McConnell's health-care Hail Mary

To paraphrase Mark Twain, reports of the death of Republican health-care reform are greatly exaggerated. Far from throwing in the towel, as some have reported, Senate Majority Leader Mitch McConnell is actually throwing a final Hail Mary pass in an effort to pass the Senate Republicans' Better Care Reconciliation Act (BCRA). And he's found an extremely clever way to do it.

Understanding McConnell's strategy requires some inside-baseball knowledge of how the Senate works.

To get to a vote on the BCRA, the Senate must first vote on what's called a "motion to proceed." If such a motion passes, then there are up to 20 hours of debate (10 hours on each side) and unlimited amendments.

McConnell's biggest challenge was getting 50 Republican senators to agree to vote for a "motion to proceed" on a bill that they disagreed with - knowing that it was unlikely to be amended in ways that would make a difference to their final votes given the split between Republican conservatives and moderates and given the Democrats' refusal to cooperate.

Instead of cooperation, Republicans would have to endure an onslaught of politically toxic Democratic amendments, as Senate Democrats forced them to cast one vote after another designed to make them look like monsters come Election Day. It is generally assumed that after getting on tothe bill, and after enduring all that pain from Democrats, Republican senators would ultimately want to emerge with some sort of legislative victory.

The announcement by Sens. Mike Lee, R-Utah, and Jerry Moran, R-Kan., Monday night that they would not vote for a motion to proceed - combined with Sens. Rand Paul's, R-Ky., and Susan Collins', R-Maine, earlier announcements - killed the chances of getting on to McConnell's repeal-and-replace bill directly.

So McConnell is now trying to get on to the bill indirectly by forcing a vote on the Republicans' 2015 clean repeal bill, letting it fail, and then moving to the repeal-and-replace" legislation.

This is a shift in tactics, not a concession of defeat.

How can Lee and Paul vote "no" on a motion to proceed on a clean repeal bill? And because all current Republican senators (except Collins) who were in office at the time voted for the clean repeal in 2015, moderate Republicans will be put in an awkward position if they vote against a motion to proceed on the same bill now.

Granted, they voted "yes" back then because they knew President Barack Obama would veto the bill, so they were not firing real bullets. The vote was more than a political statement, however: It allowed Senate Republicans to probe the parliamentarian to see how much of Obamacare could be repealed under the reconciliation rules with a simple majority. But since it had zero chance of being enacted, no one cared about whether what was left in the wake of repeal would result in a functioning insurance market. (It wouldn't.)

Of course, if moderates vote "yes" on the motion to proceed, they will eventually have to flip-flop on their 2015 votes anyway - because clean repeal would send the failing Obamacare exchanges into a full meltdown and Medicaid expansion would be terminated, as would the cost-sharing reduction payments for low-income Americans. In other words, the full repeal goes against everything the moderates have been fighting for.

Where does a failed "clean repeal" vote leave McConnell? In a pretty good position. He will have proved to the conservatives that full repeal can't pass and that the BCRA is the only hope for any kind of repeal. He can then bring the BCRA up for a vote. When he does, there will be increased pressure on the moderates, including from the White House, to vote yes - and pass a bill.

In other words, this is a tactical move to force a vote on the BCRA. The question is whether moderate Republicans will go for it, and what they will ask for in exchange in the final bill. Right now, three moderates - Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska - have indicated they will vote "no" on the motion to proceed. Collins won't change her vote under any circumstances. McConnell has to negotiate changes to the BCRA with the others to get them back, including added protections to make sure that the Medicaid expansion populations in their states are not harmed.

It's a Hail Mary, to be sure. But it just might work.

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