McCain Healthcare Votes

Phoenix Magazine – September 2017

Mike O’Neil

Senator John McCain cast the deciding vote that seems, at least for now, to have dashed Republicans’ hopes for repealing “Obamacare,” the Affordable Care Act.

Most were surprised by his negative vote; should they have been?

Why did he do it?

John McCain is a man who has just come face to face with his own mortality.  It would be hard to think of a more compelling motivation for one to focus on what is really important.

What does John McCain really care about?  McCain has been a Senator for over 30 years. It is clear, based on his own words, (and even his earlier decisive vote to permit consideration of alternative healthcare proposals) that he cares deeply about the traditions of the Senate, traditions that once made it aptly described as the world’s most deliberative body.  His 30+ years tenure in the Senate are long enough that he has seen these traditions deteriorate in increased acrimony and partisanship.

He had repeatedly objected to the “rushed” way the ACA had been passed. Months of public hearings preceded the ACA vote; hundreds of amendments were offered by Republicans and dozens of these were incorporated into the final bill. Contrast the “rushed” ACA with the current debate, wherein even most Republicans were kept unaware of what would be in the bill until a couple of days beforehand a vote.  McCain’s vote and explanation of it was a demand to return to “regular order,” meaning consideration by relevant committees, public hearings, expert testimony and careful analysis before voting. And bipartisanship. It is clear that McCain wants this bipartisan regular order to apply not just to healthcare, but to everything.  His own explanation of his vote was a clarion call for that.

A second explanation for his vote cannot be dismissed: perhaps the man who has just come face to face with his own mortality was unwilling to cast a vote that would certainly have ended healthcare insurance for millions and the premature deaths of many thousands of newly uninsured people.

Certainly, his medical diagnoses put him beyond the reach of any credible threats of repercussions, political or otherwise.  You can’t threaten to “primary” a Senator who will not run for re-election. 

Other explanations would seem not to fit the facts. If McCain wanted to vote as an act of revenge against a President who has attacked him personally (“Not a war hero; a hero does not get captured”), it might be understandable. I just don’t think such a motivation is likely to drive a dying man focused on his legacy and what is really important to him. Considerations of one’s mortality are likely to elevate one above such petty concerns.

Why did McCain cast his vote in the negative?  This “Skinny Obamacare Repeal” simply removed the individual and company mandates.  These were, however, necessary to expand coverage.  Insurance companies could agree to insure those with pre-existing conditions only if they were provided a large healthy pool of people to compensate for taking on those with pre-existing conditions. Remove these mandates and the large health pool would not be there and no insurance company would offer policies available to all. 

This bill would have ensured the collapse of the entire ACA coverage. Wavering Republican Senators knew this and were promised that this bill would never become law, it was just a mechanism to get a bill, any bill, into conference with the House.  And this bill registered approximately 17% public support. Why did Senator McCain vote down this bill?  It would be more instructive to learn why a bill with 17% support that was never intended to become law got the votes of 49 of 52 Republican Senators. The answer to that question would explain everything about the current state of our politics.

Mike O’Neil is a sociologist and pollster who has analyzed public attitudes in Arizona and the nation for over 35 years. He is host of the public affairs program, The Think Tank, on KTAR-FM 92.3. Most of his recent articles are available at