Analysis: McConnell stakes it all on health care bill

WASHINGTON (AP) — Pass or fail, there will be one man singularly responsible for the fate of health care legislation in the Senate: Majority Leader Mitch McConnell.

The shrewd Kentuckian has made himself practically the sole arbiter of the bill and will be largely responsible for the outcome, whether it's a win, a loss, or a win that turns into a loss over time as unpopular consequences of the legislation take hold.

McConnell decided to keep the bill close, writing it in secret with a close circle of aides and eschewing committee hearings, despite grumbling from fellow Republicans. GOP senators were largely in the dark until the legislation was unveiled Thursday and were still getting briefed, without seeing copies of the bill, when it was posted publicly online.

McConnell made it clear to President Donald Trump on more than one occasion that Senate business should be left to him, and as a result Trump largely stayed out of the process, unlike during the House's health care deliberations.

And McConnell made the decision to release the bill this week and push toward a vote next week, ignoring pleas from some lawmakers for more time. After seven years of GOP promises to repeal and replace former President Barack Obama's health care law, McConnell said, they'd already had time enough.

"Republicans believe we have a responsibility to act — and we are," McConnell said Thursday on the Senate floor.

For McConnell, 75, whose reputation as a legislative tactician has grown to near legendary proportions, the health care bill may be the biggest test of all. He's dealing with an unpopular piece of legislation that affects nearly every American personally and a diverse conference that includes moderates and conservatives, both of whom have problems with the bill.

And, he has almost no margin for error. McConnell will be able to lose only two senators from his 52-member conference and still pass the bill, with Vice President Mike Pence casting the tie-breaking vote. Democrats are unanimously opposed.

"It's like walking through a minefield for him," said Republican Sen. Tim Scott of South Carolina. "We all have different constituencies, and the ability to thread the needle for all those constituencies is a very difficult task."

Nonetheless, allies say if anyone can get the job done, it's McConnell. In a decade leading Senate Republicans, McConnell has displayed his legislative skills time and again. His record is not perfect, but he commands unquestioned respect from most of his conference, especially after his decision to hold a Supreme Court seat vacant after Antonin Scalia's death last year paid off when Trump won the presidency and appointed conservative Neil Gorsuch to a lifetime seat.

At the annual Republican congressional retreat earlier this year, colleagues stood up and applauded McConnell for his strategy on the Supreme Court, which some had initially questioned.

And now, on health care, McConnell is moving forward with similar resolve, once again ignoring reservations and second-guessing.

"Somebody has to lead, and somebody has to govern. He's the leader, and the Republicans are supposed to be governing right now," said fellow Kentuckian GOP Rep. James Comer.

"If there's one member of Congress that I believe has the ability to bring us together on a health care bill, it's Mitch McConnell," Comer added. "If he can't do it, then it cannot be done."

McConnell's challenges became clear immediately after the bill was released, as four conservative senators announced their opposition to the legislation as drafted. Sens. Mike Lee of Utah, Ted Cruz of Texas, Ron Johnson of Wisconsin and Rand Paul of Kentucky said they thought the bill didn't go far enough to undo "Obamacare," but that they were open to negotiation.

On the other side, moderate-leaning senators like Susan Collins of Maine were also expressing reservations.

For now, the outcome can only be guessed at.

But McConnell has made a career out of navigating such cross currents, especially since obtaining his dream job as majority leader after Republicans won Senate control in 2014.

During the Obama years — whether leading the GOP minority or as Senate majority leader since 2015 — McConnell was a key player on several must-pass items: a 2011 budget and debt deal; an early 2013 "fiscal cliff" tax bill; and several "omnibus" spending packages.

He leaned on his relationship with Vice President Joe Biden, especially in the 2013 fiscal bill, after which Democrats like former Majority Leader Harry Reid of Nevada griped that Biden gave McConnell too much.

McConnell also tried to prevent the 2013 government shutdown, but was overridden by tea party forces in the House. And on several occasions he helped orchestrate orderly action on must-do legislation to raise the so-called debt limit.

He doesn't always prevail. McConnell is not a fan of unnecessary conversation and plays his cards close to his chest, which can create the impression that he has a secret plan up his sleeve when that's not the case. Confounding his predictions, and on his watch, Congress let the Patriot Act expire two years ago —resulting in a temporary halt to some U.S. spying activities before a substitute bill could pass.

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Associated Press writer Andrew Taylor contributed.