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

What happens if Mitch McConnell has to retire?

After Senate Minority Leader Mitch McConnell appeared to experience another health episode during a news conference in Kentucky last week, his office released a note from his doctor Tuesday saying the senator underwent a series of tests to determine what may have caused him to fall silent for more than 30 seconds when he was asked whether he would seek reelection.

Brain scans, tests measuring electrical activity in the brain, and a “comprehensive neurology assessment” showed “no evidence” that McConnell has a seizure or movement disorder such as Parkison’s disease — or that he had experienced a stroke or a mini-stroke, otherwise known as a transient ischemic attack — a note from congressional physician Brian Monahan reads.

It was the second such apparent episode in two months. At the press conference last week, McConnell’s aide asked him if he had heard the question before saying, “We’re going to need a minute.” Another aide checked on him, and he eventually responded before moving on to further questions.

In July, McConnell also froze mid-sentence for about 20 seconds during a news conference on Capitol Hill before he was briefly ushered away and then returned saying he was “fine.”

It’s not clear what might have happened in either instance. McConnell’s office said in a statement last week that he “felt momentarily lightheaded and paused during his press conference today.” In July, McConnell’s office also said that he was feeling light-headed, but did not elaborate on why.

Monahan said in a statement last week that after speaking with McConnell and “his neurology team,” he deems the lawmaker “medically clear to continue with his schedule.” McConnell and his aides have maintained that he feels fine in the wake of the incident.

The incident was 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 in July, though he did not suffer any serious injuries as a result.

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 — he laughed off a question about a successor in July and his office did not respond to questions about his future plans last week — his retirement would dramatically shake up the dynamics in the Senate.

What might have happened to McConnell?

Without an official diagnosis (which McConnell has not released), it’s impossible to know what is causing these events. Monahan seemed to suggest they could be tied to McConnell’s concussion, or that it’s possible the minority leader has been negligent in drinking water, writing in his letter last week, “Occasional lightheadedness is not uncommon in concussion recovery and can also be expected as a result of dehydration.”

One other explanation could be that he is experiencing episodes 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, whether episodic or persistent, 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.

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, events like these merit immediate medical evaluation to diagnose and treat whatever underlying condition is causing them.

Although he left the podium immediately after the July event, he returned a few minutes later to answer questions from the press corps, and he spoke with reporters in the evening. Beyond sharing Monahan’s letters, his office has not shared details about his health. —Keren Landman

Who could replace McConnell if he retires?

Though a few GOP lawmakers are reportedly weighing whether to gather the caucus to speak about McConnell and his future, McConnell’s Republican colleagues have remained publicly supportive of him.

Texas Sen. John Cornyn said in July, “I’ll support Senator McConnell as long as he wants to remain as leader.” Texas Sen. Ted Cruz told Politico at the time, “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.” And even his sometime rival Sen. Rick Scott told CBS after his second incident, “I expect he’ll continue to be the Republican leader through this term.”

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.

Update, September 6, 10:30 am ET: This story, originally published July 27, has been updated multiple times, most recently with additional information from McConnell’s physician.

Correction, August 30, 5:20 pm ET: A previous version of this story misstated Mitch McConnell’s title. He is the Senate minority leader.