By Rachel Roubein - 07-12-17 06:00 AM EDT
Senate Majority Leader Mitch McConnell is in a dicey spot in more ways than one when it comes to the Senate's healthcare bill.
If the Kentucky Republican fails in his effort to repeal and replace ObamaCare, his reputation as a master tactician of the Senate will take a hit, with lawmakers second-guessing his decisions on drawing up a bill largely behind closed doors.
It would also deal a serious blow to the GOP effort to end ObamaCare and would mean Republicans have wasted the first seven months of the new Trump administration with little to show for it. Questions about the rest of their agenda would grow.
Back in Kentucky, McConnell would also face some politically tricky questions.
In his home state, the law has led to a drop in the rate of uninsured people from 20.4 percent of the state's population in 2013 to 7.8 percent in 2016, according to Gallup - the largest reduction of any state in the country.
That doesn't mean ObamaCare is necessarily popular in Kentucky, but the fight over healthcare does pose some risks for McConnell, who is up for reelection in 2020. Democrats fought hard to defeat McConnell in 2014 and lost. They would love to find a way to defeat him in three years by putting healthcare front and center.
GOP strategists in Kentucky acknowledge the situation is complicated, but they argue it's an easy call for McConnell to forge ahead with his repeal effort.
They say the cost of ObamaCare - even in a state such as Kentucky, where more residents are now insured - is too great, premiums are too high and people will be OK with undoing it even if it leaves more people uninsured.
"People who are observant as to what's going on in both D.C. and in Frankfort, they understand that we were very successful at the [ObamaCare] rollout in this state. Former Gov. Steve Beshear did a great job," Tres Watson, Kentucky Republican Party spokesman, said, referring to the Democratic governor who launched the exchange.
"But at the end of the day, he's kind of like your buddy who shows up at the restaurant, orders a round of drinks and an appetizer and then leaves before the check comes. And, unfortunately, the time has come to pay the bill."
For McConnell, repealing ObamaCare is an attempt to fulfill not only a major national GOP promise, but also one he made in his own campaign in Kentucky, said Scott Jennings, who served as a campaign adviser to McConnell in 2002 and 2008 and ran his reelection super PAC in 2014.
On the Senate floor, McConnell has sounded the alarm about how ObamaCare has been failing the American people for years. "It will collapse around them if we fail to act," he said Monday. He told anecdotes of Kentucky residents who ObamaCare hurt one way or another, a full-time student and single mom who found "high premiums and a staggering deductible" on the law's exchanges.
"At the end of the day, Mitch McConnell has to come back to Kentucky and say, 'I tried everything I could find to fulfill this campaign promise that you have asked us to do, and fortunately or unfortunately, here are the results,' " said Jennings.
"I think he'll sleep fine at night knowing he did what the people of Kentucky wanted him to do. I just think the Republican Party at large needs to listen and think hard before they abandon ship."
McConnell is barreling toward a vote on a bill next week despite misgivings in his conference. A new version of the legislation is promised on Thursday.
Centrists worry the GOP's changes to Medicaid could cause more uninsured residents in their states amidst a nationwide opioid epidemic. Conservatives say the bill doesn't go far enough, and are pushing for an amendment to allow insurers to sell plans that don't comply with ObamaCare insurance regulations as long as they also sell ones that do.
There are those in Kentucky who want ObamaCare to stay.
Jason Bailey, executive director of the Kentucky Center for Economic Policy, called the Senate bill "the biggest policy threat that has faced Kentucky in recent history."
Kentucky's uninsured rate would rise by 231 percent by 2022 if the current version of the Senate bill passes - the second-highest increase of any state, according to an analysis from the left-leaning Urban Institute.
At least initially, Kentucky implemented ObamaCare to the fullest extent possible. Beshear opted to expand Medicaid, the joint federal-state health insurance program for low-income and disabled Americans.
He also decided the state would create its own online healthcare marketplace instead of using HealthCare.gov. He called it kynect - a strategically chosen name since only a little over one-third of Kentuckians approved of Obama's presidency in 2013, the year the health marketplaces opened for business.
Beshear traversed the state, discussing the law in an effort to combat what he called the "anti-Obama feeling."
"I told our people, 'Look, you don't have to like the president and you don't have to like me, because this is not about him or me, it's about you and it's about your families, it's about your kids,' " Beshear said. " 'Just do me a favor. It won't cost you a dime to just go online and take a look at what you might be able to get.' "
During the 2015 governor's race, Gov. Matt Bevin (R) promised to dismantle kynect, and as of late 2016, his state residents bought their health plans through HealthCare.gov instead of the exchange Beshear set up.
Bevin also promised to roll back the state's Medicaid expansion. Instead, he's trying to limit it, asking the Trump administration to approve a waiver to overhaul the program in his state to include items such as work requirements and a monthly premium.
The Senate GOP healthcare bill would reshape Medicaid in a large overhaul of the program. It includes a three-year phaseout of the enhanced federal funds for Medicaid expansion starting in 2021. The expansion added more than 473,000 Kentuckians to the Medicaid rolls, according to the Kentucky Center for Economic Policy.
"One thing McConnell is hearing about when he comes home is, how are we going to afford to keep the expansion here when you've got these other pressures, such as public pension crisis, pushing Gov. Bevin and the legislature to act?" Jennings said.
The Bevin administration has said that the expanded Medicaid will cost Kentucky $1.2 billion over the next five years, "and we don't have it," Jennings said.
Both opponents and supporters believe McConnell will survive his next election in Kentucky, no matter what happens with ObamaCare repeal.
Beshear pointed to McConnell's robust war chest.
"I think if his bill passed it would hurt him in Kentucky. That's not to say he would lose his next election," Beshear said, "because Sen. McConnell years ago figured out how to win elections, and the one word that summarizes his ability to win elections is 'money.' "
Al Cross, a longtime political writer at the Louisville Courier-Journal, noted that under the GOP bill, the Medicaid expansion doesn't begin to phase out until after the 2020 election cycle - and that McConnell doesn't have to be on the ballot for another three years.
"Kentuckians see McConnell as being one of the most important people in the world," Cross, who is also the director of the Institute for Rural Journalism and Community Issues at the University of Kentucky, said, noting he's been ranked high on lists of influential people.
"Kentuckians are proud of that. They may not like Mitch McConnell, may not like him personally, may not like most of his policies, but they have a certain degree of pride that a Kentuckian is in the place that he is."