Among the important pieces of Trumpcare that now would require 60 votes are the two changes that ban insurance policies that cover abortion and Planned Parenthood services, a key piece for anti-abortion conservatives. Similarly, the change to allow Medicaid to avoid offering essential health benefits, a key piece of the GOP plan to reduce costs by reducing coverage, would also require 60 votes. In an truly ironic twist, the current bill requires the continued payment of those insurer subsidies that Trump is constantly threatening to cut off. When Obama was President, Republicans actually sued to stop these payments saying they were not properly authorized by Congress. Now they are trying to make them permanent in this bill but the parliamentarian has ruled that this change would require 60 votes. In addition, the GOP answer to the individual mandate, the 6 month lockout period if you do not have continuous coverage, will also require 60 votes as will the removal of the requirement that insurers spend at least 80% of revenue on actual medical care.
Individually, any one of these items like abortion or Planned Parenthood, would kill the bill, Collectively, they make a mockery of the whole effort to round up 50 Republican votes because even that would not be sufficient to pass significant elements of the bill. Indeed, Mark Meadows, the leader of the Freedom Caucus in the House, has already declared the abortion issue a deal killer. While the Planned Parenthood ruling may encourage the moderates, it will infuriate the hard right and the 6 month lockout and CSR rulings may actually make the resulting CBO score even worse than it already is.
Now, of course, the Republican response to this latest hurdle could be similar to their attitude toward most issues in the recent past and that would be to essentially change the rules to get what they want. That would require having the Presiding Officer of the Senate, Vice President Mike Pence, simply overrule the parliamentarian, (the GOP did this once before in the 1970s), or, more likely, simply find a way to repeal the Byrd rule. It was the approach the party has taken with Merrick Garland and Neil Gorsuch, and a whole host of other issues.
Mitch McConnell may not be the political wizard that Democrats and some Republicans apparently believed. But he is a parliamentary expert. He had to know these issues would never pass muster to be passed with 50 votes. So you really have to wonder why he's wasted months of Senate time on a bill he had to know would never pass.
McConnell has relied on an absolutely unified Republican caucus ever since Obama was elected in 2008. Under his leadership of the opposition, the party learned many ways to successfully say no. Now that they need to actually govern, a majority sill only seem to be able to still say no. For the first time that I remember, a Republican Senator actually openly questioned McConnell's leadership when Ron Johnson said the leader had engaged in a "breach of trust" regarding the phase out of Medicaid funding.
More than anything, Trumpcare shows that Republicans are so far simply incapable of making the difficult trade-offs that actual governance requires. Part of this is the split between the minority of moderates in the conference and the hard right majority. But most of this is because the GOP has been lying to their base for a decade about what they would accomplish and the costs it would entail to do so. And, at least to this point, the party is so scared of the base they refuse to admit to their lies. Only when they do so, will they be capable of actually governing.
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