The switcheroo that could give McConnell enough votes to repeal Obamacare

Just when you thought the Republican drive to repeal the Affordable Care Act was finally dead, there is a plausible new scenario being discussed on how Senate Majority Leader Mitch McConnell could resuscitate it.

Some congressional Democrats think it's possible, even likely, that President Donald Trump will offer Democratic Sen. Joe Manchin of West Virginia the post of Department of Energy secretary. That would allow Trump to move current Energy Secretary Rick Perry to the Department of Homeland Security to fill John Kelly's vacancy created when he shifted to become the White House chief of staff.

In this musical-chairs scenario, West Virginia Gov. Jim Justice—who just switched from Democrat to Republican—would then appoint a Republican to fill Manchin's Senate seat.

That could give McConnell the 50 Republican votes he needs to pass a new repeal-and-replace bill under Senate budget reconciliation rules. If the 49 GOP senators who voted for McConnell's stripped-down repeal bill last month backed the new legislation, the McConnell wouldn't need the votes of the three Republicans—Susan Collins, Lisa Murkowski and John McCain—who voted no last time.

It's important to note that Manchin's office won't say whether he is being considered for the Energy secretary position or whether he would accept it. All his spokesman would say is that "Sen. Manchin has not had any recent conversations with the administration about the Secretary of Energy position."

But Rep. Karen Bass (D-Calif.) said Monday morning at a healthcare town hall in Chicago that she and other Democrats expect Manchin will be offered the job and he will accept it. Then, they expect McConnell to quickly launch a new drive to pass a repeal-and-replace bill. That's what Trump has been needling McConnell to do since the previous bill failed by one vote on July 28, when McCain dramatically turned his thumb down.

"It would be a selfish thing for Manchin to do," Bass said. But if he is offered the job and accepts it and a Republican is appointed to take his Senate seat, "we'll turn up the pressure on other Senate Republicans who should have voted no."

Christopher Condeluci, a Republican healthcare lobbyist and former Senate staffer, said it appears the White House is trying to get to 50 votes in the Senate for repeal by finding a way to appoint another Republican senator.

"There is certainly talk about possibly revisiting the issue if it appears McConnell has 50 votes," he said.

GOP leaders also are considering the possibility that McCain could resign from the Senate if his health deteriorates as he battles brain cancer, Condeluci said. If that happened, Arizona's Republican governor would appoint a Republican replacement.

Ron Pollack, chairman-emeritus of Families USA, who helped build grass-roots support for ACA's passage in 2010, said he is skeptical about the Manchin replacement scenario, but he cautioned that ACA supporters should remain vigilant.

"Nobody seeking to protect the ACA and Medicaid should drop active opposition to the Trump and congressional Republican efforts seeking to decimate healthcare coverage," he said.

Even if Republicans succeed in executing this personnel switcheroo, McConnell wouldn't necessarily have 50 votes he needs to pass either the so-called skinny repeal bill or a broader repeal-and-replace package.

"The next hurdle is finding 50 real votes for skinny repeal when McCain isn't available to bail out up to a half-dozen or more Republican senators who voted for it very reluctantly last time," said Tom Miller, a conservative health policy analyst at the American Enterprise Institute. "It still looks like cut-your-losses-and-move-on time."

Some Republican and Democratic lawmakers in both the House and Senate are planning to consider bipartisan legislation next month to stabilize the ACA-regulated individual insurance market. They are talking about funding payments to insurers for the law's cost-sharing reductions for low-income exchange plan members; establishing a new reinsurance program to protect carriers that sign up sicker enrollees from financial losses; and some easing of ACA insurance market rules to let insurers sell cheaper plans with fewer benefits.

At the town hall Monday, Bass and Rep. Jan Schakowski (D-Ill.) both expressed wariness over a bipartisan solution because of the GOP proposals to let insurers offer plans with fewer benefits and consumer protections.

"The Republicans are being misleading," Bass said. "What they really want to do is repeal Obamacare."