What we know about Mitch McConnell’s health and his future in the Senate

What happens if Mitch McConnell has to retire?

Senate Majority Leader Mitch McConnell appeared to experience a health episode during a press conference on Capitol Hill Wednesday, freezing mid-sentence for about 20 seconds at the podium before he was briefly ushered away and then returned saying he was “fine.”

It’s not clear what might have happened. McConnell’s office has said that he was feeling light-headed but has not elaborated on his condition. President Joe Biden reportedly called McConnell to check up on him Wednesday, and the senator attended a reception for Major League Baseball that evening.

This incident is the latest in a series of health issues that have raised concerns about the 81-year-old Senate leader’s health. He suffered from a concussion and a fractured rib from a fall at a DC hotel earlier this year, for which he was hospitalized for five days and stayed at a rehabilitation facility. He did not appear on the Senate floor for six weeks following the fall. He also tripped and fell while disembarking from a plane earlier this month. Though he did not suffer any serious injuries as a result, he now uses a wheelchair at airports.

McConnell is not the only senator facing concerns related to their health and age. Ninety-year-old California Sen. Dianne Feinstein (D) has recently faced calls to resign from congressional Democrats amid questions about her cognitive abilities.

While McConnell has not articulated any intention of stepping down anytime soon, laughing off a question about a successor Wednesday, his retirement would dramatically shake up the dynamics in the Senate.

What might have happened to McConnell?

Without an official report of a diagnosis (which McConnell has not released), it’s impossible to know for sure what happened. But one explanation could be that he experienced an episode of transient aphasia, which is a temporary interruption in a person’s ability to use language. This interruption could coincide with the person not understanding what is being said to them or what’s going on, but it’s also possible for the person to be fully aware of what’s happening during the episode.

Aphasia is often a long-lasting or permanent feature of conditions affecting the brain, including cancers, infections, and many forms of dementia. However, it can also occur in shorter bursts when it’s caused by temporary changes in brain circulation or in the pathways that conduct electrical impulses through the organ.

One of the most common causes of transient episodes of aphasia is a temporary blockage of a blood vessel in the brain, called a transient ischemic attack, or a “mini-stroke.” When a person has one of these events, it suggests they’re at high risk of a full-blown stroke in the next few days or weeks.

Certain types of seizures can also cause episodes of transient aphasia. Seizures have many possible causes and are sometimes the first symptom of medical conditions affecting the brain, including strokes and head injuries. It’s unclear whether McConnell’s multiple falls earlier this year represent the cause of his freezing episode, the result of an ongoing condition, both, or neither.

Other, less likely conditions — like migraines and medication reactions — could lead to similar symptoms but are less likely in this case. Again, without an official diagnosis, it’s impossible to know the cause; regardless, an event like this merits an immediate medical evaluation to diagnose and treat whatever underlying condition caused it.

It’s not clear what kind of evaluation McConnell had after his episode. Although he left the podium immediately after the event, he returned a few minutes later to answer questions from the press corps, and he spoke with reporters in the evening. —Keren Landman

Who could replace McConnell if he retires?

McConnell’s Republican colleagues remain supportive of him. Texas Sen. John Cornyn said Wednesday, “I’ll support Senator McConnell as long as he wants to remain as leader.” And Texas Sen. Ted Cruz told Politico, “That obviously was concerning. I hope it was just a momentary issue and that he’s doing better. … I have every hope that he will fight back from any health issues and fully recover.”

McConnell’s term is up in 2027, and he’s ensured that if he were to retire before then, anyone who replaces him would have to be a Republican. In 2021, he pushed for the passage of a new law in Kentucky that requires the governor to appoint a Senate replacement from the same party as the previous senator and from a list of names provided by the state party. That means that even though Kentucky’s governor is a Democrat, should McConnell retire, it wouldn’t change the balance of power in the Senate.

Then there’s the question of who would replace him as the party’s leader in the Senate. Cornyn, Sen. John Barrasso (R-WY), and Sen. John Thune (R-SD) are seen are possible contenders to be McConnell’s successor. All three have at times sought to keep their distance from former President Donald Trump.

Cornyn, formerly McConnell’s whip and head of the National Republican Senatorial Committee, has likened his relationship with Trump to a bad marriage (even though he has cast votes supporting Trump’s agenda 95 percent of the time.)

Thune, McConnell’s current deputy, has endorsed South Carolina Republican Sen. Tim Scott for president over Trump. That made him the highest-ranking Republican to break with Trump in the 2024 contest.

And Barrasso, the third highest-ranking Republican as chairman of the Senate Republican Conference, has cast doubt on Trump’s legal defense in the face of a federal indictment for retaining classified documents after he left office. But he’s also sided with the former president; for example, by refusing to condemn Trump’s remarks defending January 6 rioters who sought to “hang” former Vice President Mike Pence. —Nicole Narea

What would McConnell’s retirement mean for the Senate?

McConnell has often been at odds with the MAGA wing of the Republican party, which has not forgiven him for acknowledging the events of January 6, 2021, as a “violent insurrection” at the US Capitol while the Republican National Committee insisted it was “legitimate political discourse.” He’s also recently broken with MAGA on funding for the war in Ukraine and has said that he won’t just back the candidates endorsed by Trump going forward after such candidates broadly underperformed in the 2022 midterms.

While the people who are most likely to succeed McConnell aren’t in the mold of Trump, McConnell’s departure would create a power vacuum — and an opening for the MAGA wing of the party to grow its influence. Sen. Rick Scott (R-FL), who identifies as a key Trump ally, launched a leadership challenge to McConnell earlier this year. Though Scott only picked up 10 votes, it was a signal that the party is undergoing an ideological shift that, in McConnell’s absence, could accelerate.