It looks as if John McCain’s Senate colleagues are going to test him once again. And the health insurance of millions of Americans depends on the outcome.
This summer, when his party was trying to force a health bill with unprecedented haste – no hearings, no support from medical experts – McCain, R-Ariz., stood up for the idea of the Senate. By now, you’ve probably heard a line or two from his July 25 speech, shortly after learning he had aggressive brain cancer. But the full speech is worth reading. It’s McCain at his best, a defense of the imperfect but noble pursuit of democratic politics.
“Our arcane rules and customs are deliberately intended to require broad cooperation to function well at all,” he said from the Senate floor.
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“Incremental progress, compromises that each side criticize 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.”
When his colleagues ignored him, McCain cast the vote that defeated their health bill two days later, with a dramatic 1:30 a.m. thumbs-down. The vote was remarkable because McCain is a conservative, reluctant to tax people for social programs, as the Affordable Care Act does. But he believed in a higher principle: the Senate’s credibility.
The latest Trumpcare, known as Graham-Cassidy, risks the Senate’s credibility again. There has been none of the regular process that McCain demanded, not even a Congressional Budget Office analysis. No major medical group – not doctors, nurses, hospitals or advocates for the treatment of cancer, diabetes or birth defects – supports the bill.
Passing it would violate every standard that McCain laid down.
Yet Republican leaders are rushing toward a vote. Their proposals have always depended on distraction, because they are so unpopular. And the country has been distracted lately, largely ignoring Graham-Cassidy until now, despite its effect if enacted.
The bill would sharply cut federal health funding in 2020 – and even more in 2027. Millions of people would lose coverage. The bill’s proponents are trying to sell it as flexibility for states. But “flexibility” alone won’t pay anybody’s medical bills.
Consider the “Jimmy Kimmel test.” That’s what Sen. Bill Cassidy, R-La., said in May that he would use to judge any proposal, in honor of the talk-show host whose newborn son needed heart surgery. Cassidy said he wanted to ensure “a child born with a congenital heart disease be able to get everything she or he would need in that first year of life.”
Cassidy, though, has now put his name on a bill that would harm such a child (because insurers could hike the family’s rates after the diagnosis). He has recanted, without acknowledging it.
For the bill to pass, McCain would probably also need to reverse himself. Any three Republicans can stop the bill, and he – along with Susan Collins, Lisa Murkowski, Rand Paul, Jerry Moran, Lamar Alexander and a few others – is one of the swing votes.
There is reason to believe McCain will stand firm, starting with his sense of personal honor. It’s hard to imagine him violating it to help a president who personally demeaned him. But McCain showed worrisome signs of wobbling Monday, saying he may “reluctantly” support the bill. He also listens to Arizona’s governor, Doug Ducey, who endorsed the bill even though it could nearly double the state’s uninsured population.
No doubt, the White House and other senators are concocting rationales – like a single hearing next Tuesday – for why a yes vote by McCain would not violate his principles. But that’s laughable. Graham-Cassidy has followed the hasty, secretive, partisan process that McCain so eloquently decried.
The good news is that McCain has leverage. The compromise that he wants – that both sides “criticize but also accept” – is entirely feasible. Democrats want to fix Obamacare’s problems, both for substantive reasons and to avoid a civil war over a single-payer system. The outlines of a deal, with more state flexibility but without coverage losses, are obvious.
John McCain is a complicated figure. One of his own aides recently described him as “nine parts hero, one part troll.” He has strengths and weaknesses, as the rest of us do, and I won’t pretend to agree with all of his opinions. But he has, undeniably, made greater sacrifice for this country than most of us ever will.
It would be a tragedy for the country if he were now willing to take away decent health care from millions of people. It would be a tragedy for him if he went back on his word so blatantly. I remain hopeful that he will stay true to it.