The NPR Politics Podcast - McCain Deals Death Blow To Republican Health Care Efforts

Episode Date: July 28, 2017

In a moment of drama, Senator McCain bucked his party's leadership and voted against the "skinny repeal" of the Affordable Care Act. This episode: Host/White House correspondent Tamara Keith, congressional correspondent Susan Davis and political editor Domenico Montanaro. Email the show at [e-mail]. Find and support your local public radio station at npr.org/stations.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Yo, yo, yo, everybody. It's Stretch Armstrong. And my name is Bobbito Garcia, aka CoolBobLove. If you love this podcast you are listening to, you should check out our new show, What's Good with Stretch and Bobbito. This is not your average interview show. We're going to be telling stories that you're not going to hear anywhere else. Find it on Apple Podcasts, the NPR One app, or however you find your podcasts. It's What's Good.

This is Austin Baker from Georgetown, Texas. This podcast was recorded at 1 23 p.m. on Friday, July 28th. Things may have changed by the time you listen. Keep up with all of NPR's political coverage at NPR.org, the NPR One app, and on your local public radio station. All right, here's the show. It's the NPR Politics Podcast, here to talk about the most dramatic night on Capitol Hill in years. Republican efforts to repeal and replace the Affordable Care Act had been on life support. They now appear to have flatlined. I'm Tamara Keith. I cover the White House for NPR. I'm Susan Davis. I cover Congress. And I'm Domenico Montanaro, political editor. Wow. So it does not get much more dramatic than what happened at 129 this morning.

Senator John McCain walked up to the well of the Senate and with a single word, no, killed Senate Republicans' efforts to repeal and replace the Affordable Care Act. Republican Senators Susan Collins and Lisa Murkowski had already voted no. Are there any members in the chamber wishing to change their vote? If not, the ayes are 49, the nays are 51. The motion is not agreed to. The amendment is not agreed to. All right.

So, Sue, you were there in the Senate chamber watching this as it happened. And there were these audible gasps when John McCain came up and did that thumbs down. There was a lot of anticipation around McCain's vote. And it probably had started building for even 20 minutes or so prior to the vote, because before they were in this vote, they were in another procedural vote. It was a Democratic vote. But the vote was over. Every Senate vote had been cast, and the majority leader, Mitch McConnell, was keeping that vote open. And the one thing you have to know about Congress is when they have the votes, they vote. When they don't have the votes, they talk. So they had been keeping this other vote open probably for 15, 20 minutes. And that's when the press galleries and the people covering this started the what's

going on, what's happening. And then because of the, you know, the deduction we had all gone through over the course of the evening, other holdout senators like Rob Portman of Ohio, like Lindsey Graham of South Carolina, had all come out and said they were going to vote yes. So we knew McCain was the big question mark. And again, we already presumed that Lisa Murkowski and Susan Collins would vote no. And so McCain became the decisive vote. And inside the gallery, or, you know, the press sits when you're watching C-SPAN, where you see the person sitting at the, what would you call that, at the head of the chamber? The presiding officer. The press are all right above that. You never see that on C-SPAN, but we're like in the stands behind that desk. And we're all watching the scene play out. And when McCain comes onto the floor, you know, he's talking to the majority

leader, Mitch McConnell. Vice President Mike Pence has come to Capitol Hill. He's on the floor talking to McCain. That's usually not really happening unless you're trying to ask someone for a vote. You don't need to do that when you know people are going to vote yes. Then at one point, McCain goes over and starts talking to Chuck Schumer and about 12 or 15 Democrats come and huddle around them really quickly. And we can't see what they're saying, but we're like leaning over trying to pick up any sense of body language. And then Dianne Feinstein hugs mccain she puts her arms around him and hugs him and we're like oh god something's happening here

and then within a couple of minutes mccain walks over to the vote talliers and he lifts his hand up and then we're all watched like literally everyone is watching mccain and he just points down and says no and then you heard heard, including myself, people just went, ah! For a second it sounded like some Democrats may have started to applaud. And Chuck Schumer, who's the minority leader, very quickly put his hand up, sort of signaling, don't celebrate this. Be respectful. There's an element where they don't want them to be gloating on the floor. This isn't, don't consider this you know like be respectful there's an element where they don't want them to be like gloating on the floor this isn't don't consider this like a political victory let this

moment just be and then everybody kind of quieted down and then because the senate rules you can't have your iphones you can't have laptops you can't have any electronic devices in there so you immediately had this like rush of reporters like out of my way because Collins and Murkowski had already cast no's at this point. Once they had gone into the vote, we were waiting on McCain. And when he went no, that meant they had three. They meant they didn't have the votes. So there was this like cascade of reporters out of the galleries to file and call their editors and tweet and do whatever. And that was it. And it was dramatic when you think that John McCain came back to Washington this week and was a critical vote.

Yes. So they could get on this bill. He saved health care on Tuesday. Yeah. And then he was essentially, you know, the vote that killed it by Friday. It was unbelievable. I mean, that moment where he comes out and he puts his hand up and he just sort of lets it linger there for a little bit. And Mitch McConnell is only feet away from him. Just staring, just staring him down, sort of like, I know what you're going to do. Don't do it. Don't do it. And then he did. And, you know, it's one of those things, you know, a lot of people talk about John McCain, the maverick. Right. And, you know, there's always some like mythology around some of these nicknames and like whether or not somebody is a maverick or not,

because if you look at McCain's voting record, I mean, it is very conservative. It's not like he, you know, is a 50 50 guy on a lot of stuff. But what he is is unpredictable. And you're just never quite sure where he's going to go with certain things. And, you know, usually most of the time, John McCain is like, I speak truth to power and then I vote with my party. True. And this was a moment where he absolutely bucked his party. You know, McCain has been a thorn in the side of the Republican Party over the years, over earmarks, over federal spending. You know, that that was a big fight for a long time that people don't remember that he drove leadership crazy over. Campaign finance, you know, that was a John McCain-led effort in the early 2000s. And his chief opponent on that was Mitch McConnell.

They fought, you know, philosophically and dramatically and up to the Supreme Court over campaign finance. So his willingness to pick a fight with his party on big issues is something he has done throughout the course of his career. You just never know which fight he's going to pick. Yeah, he's he's kind of ornery. He will dig in and speak out on certain things. And, you know, the campaign finance stuff comes back to where he was involved in the Keating Savings and Loans scandal back in the late 1980s. And he had this sort of breakthrough ethical moment where he knew it was a black guy.

He admitted that what he did was wrong. And he wound up going through with the bipartisan campaign finance reform act with a Democrat, Russ Feingold, which was, like Sue says, something McConnell could not stand. coincidence that McConnell named the first version of the Senate health care bill the Better Care Reconciliation Act, a.k.a. BICRA, which is the same name as that other one. Let's just go backwards just a tiny bit to what they were actually voting on, which was called the Skinny Repeal. Skinny Repeal was the nickname that was given to what was the third and final proposal from Senate Republican leaders on what they could vote for. So they had already voted down the bigger repeal and replace, the thing that Mitch McConnell had been working on for several

weeks and other Republicans behind closed doors. The BICRA, the Better Care Reconciliation Act. Better Care Reconciliation Act, which was the Senate version of the House bill. It failed. It failed. They voted that down. They voted down another proposal that was popular with conservatives that was just repeal. It would repeal Obamacare with a two-year delay and give Congress time to find something to replace it with. That also went down. So this was McConnell's way of saying, OK, let me find the least common denominators of policies that we say we agree with to give ourselves a vehicle just to go to conference. This was like the Hail Mary. This was like, we just need a win. Give us something.

Let us get out of here. But it is it was a pitch which is so unusual. And this is very important. This debate is how it came together. The process in this is unlike anything I've ever covered, where leadership was also telling its senators, vote for just vote on something and then we can go into what is known as a conference committee with the House, which had passed its own version of the legislation in May. We'll live to fight another day. We'll try to come up with a final solution. You can be a no on the final bill, but you can't be a no on this vote. This is just a process vote, just a process vote. We're just moving the ball forward. That wasn't good enough. And there was a lot of senators early Thursday who were saying this wasn't good enough. And there was a lot of senators early Thursday who were saying this wasn't good enough, where it required McConnell to make assurances to them

it would go to conference. Paul Ryan put out a statement saying, I'm willing to go to conference on this. He met privately with senators, including Lindsey Graham and John McCain, to say, it's my commitment to you to go to conference on this and try and get a better deal. Clearly, it wasn't good enough. There were a lot of senators who had concerns about this bill. They did not like it. They didn't think it was good policy. You had Lindsey Graham come out and say it was a sham or a fraud and then still was going to vote for it because of these assurances that he's supposedly gotten in private from Paul Ryan that wouldn't be brought to the House floor and then made law, basically. But what McCain basically did

was give cover for a lot of those senators, you know, half a dozen to a dozen senators who might not wanted to have to buck Mitch McConnell, but McCain was willing to do so. And, you know, it's not just about McConnell. This is like a bunch of senators, Donald Trump, who don't want to buck the president, who don't want to be on the record voting to kill the repeal of Obamacare. And his speech that he had given on the Senate floor talked about regular order and bringing up his own feelings of what he felt he had done wrong in his career. We've all played some role in it. Certainly I have. Sometimes I've let my passion rule my reason. Sometimes I made it harder to find common ground because of something harsh I said to a colleague. Sometimes I wanted to win more for the sake of winning

than to achieve a contested policy. Incremental progress, compromises that each side criticized but also accept, just plain muddling through to chip away at problems and keep our enemies from doing their worst isn't glamorous or exciting. It doesn't feel like a political triumph, but it's usually the most we can expect from our system of government operating in a country as diverse and quarrelsome and free as ours. And then I think there was probably a moment of conscience for him where he said, do I vote on something I don't really agree with in this situation where I don't feel like this was the way the process should have gone.

Earlier in the day on Thursday, he and some other senators held a press conference. And at that press conference, he sort of made made his argument on this. When we passed Obamacare in 2009, it split us. It split us dramatically and it split us for years. It's time we sat down together and came up with a piece of legislation that addresses this issue. You know, we tried to talk to McCain after the vote late last night or early this morning. I get confused. I get confused when we vote on this morning. Early Friday morning. He left the Capitol really quickly. He said he didn't want to talk. He said, I'm not going to talk through my reasoning right now. But he did put out a statement and essentially echoed that, that he said that this is the wrong way to do something this complicated

and that the health care issues that need to be resolved should go through regular order, which means it should start in the committee process. It should have some minority party buy-in and we should work it up from the bottom up, not from the top down, from the leadership down, telling us how we have to vote. One of the things I think is so interesting when you're talking about the leadership trying to assure McCain and other wary senators, he also spoke to the president on the phone prior to voting no, is I think that it also highlights that there is some element of a trust deficit in the Republican Party,

that the House and Senate leaders saying, we promise you something won't happen. And a president saying, come on, get on board. And you don't believe them. And I think that there was a lot of Republicans and others voiced this, but I think they were more willing to trust McConnell and vote yes. There was no guarantee that the House wouldn't take up this skinny repeal bill and ultimately vote on it. And that really, really, really concerned a significant number of Republican senators. I think most of them showed they were willing to trust McConnell and the speaker, that they wouldn't let that happen.

I'm not sure John McCain had that same level of trust. So after the vote happens and it's over and it's done, Mitch McConnell, the majority leader, gets up and gives a speech. He's very deliberative. He's slow. He seems genuinely upset about how this all went down. This is a disappointment. A disappointment indeed. Our friends over in the House, we thank them as well. I regret that our efforts were simply not enough this time. He also made a comment at the end that said, and I look forward to hearing ideas from our friends across the aisle over how to fix health care, which is sort of that subtle McConnell way of saying the next option is the one I warned you about. If we can't do it on our own, we have to work with Chuck Schumer, who's the minority leader from New York.

Because he basically played out every possible trick in the book to get the process where it got to. Because this bill was considered – this bill, whatever – this process had been considered dead several times. And one time very publicly over the last couple of weeks, McConnell wound up, remember, keeping the Senate in session when they were going to go home for the summer. And they felt like this was the one last procedural trick in the book. And you just sort of saw the wheels spinning for McConnell as he's giving this speech, almost thinking, what now? Like, what can I put forward to even think about how to keep this alive? And you could tell he was sort of out of tricks. President Trump put out a statement on Twitter.

At 2.25 a.m. Indeed, it was 2.25 a.m., about an hour after the vote failed. He says three Republicans and 48 Democrats let the American people down. As I said from the beginning, let Obamacare implode, then deal. Watch! Exclamation point. And we should say, by the way, just a small fact check on that and on us sometimes, because there were actually two independents who caucused with the Democrats, 46 Democrats or described as Democrats, as well as these three Republicans. Right. And then two independents who caucused with Democrats, one of whom maybe ran for president as a Democrat just last year. What's that guy's name?

Bernie something. Something like that. So we've all watched movies with zombies or giant man-eating sharks or whatever where- I try not to. Where it seems like the movie is over. And then all of a sudden, Jaws is actually still alive and he's eating people. So here's the question. Is the movie over on repeal and replace?

Or is this like one of those plot twists where the happy music starts and then dun-dun-dun-dun-dun? I think rhetorically, you're never going to hear Republicans say this is over. Already, you've heard Republicans in both the House and Senate say we're going to keep fighting. We're never going to give up. You know, admitting defeat is not really something that you're going to hear them talk about. But this was a big deal. This was a huge failure. And, you know, one of the senators I talked to after the vote last night was Ted Cruz, who is one of those Republicans who won his seat in Congress being a very strong advocate for repealing the Affordable Care Act or Obamacare. And he said, I'm afraid tonight that many Americans are going to feel betrayed by us. And those feelings are not unjustified. If you stand up and campaign and say we're going to repeal Obamacare and you vote for Obamacare, those are not consistent.

And the American people are entirely justified in saying any politician who told me that and voted the other way didn't tell me the truth. I mean, there is a profound concern among Republicans that this failure is not only going to hamstring their ability to get anything else done this Congress, but it's really going to hurt them in the next year's midterm elections. I know that you've talked to Republicans who say it's not about whether or not they got kept this promise or whether it gets in the way of other things, but like for their voters who this really, really matters to this could this could depress turnout. This could this could turn people off. This could make them just lose the lose the passion. And this is like just the, there's the policy calculation and the political calculation.

And this is just a pure political calculation that, to the question of, does the Republican Party keep its promises? Can the Republican Party govern? Do they do the things that they say they're going to do? This was a terrible failure on all those fronts. Now, you could find other Republicans who will say, maybe failure isn't such a bad idea. If we were, if the option was passing a law that people might like even less. I will only just tell you and I don't know what the answer is. Maybe failing on this helps them in next year's midterms.

Right. I'm hesitant. I'm hesitant to make any projections about what it means. But I will tell you that to the member, Republicans I talked to have consistently said they were more concerned about the repercussions of failure than the repercussions of action. And a lot of that is because, as we know, we've been covering for so long that the Republican base wanted something done about Obamacare. motivating, single motivating issue when it came to Republicans taking over the House in 2010 and all of the rank and file enthusiasm in all of the elections that have led to Republicans being able to take back the Senate, take back the White House. This was the one galvanizing issue, and they've failed to do it. They have the House. They have the Senate. They have the White House. And even I mean, yes, the math is pretty tight in the Senate and it wasn't going to be easy. But they didn't. They couldn't. They haven't done it.

President Trump, as we speak, has has arrived in New Jersey for an event unrelated to health care. Reporters shouted out a question about the health care bill because aside from the tweets, he hasn't really weighed in. And he said it's going to be fine. Now, I don't know what that means. I don't know what aspect of it is going to be fine or whether he thinks that they will ultimately get a bill. But Sue, where does this go from here? Like what happens with health care? I think in the short term, health care gets pushed to the side in Congress in terms of the agenda. Very quickly, Republicans immediately, even last night and today, are already pivoting to their next big priority, which is rewriting the tax code.

I don't think that this failure should start that journey with much encouragement. I think this failure has highlighted the many, many challenges the party has in trying to govern. On health care, there's three things that I'm thinking about. One, if there is some sort of acknowledgement that Congress is no longer going to try to repeal the Affordable Care Act or is unable to, that could have into itself a stabilizing effect on the market. Part of why there's been so much uncertainty is there is a view that this administration could undo the law. So insurance companies are trying to set rates and set premiums. Just inaction can be a stabilizing effect on markets when it comes to what Washington does.

Two, we're going to have another fight this fall over something people are going to start to hear a lot about, which is CSRs or cost sharing reductions, which is money that the federal government pays out to help people pay for insurance. Democrats think one way to stabilize those markets is to spend more money. And that is that is when they say, well, what how do you fix this problem? Usually the problem, the answer in Washington is more money. Throw money. So that's why there's an answer. But it's not an easy one, because I don't think I think you can anticipate that Republicans aren't excited. And on a month to month basis, the Trump administration has been saying, OK, we'll pay those. We'll make those payments this month. Yeah, we'll make those payments next month. But they haven't given any long term certainty to the insurance companies that sort of rely on those payments to and to the consumers.

So there hasn't been any. When you talk about stability, there's been a lot of uncertainty on that. And what does the Trump administration do? Do they now take moves to give confidence these markets? Oh, we're going to fund these payments. Don't worry. Everything's going to be fine, as the president said today. And then the third question I have, which is not a question for Congress, but is a question is, do more states opt to take the Medicaid expansion. If governors who have resisted it because they thought people were going to Washington was going to change the law. Do states now say, hey, if this is the law of the land, I want in on this in this pot of money and this help from the federal government? I think that Sue hits an exactly right point, because the fact is, if the Trump administration decides that it's going to dig in and undercut the law itself, it can do that. I mean, if it decides not to pay those subsidies or if it decides not to enforce the mandate, for example, that really could undercut the law. So does it move on from that posture and wind up doing all

the things to keep the law afloat while then trying to work with Democrats on the other side to try to make fixes? Then you could see something moving forward. But if they decide not to do that, you could wind up having more of those gears grinding against each other. Beyond health care, Republicans in Congress are having a very hard time. They still don't have any agreement on next year's budget, on spending bills. Yes, they put out a nice statement this week saying we're ready to move on tax reform, but do not underestimate how difficult that challenge is going to be. They're heading home for the summer break and they don't really have much to show for their majority.

There is a certain amount of irony in probably the most high profile piece of legislation Congress is going home on is a new sanctions bill against Russia that will make it harder for President Trump to ease sanctions. And that was passed with overwhelming veto proof margins in both chambers of Congress. So I guess this is where we say time will tell. Oh, geez. We'll find out. Eventually we will know. All things will become clear with time, Tam. So that is a wrap for this week. We'll be back in your feed on Monday. And this time we really mean it. Keep up with us on the NPR Politics Facebook page. And if you like the show, leave us a review on iTunes. That helps other folks find the podcast. All right. I'm Tamara Keith. I cover the White House for NPR. I'm Susan Davis. I cover Congress. And I'm

Domenico Montanaro, political editor. Thanks for listening to the In Fair Politics podcast.