Senate Majority Leader Mitch McConnell, R-Ky., aims to send a message to the Republicans he leads: After four elections and seven years of promising to repeal Obamacare, it's time to choose.
That's why, knowing full well the votes weren't there, McConnell switched from the Better Care Reconciliation Act, which would partially repeal and replace Obamacare, to the straight-repeal legislation that Senate Republicans approved in 2015, when President Barack Obama was still around to veto it.
McConnell couldn't round up the 50 out of 52 available Republican votes he needed to pass BCRA. The bill collapsed amid complaints about a leadership-driven legislative process and philosophical differences among conservatives and centrists about what to do with Medicaid.
But the majority leader essentially thinks Republicans are making excuses.
To teach them a lesson about governing, and smoke out exactly where various members stand on Obamacare repeal, McConnell is forcing a tough vote on a bill that's likely doomed — an unusual move for a political operator who always has his eye on the next election.
"These members have to be held accountable," said a Republican operative familiar with McConnell's strategy, who like others interviewed by the Washington Examiner, requested anonymity in order to speak candidly.
"They have been hiding behind him — and hiding behind process arguments — for months now," this operative added. Said another, this one a veteran McConnell observer: "It's important to set a marker. If this ends in an insurance bailout, there will be no revisionist history."
In other words, if you're a Republican senator opposed BCRA, or voted against straight repeal, you own the consequences, one of which could be that Republicans, possibly working with Democrats, back legislation to stabilize insurance markets rocked by problems stemming from flaws in the ACA.
Publicly, McConnell is giving little hint of frustration. "This has been a very, very challenging experience for all of us," he said Tuesday during his weekly news conference. "It's pretty obvious that we don't have 50 members who can agree on a replacement."
The vote on straight repeal is set for early next week. By lunchtime on Tuesday, however, a sufficient number of Republicans had already announced their opposition to make clear that it would come up short in a roll call.
Eighteen months ago, the same bill passed with 52 GOP votes under "reconciliation," a parliamentary maneuver that allows the majority to sidestep a filibuster. Obama promptly vetoed it, but Republicans heralded the results as an example of what was possible with a friend in the White House.
"The idea that Obamacare is the law of the land for good is a myth," House Speaker Paul Ryan, R-Wis., said at the time. "We have now shown that there is a clear path to repealing Obamacare without 60 votes in the Senate."
It hasn't quite worked out that way.
Since President Trump's inauguration, Republicans in the House and Senate that routinely voted to repeal Obamacare wholesale while Obama was in the White House have splintered over concerns about Medicaid, worried about the impact that reform might have on their poorer constituents.
Conservatives have pushed for a rollback of the ACA's Medicaid expansion plus other program reforms. Centrists, and even some Republicans who are otherwise conservative but are from Medicaid-expansion states, have demanded coverage gains be protected.
The negotiated compromise, which passed the House as the American Health Care Act but stalled in the Senate in the form of a similar bill, BCRA, was a watered down proposal that only partially repealed Obamacare.
McConnell could have proved his point about his party's responsibility to govern and do something about the troubled healthcare system by forcing a vote on BCRA.
But Senate Republicans, though hesitant to criticize their colleagues, conceded that McConnell might be attempting to shake things loose by forcing the conference to vote on straight repeal legislation that most of them voted for in January of 2016, possibly as a means to force them to confront whether they favor repeal or not.
"We have evidence — or we had  votes for the full repeal in January of a year ago. For those individuals, if they want to be consistent, the repeal gives us, with a delay, it gives us two years to actually do the replacement," Sen. Mike Rounds, R-S.D., said.
"It's amazing what the moderates are saying about changed circumstances since [2016.] The only relevant change was that Trump will sign it into law," a Republican senator added.
Unhappiness with how the bill was written, a process dominated by McConnell, also is being some Republicans who are disappointed that Obamacare repeal has run aground.
Prominent critics of BCRA, and straight repeal, sit in the committees of jurisdiction over healthcare. Not only did drafting healthcare reform in the leader's office allow more Republicans to have input, McConnell's allies contend, but it might have died in committee.
Sen. Dean Heller of Nevada and Sen. Rob Portman of Ohio, supporters of preserving in some fashion the Medicaid expansion, serve on the Finance Committee. Sen. Bill Cassidy, R-La., who has waffled on the issue, also sits on Finance.
Other Medicaid expansion supporters serve on the Health, Education, Labor, and Pensions Committee, including Sen. Susan Collins of Maine and Sen. Lisa Murkowski of Alaska. Sen. Rand Paul, R-Ky., who opposed BCRA from the right, also sits on HELP.