forces arrayed against Mr. McConnell were many, including doctors and hospitals, patient advocacy groups and, perhaps more than anyone else, governors — many of them Republicans — from states where tens of thousands of residents have found themselves newly insured under the health care law and are not eager to see that evaporate.

“There may be some philosophical, you know, kind of textbook disagreement,” Gov. John R. Kasich, Republican of Ohio, said at a news conference in Washington on Tuesday. “But when you sit in a room and you say to people, ‘Should we strip coverage from somebody who’s mentally ill?’ I’ve never heard anybody say yes.”
They could all agree on what they didn't want, but when it came to what they did want they were all over the map and The Great Mitch hadn't bothered to get his ducks in a row before he brought forth his magnum opus. Now he has to see if he can buy everybody's agreement to get his dog's breakfast passed, his reputation in tattered shreds.

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