“Historic,” CNN’s Wolf Blitzer said as House Republicans passed TrumpCare II by two votes.  “It’s gonna be an unbelievable victory,” President Trump bragged in advance, a few hours later.

“Unbelievable,” indeed.  Yesterday’s events were a Kabuki performance.  The bill passed because it’s sure to fail.

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By letting states opt out of federal requirements that insurers provide essential health benefits and cover pre-existing conditions, TrumpCare II brought the hard-right “Freedom Caucus” on board.  But these opt-outs don’t stand a chance in the Senate.  Republican moderates — the so-called “Tuesday Group” — know that.  So they swallowed and signed on, giving their faltering party a briefly-famous victory — and counting on the Senate to deliver the kill.

 

There’s a long list of reasons why they made a safe bet.  For starters, the language that won over the hard right — the essential-health-benefits and pre-existing-condition opt-outs — breaches the generally-accepted understanding of what Senators can do within budget-reconciliation constraints.

As my colleague Timothy Westmoreland, one of Washington’s wizards of legislative procedure, pointed out to me, Republicans have in the past proceeded on the premise that reconciliation rules don’t allow rollbacks of ObamaCare’s essential-benefits or pre-existing-condition coverage requirements.

Expect the Senate parliamentarian to rule that any changes in spending or revenue ensuing from the hard right’s hard-won opt-outs are “merely incidental” to these opt-outs’ non-budgetary effects.  The practical result: Republicans will need 60 votes to pass these opt-outs, an impossibly-high barrier, given unified Democratic opposition.

Senate Republicans could try to overrule the Parliamentarian via a “point of order” from the floor, but this would require the same 60 votes.

There’s a snowball’s chance in June (when all of this could play out) that the parliamentarian will take a dive for the cause of “freedom,” allowing the opt-outs to proceed under reconciliation rules.  A more absurdist possibility is Sen. Ted CruzTed CruzGOP wrestles with soaring deductibles in healthcare bill Cruz: Tax reform chances ‘drop significantly’ if healthcare fails Ex-CBO directors defend against GOP attacks on ObamaCare analysis MORE’s proposal that Vice President Pence chair the proceedings and, as Westmoreland put it to me, “simply ignore the parliamentarian.”  The optics of either route are beyond-ugly, to the point of implausibility.

Even if “repeal and replace” frenzy were to drive the Senate down one of these paths, prospects for anything resembling TrumpCare II would be grim.  Not only are the opt-outs poison pills for enough Senate Republicans to kill the House bill; TrumpCare’s Medicaid cuts, higher premiums for older Americans, and paltry tax subsidies for the purchase of insurance continue to arouse alarm.

Add to this the health sector’s united opposition: never before have doctors and hospitals, insurers, consumer groups, advocates for the poor and so many others come together to block health care legislation.  Expect this resistance to be heard loudly in the next few months — on the air and online and wherever else political muscle is flexed.

So why did House Republicans go out on such a long limb for TrumpCare II?  More precisely, why did “Tuesday Group” moderates mostly sign on to a scheme that could send them home in November 2018?

The answer is that if the Senate kills the bill, their general-election risk is capped: voters tend not to get hot and bothered by things that didn’t happen.  Sure, Democrats will try to hold the moderates’ feet to the fire, but the fire will burn cool.  Conversely, had Tuesday-Group types abandoned TrumpCare II in the House, they would have felt white heat — from Team Trump, House leaders, and others poised to punish infidelity.  Think hard-right primary opponents, campaign fund cut-offs, and other tools of internecine vengeance.

So the Republican moderates who put TrumpCare II over the top made a savvy calculation.  Assuming the Senate acts as the “fence” against the House’s “fickleness and passion,” as James Madison envisioned, yesterday’s “historic” vote will soon be forgotten.

Count on this outcome — bad news for Democrats who’d love to see Republicans punished for their willingness to take meaningful medical coverage from tens of millions, but reassuring for all who’d face desperate circumstances without the health safety net the Affordable Care Act provides.

M. Gregg Bloche, M.D., J.D., @greggbloche, is professor of law at Georgetown University and author of "The Hippocratic Myth." He helped to develop President Obama’s 2008 campaign healthcare reform plan and advised the 2008-2009 presidential transition.


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