Political News

Health care state of play: What happens next

Posted July 28

By now, the events related to Republicans' plans for health care early Friday morning have reverberated across Washington. Three GOP senators voted down a so-called "skinny repeal" plan, a devastating blow to President Donald Trump and Republican leadership.

CNN's Hill team has reported extensively overnight, so you can get caught up on what happened, why Sen. John McCain voted the way he did and what it means for Senate Majority Leader Mitch McConnell.

Here's what's happening with everything else:

So what happens next?

House Republicans met Friday morning. The closed-door conference was planned to be a discussion where House Speaker Paul Ryan laid out the conference committee structure/next steps.

In fact, GOP aides say they were planning to vote to go to conference, appoint conferees and motions to instruct Friday before they left town. That obviously isn't applicable anymore.

It's worth keeping an eye on House members participating in their favorite pasttime, dumping on the Senate, as well as whatever the speaker's message is post-failure. Conservative members will certainly will be agitating for some, any, kind of path forward. But prospects at the moment aren't great for that.

Is repeal really dead?

Congressional observers should feel wary of ever pronouncing GOP effort's on health care completely dead, as it's made people look dumb before in the last six months, but it's certainly deader than it's ever been.

McConnell said on the floor it's time to move on -- and the Senate is doing just that.

Look, conservatives aren't going to stop trying, but as has been reported many times before: the US Senate Republican conference appears incapable of getting 50 votes for anything. That's not a political issue (though politics obviously play a role), this is a policy/ideology/belief issue.

At the core of this failure -- and there are many factions that deserve blame -- is the fact that Republicans don't agree on what the government's role should be in health care. That's a divide they simply couldn't bridge in the Senate.

What about a bipartisan approach?

Democrats are more than happy to admit fixes need to be made.

The administration needs to provide clarity on Cost Sharing Reduction funding and a short-term market stabilization package is almost certainly needed. It's unclear if such a package could ever make it to the President's desk.

Obviously keep an eye on the President's tweets for guidance -- though his positions have been inconsistent -- but more important is conservatives who've made clear "fix" is not in their vocabulary. Their baseline is repeal. It's what they campaigned on. It's what they promised. And it's why bipartisanship was never going to work in this initial effort.

Now, Senate health committee chairman Lamar Alexander has already prepped for hearings on repairing the individual market. Several GOP senators have voiced support for something short-term, as have several House Republicans.

But the Senate floor schedule is packed this fall: Debt ceiling, nominations, the National Defense Authorization Act, appropriations bills, the budget for fiscal year 2018, even possibly tax reform. Will McConnell agree to bring something to the floor conservatives will fight tooth and nail? Will Ryan? Wait and see, but it's tough sledding.

One final note about McCain

Several Republican aides have told CNN McCain's real reason for coming back was to manage the NDAA on the floor.

That was what was up next on the calendar, that, as CNN's Jeremy Herb has pointed out repeatedly, is "his baby" and that was what he wanted to do before he started treatment.

At 12:53 p.m. Thursday afternoon, Senate leadership sent out a "hotline" notice regarding NDAA -- basically, a notification that they were going to immediately take up NDAA after health care (passage or failure) and they wanted anyone who objected to this to let them know.

The idea being, if any senator is going to object to taking this up, flag it please, and we'll hold off and discuss next steps.

Senate Minority Leader Chuck Schumer cut a deal with McConnell to immediately move onto the bill -- i.e. no Democrats would object to starting. McConnell moved to bring it up on the floor and Kentucky Republican Sen. Rand Paul objected.

This was not expected, aides told CNN. While they knew Paul had serious issues with the bill and had amendments he was demanding merited consideration, aides and senators say McCain's staff had given assurances that he would get those amendments put in order. And Paul objected anyway.

What does that mean? Well, the Senate adjourned. When they come back Monday, they'll move to a nomination, not the NDAA. And oh by the way, three congressional sources told CNN on Friday that McCain is planning to return to Arizona to start cancer treatment Monday, and it's unclear when he'll return.

So, at least as aides in both parties are viewing this right now, in a somewhat stunned manner, Paul essentially undercut a carefully orchestrated move to give McCain a chance to manage his bill and priority from the floor, with no knowledge of when he'd be back again. Staff wasn't just surprised, but many were very angry.

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