McCain Has a Lot of Decisions to Make

I’m not a doctor, but I’d be surprised if John McCain’s recent confused public behavior wasn’t in some way related to the five centimeter blood clot that was found above his left eye. At a minimum, I suspect the clot was discovered because McCain wisely sought expert medical opinion on why he was acting so strangely. With any luck, the procedure that removed the clot will also solve the problem he’s been having with lucidity.

Based on the speculation I’ve seen from doctors (who aren’t treating McCain), it might be a little longer than a week before he’s able to return to work in the Senate. Mitch McConnell is putting his health care bill on hold until McCain returns, which is interesting because McCain isn’t even a definite yes vote on a motion to proceed to the bill. Last week, I cited a Washington Post roll call that was listing him as a ‘no.’ I also noted that McCain can’t be trusted to block the bill even if he makes indications that would you to think he’s not on board.

On Thursday, McCain released a statement that be taken two ways. On the one hand, it’s clear that he hates the bill. On the other hand, what’s he proposing to do is fix it in the amendment process which would indicate that he’s inclined to let McConnell bring the bill to the floor.

He was in surgery shortly after releasing the statement, so I don’t know that it represents his best thinking. But here’s what he said:

In a written statement, McCain, R-Ariz., vowed to champion amendments that he is authoring in consultation with Republican Gov. Doug Ducey and others from Arizona, provided the bill makes it to the Senate floor.

“Arizona has been nationally recognized for running one of the most efficient and cost-effective Medicaid programs in the country,” McCain said. “This legislation should reward states like Arizona that are responsibly managing their health-care services and controlling costs — not penalize them.”

That might sound good, but it looks a little less robust in detail:

McCain wants to give Arizona and the other 30 [Medicaid] expansion states more time to adapt their budgets to the loss of federal money and prevent an abrupt loss of coverage for the 14 million Americans nationwide who benefit from the expanded program.

He also wants to alter the Medicaid growth rate in a way that he says would protect Arizona.

McCain further doesn’t want to see the state pay a price for having passed Proposition 204, a pre-Obamacare, voter-approved decision in 2000 to boost the number of people eligible for the Arizona Health Care Cost Containment System, the official name of Arizona’s Medicaid agency.

Assuming for the sake of argument that McCain votes to let the bill come to the floor and that it does in fact come to the floor, it’s likely that McCain can pass amendments to address these concerns if the Democrats are willing to support him. Depending on details, the passage of these amendments could help the bill pass or derail the entire effort. Likewise, a failure to pass these amendments could cause a loss of support for the bill from McCain and some of the nineteen other Republican senators from Medicaid expansion states. Or, it could be that they’ll be contented to have the vote even if it doesn’t pass.

A week ago, McCain all but declared the health care bill effort dead. And he’s prepared to take a completely different approach.

McCain said in his written statement. “But if we are not able to reach a consensus, the Senate should return to regular order, hold hearings and receive input from senators of both parties, and produce a bill that finally provides Americans with access to affordable and quality health care.”

Obviously, some have interpreted his remarks as indicators that he’ll block the bill from coming to the floor, but he doesn’t seem to have ever said that in a clear and decisive way. And, as I’ve noted, he’s been operating with a sporadic loss of lucidity lately.

As he convalesces from his surgery, he’ll have some time to figure out what he plans to do. He can kill this bill in a variety of ways. He can kill it in the crib by voting against bringing it to the floor. He can push through amendments that protect Medicaid but cause a loss of support for the bill from the right. He can vote against final passage if his amendments fail.

I have no idea what he thinks the best course for him will be, but his brush with mortality ought to have reminded him about the importance of access to live-saving health care. It might have focused him on meeting his maker, too, which depending on his beliefs could change how he views this vote.

Maybe the doctors who are caring for him might have a few ideas on the matter, too, which could influence him.

All we know for sure right now is that the whole thing will be delayed until McCain is available to vote.

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