With health-bill collapse, Republicans face uncertain electoral future in 2018

David Weigel, reporting for the Washington Post:

As the seven-year Republican effort to repeal the Affordable Care Act crashed on the threshold of the Senate, President Trump offered his party a rescue strategy. Step one: Blame Democrats. Step two: Win more seats and try again.

“We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it,” said Trump. “In ’18, we’re going to have to get some more people elected. We have to go out and get more people elected that are Republicans.”

Trump made explicit what Republicans had been hoping since the repeal fight started — that whatever happened, voters would blame the Democrats for their health-care costs. It’s an audacious strategy that flies against current polling and electoral history. It counts on messaging, distracted voters and a built-in electoral advantage to guide the party past the rocks.

“The worm’s kind of turned on this issue,” said Tom Davis, a former Republican congressman from Virginia who ran the party’s House campaign group in several cycles. “Republicans might have gotten a break by not seeing an unpopular law go into effect. Sometimes, having no law is better than having one that people perceive as bad law.”

By the time the Better Care Reconciliation Act tanked late Monday, Trump had repeatedly predicted that the “disaster” of the ACA would collapse, forcing Democrats to the bargaining table. The administration’s indecision on whether to keep funding subsidies for plans bought on ACA exchanges had been cited by many insurers announcing rate hikes or canceled plans — announcements that the administration cited as proof of collapse.

Polling, however, found most voters ready to blame Republicans for the rate hikes. An April survey by the Kaiser Family Foundation found 60 percent of voters opposed to using the subsidies as bargaining chips; even 28 percent of Republicans were opposed. Seventy-four percent of voters said they wanted the administration to “make the law work,” and 64 percent said that “President Trump and Republicans in Congress” would be accountable for “any problems.”

Even some Republicans who wanted to force Democrats to negotiate said that six months of negotiations had sapped the party’s momentum. “I advocated collapse and replace for months,” said Sen. Lindsey Graham (R-S.C.). “But we’re so deep into this thing right now, I don’t even know if that’s a viable option.”

In interviews Tuesday, Democrats who face re-election in 2018 expressed disbelief at the idea that they, not Trump, would be held accountable for problems with the health-care system.

“I have a bill in that will stabilize the individual market, if they’d just allow the Senate to work,” said Sen. Tim Kaine (D-Va.), the party’s 2016 vice presidential nominee. “Let the committee chairs tackle this.” If premiums spiked, said Kaine, voters would look to “the party that’s governing, that refuses to allow a process that would bring premiums down.”

Sen. Bill Nelson (D-Fla.), who may be challenged by longtime ACA opponent Gov. Rick Scott (R-Fla.), said that he was eager to work with Republicans on shoring up the subsidies. Voters back home, he said, clearly saw the Trump administration as the impediment to fixing the law.

“Let me tell you, people are coming out of the woodwork,” said Nelson. “I go to the Tampa Bay Rays game, I throw out the first pitch, and people are begging: Don’t let them take away my health care. People are onto this.”

Nelson is one of 10 Democrats up for reelection in states won by Trump last year, a factor that Republicans once thought would scare incumbents into making deals. Instead, Democrats have grown more confident about their 2018 chances, with few top-tier candidates jumping into “Trump state” races, and credible Democrats running for seats in Nevada and Texas.

In all of those races, it’s not clear how “Obamacare” will play, or how Republicans will play it. From April through June, the GOP played a perfect game in four special House elections, winning by single digits in typically Republican districts. Yet for the first time since 2010, Obamacare repeal was not a focus of Republican ads and attacks.

Instead, Republicans moved closer to attacking Democrats on what they might want to build on top of the ACA. In Montana’s special election, that was the Medicare-for-all plan favored by Sen. Bernie Sanders (I-Vt.). In a series of statements this month, the Republican National Committee and National Republican Congressional Committee went after Democrats on the estimated cost of creating a single-payer system, similar to Canada’s, in the United States. In districts where vulnerable Republicans had cast votes for repeal, putting them on the record for Medicaid cuts and high estimates of lost health insurance, Republicans would warn that Democrats wanted socialism.

“Their House primaries are starting to look like a ten-car pile-up and the activist base is screaming for Democrats to run on single-payer health care,” wrote NRCC spokesman Jesse Hunt in a press release just hours before the Senate repeal push collapsed.

“They don’t want to get us off of the Obamacare train; they want to double-down on a failed system that is in the middle of a collapse,” House Speaker Paul D. Ryan (R-Wis.) said at a Tuesday morning press conference. “Ultimately, it’s very clear that they’re more interested a single-payer system which means government-run health care. Government-run health care is not in our nation’s interest.”

Other Republicans suggested that the health care issue could fade as the election approaches — an advantage for the party, so long as it doesn’t fumble on anything else it has promised.

“It’s more important for Republicans to do something on taxes,” said Davis. “If they can’t produce on that, then I think they have a problem.”

Senate Republicans’ effort to ‘repeal and replace’ Obamacare all but collapses

Via The Washington Post:

Senate Republicans all but admitted defeat Tuesday in their seven-year quest to overturn the Affordable Care Act, acknowledging that they lacked the votes to make good on their vow to “repeal and replace” President Barack Obama’s signature legislative accomplishment.

Hours after GOP leaders abandoned a bill to overhaul the law known as Obamacare, their fallback plan — a proposal to repeal major parts of the law without replacing them — quickly collapsed. A trio of moderate Republicans quashed the idea, saying it would irresponsibly snatch insurance coverage from millions of Americans.

“I did not come to Washington to hurt people,” tweeted Sen. Shelley Moore Capito (R-W.Va.), who joined Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) in opposing immediate repeal.

Senate Majority Leader Mitch McConnell (R-Ky.), who spent weeks trying to knit together his fractious caucus in support of the original GOP legislation, said he would nonetheless schedule a vote “early next week” on the repeal plan. But he appeared to acknowledge that it seemed doomed.

“This has been a very, very challenging experience for all of us,” McConnell told reporters. “It’s pretty obvious that we don’t have 50 members who can agree on a replacement.”

The collapse of the effort marks a devastating political defeat for congressional Republicans and for President Trump, who had pledged to roll back the Affordable Care Act on “Day One” of his presidency.

It also leaves millions of consumers who receive health insurance through the law in a kind of administrative limbo, wondering how their care will be affected now that the program is in the hands of government officials who have rooted openly for its demise.

On Tuesday, Trump told reporters in the White House’s Roosevelt Room that he now plans to “let Obamacare fail. It will be a lot easier.” That way, he said, his party would bear no political responsibility for the system’s collapse.

“We’re not going to own it. I’m not going to own it,” the president said. “I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us” to fix it.

But Trump’s comments appeared to ignore the many Republican lawmakers who are anxious about depriving their constituents of federal benefits on which they now rely. The president invited all 52 Republican senators to join him for lunch Wednesday at the White House to try to get the repeal effort back on track.

Senate leaders have been struggling to devise a plan to overhaul Obamacare since the House passed its version of the legislation in May, a flawed bill that some House members openly invited the Senate to fix. With just 52 seats, McConnell could afford to lose the support of only two members of his caucus — and even then would rely on Vice President Pence to break the tie.

The measure he produced would have scaled back key federal insurance regulations and slashed Medicaid deeply over time. But it did not go far enough for many conservative Republicans, who wanted to roll back more of the ACA’s mandates on insurers.

And the bill went much too far for many moderates, especially Republicans from states that had taken advantage of the ACA’s offer to expand Medicaid eligibility. The bill would have cut Medicaid funding and phased out its expansion in 31 states and the District of Columbia. Some senators worried that their states would be saddled with the unpalatable choice of cutting off people’s health coverage or shouldering a massive new financial burden.

“This is the Senate. Leadership sets the agenda, but senators vote in the interests of their states,” said Sen. Marco Rubio (R-Fla.).

Sen. Orrin G. Hatch (R-Utah) offered a blunt assessment of why the effort fell short: “We are so evenly divided, and we’ve got to have every Republican to make things work, and we didn’t have every Republican,” he said.

Two Republicans — Collins, a moderate, and conservative Sen. Rand Paul (Ky.) — declared late last week that they could not support the latest version of the bill. Late Monday night, as six of their colleagues talked health-care strategy with Trump over dinner at the White House, conservative Sens. Mike Lee (Utah) and Jerry Moran (Kan.) announced that they, too, would oppose the bill, and the measure was dead.

Senate Majority Whip John Cornyn (R-Tex.), whose job is to count votes, said he had “no idea” Lee was defecting until he left the White House meeting — though he had gotten a heads up from Moran.

Much more here.

 

Two more Senate Republicans oppose health-care bill, leaving it without enough votes to pass

Sean Sullivan and Lenny Bernstein, reporting for the Washington Post:

Two more Senate Republicans have declared their opposition to the latest plan to overhaul the nation’s health-care system, potentially ending a months-long effort to make good on a GOP promise that has defined the party for nearly a decade and been a top priority for President Trump.

Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements declaring that they would not vote for the revamped measure. The sudden breaks by Lee, a staunch conservative, and Moran, an ally of Senate Majority Leader Mitch McConnell (R-Ky.), rocked the GOP leadership and effectively closed what already had been an increasingly narrow path to passage for the bill.

They joined Sens. Rand Paul (Ky.) and Susan Collins (Maine), who also oppose it. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the Affordable Care Act. All 46 Democrats and two independents are expected to vote against it.

In a pair of tweets Tuesday morning, Trump decried the defections, called for letting the Affordable Care Act “fail” and vowed to keep pushing for a GOP plan.

“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” he wrote in the first tweet.

He followed that with: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”

Republicans, who have made rallying cries against President Barack Obama’s 2010 health-care law a pillar of the party’s identity, may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.

Meanwhile, Trump and other Republicans will confront a Republican base that, despite fervent support for the president, still seeks a smaller federal government and fewer regulations.

All of these forces remained vexing factors Monday as senators bailed on the bill. And no evident solution was offered by the White House — which has been limited in its sale of the GOP plan — or from McConnell, for how to bring together a party in which moderates and conservatives are still deeply divided over the scope of federal health-care funding and regulations.

McConnell did announce late Monday that he plans to push for a vote in the coming days anyway, but with a catch: senators would be voting to start debate on the unpopular House-passed bill. McConnell has promised to amend the bill to a pure repeal, but with no guarantee that such an amendment would pass.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations,” Lee said in a statement.

Moran said the bill “fails to repeal the Affordable Care Act or address healthcare’s rising costs.”

The two senators timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by McConnell would not be enough to meet their demands.

They joined a pair of GOP colleagues in calling for a complete redrawing of the legislation that would take many months, short-circuiting McConnell’s wish to end the debate this month.

The news threw the effort to pass the legislation into turmoil, with additional Republicans weighing in on Twitter about a flawed process that must take a new direction. Trump tweeted that “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan.”

Sen. Lindsey O. Graham (S.C.) called for a “new approach” while Rep. Mark Meadows (N.C.) tweeted, “Time for full repeal.” White House aides, meanwhile, said they still plan to press ahead.

Much more here.

By a 2-to-1 margin, Americans prefer Obamacare to Republican replacements

Philip Bump, writing in the Washington Post:

Republicans racing to pass a bill that would overhaul the Affordable Care Act (better known as Obamacare) certainly understand that their efforts aren’t polling well. In survey after survey, a majority of respondents view their legislative proposals unfavorably. At the same time, survey after survey shows Obamacare as more popular than not.

In the new Post-ABC News poll released Sunday, we decided to ask the question directly: Which do you prefer, Obamacare or the Republican replacement plans?

By a 2-to-1 margin — 50 percent to 24 percent — Americans said they preferred Obamacare.

There’s a split by party, as you might expect, with Democrats broadly favoring the existing law and Republicans the latter. But that split wasn’t even, with 77 percent of Democrats favoring the legislation passed in 2010 by their party and only 59 percent of Republicans favoring their party’s solution. Independents in this case came down on the side of the Democrats, with 49 percent favoring the existing law vs. 20 percent backing the GOP alternative.

What’s more, roughly 6-in-10 Democrats and a third of independents strongly prefer Obamacare. Only 43 percent of Republicans strongly prefer their party’s proposal.

Some respondents, unprompted, said they preferred some other proposal, or neither. One-in-10 Democrats offered one of those responses, while about 2-in-10 Republicans and independents did.

More worrisome for Republicans hoping to pass a new bill is how the support broke out by demographic. Only among Republicans, conservatives, white evangelicals and white men without college degrees did more Americans support the GOP bill than Obamacare. In every other group analyzed, including older respondents and white women without college degrees — an important part of President Trump’s voting base in 2016 — backed the existing law by some margin.

Much more here.

Republicans thought they could force 2018 Democrats to cut deals, but Trump keeps sliding in polls

Paul Kane, reporting for the Washington Post:

Senate Republicans began this year thinking that they had leverage over some Democrats, particularly the 10 up for reelection next year in states that President Trump won in the fall.

Those Democrats, some GOP strategists believed, would want to work with the president to appeal to enough Trump voters to win their states in November 2018.

That didn’t happen. Instead, Trump’s standing has slipped in many of these states. The president has faced legislative gridlock and a deepening investigation of his campaign’s connections to Russia. His focus, in public appearances and on social media, has regularly drifted away from the policy agenda on Capitol Hill.

That’s left Senate Democrats feeling stronger than they expected to be eight months after their highly disappointing showing in 2016, which left them in the minority and heading into 2018 defending 25 seats compared with Republicans’ eight.

If Trump had spent his first six months increasing or even maintaining his popularity in these states, he might have struck enough political fear in these 2018 Democrats to compel them to support some of his initiatives.

That’s looking more and more like the sort of negotiation that will happen only if Democrats can command a good deal in return.

The dynamic is sure to test Senate Majority Leader Mitch McConnell (R-Ky.) in the months ahead, particularly if Republicans fail to muster the votes solely from their side of the aisle to repeal chunks of the Affordable Care Act. McConnell has warned that such an outcome will force him to work with Democrats to shore up imploding insurance markets.

“No action is not an alternative,” McConnell said Thursday while in Kentucky.

Beyond the health-care fight, McConnell has also made clear that there are many other agenda items that will require the traditional 60-vote threshold to choke off filibusters, meaning he needs at least eight Democrats to move legislation such as annual government funding bills and an increase in the government’s borrowing authority.

But the bargaining table is different now.

Take Sen. Tammy Baldwin (D-Wis.), whose state delivered a critical victory for Trump, the first by a GOP presidential nominee since 1984.

A staunch liberal, Baldwin began the year expecting her 2018 reelection bid to be a 50-50 prospect. Her state had voted Republican three straight times for governor and in two of the past three Senate races.

Trump has used the presidential bully pulpit to focus on the Badger State, making three trips there since November. But his visits have done little to boost his standing.

Just 41 percent of Wisconsin voters approved of Trump’s job performance in late June, while 51 percent disapproved, according to a poll by Marquette Law School.

On basic popularity, Trump is easily the most disliked politician among Wisconsin voters, with 54 percent holding an unfavorable view of him and 40 percent a favorable one.

Baldwin’s image is not great, but it is far better in Wisconsin’s eyes than Trump: 38 percent have a favorable view and 38 percent unfavorable.

It’s the same in Michigan and Pennsylvania, both states Trump narrowly won. In Michigan, just 35 percent of voters approved of his job performance in a late May poll conducted by EPIC-MRA, with 61 percent disapproving. In Pennsylvania, 37 percent supported his job performance while 49 percent did not, according to a May poll by Franklin & Marshall College.

More here.

Attack of the Republican Decepticons

Paul Krugman, reporting for the New York Times:

Does anyone remember the “reformicons”? A couple of years back there was much talk about a new generation of Republicans who would, it was claimed, move their party off its cruel and mindless agenda of tax cuts for the rich and pain for the poor, bringing back the intellectual seriousness that supposedly used to characterize the conservative movement.

But the rise of the reformicons never happened. What we got instead was the (further) rise of the decepticons — not the evil robots from the movies, but conservatives who keep scaling new heights of dishonesty in their attempt to sell their reverse-Robin Hood agenda.

Consider, in particular, Republican leaders’ strategy on health care. At this point, everything they say involves either demonstrably dishonest claims about Obamacare or wild misrepresentations of their proposed replacement, which would — surprise — cut taxes for the rich while inflicting harsh punishment on the poor and working class, including millions of Trump supporters. In fact, there’s so much deception that I can’t cover it all. But here are a few low points.

Despite encountering some significant problems, the Affordable Care Act has, as promised, extended health insurance to millions of Americans who wouldn’t have had it otherwise, at a fairly modest cost. In states that have implemented the act as it was intended, expanding Medicaid, the percentage of nonelderly residents without insurance has fallen by more than half since 2010.

And these numbers translate into dramatic positive impacts on real lives. A few days ago the Indiana G.O.P. asked residents to share their “Obamacare horror stories”; what it got instead were thousands of testimonials from people whom the A.C.A. has saved from financial ruin or even death.

How do Republicans argue against this success? You can get a good overview by looking at the Twitter feed of Tom Price, President Trump’s secretary of health and human services — a feed that is, in its own way, almost as horrifying as that of the tweeter in chief. Price points repeatedly to two misleading numbers.

First, he points to the fact that fewer people than expected have signed up on the exchanges — Obamacare’s insurance marketplaces — and portrays this as a sign of dire failure. But a lot of this shortfall is the result of good news: Fewer employers than predicted chose to drop coverage and shift their workers onto exchange plans. So exchange enrollment has come in below forecast, but it mostly consists of people who wouldn’t otherwise have been insured — and as I said, there have been large gains in overall coverage.

More here.

McConnell says GOP must shore up ACA insurance markets if Senate bill dies

Juliet Eilperin and Samy Goldstein, reporting for the Washington Post:

Senate Majority Leader Mitch McConnell (R-Ky.) said Thursday that if his party fails to muster 50 votes for its plan to rewrite the Affordable Care Act, it will have no choice but to draft a more modest bill with Democrats to support the law’s existing insurance markets.

The remarks, made at a Rotary Club lunch in Glasgow, Ky., represent a significant shift for the veteran legislator. While he had raised the idea last week that Republicans may have to turn to Democrats if they cannot pass their own bill, his words mark the first time he has explicitly raised the prospect of shoring up the ACA.

“If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said. “No action is not an alternative. We’ve got the insurance markets imploding all over the country, including in this state.”

McConnell, who pledged in 2014 to eradicate the law also known as Obamacare “root and branch,” initially raised the prospect of having to work with Democrats last week after he pulled a measure he had crafted behind closed doors. That bill would jettison the ACA’s requirement that most individuals prove they have health coverage, would repeal or delay billions in taxes imposed under the current law and would make deep, long-term cuts to the nation’s Medicaid program.

But while he previously declared that Republicans “need to come up with a solution” if they wanted to make real changes to the nation’s health-care system, McConnell on Thursday acknowledged how difficult it is proving to craft an alternative that can satisfy the GOP’s conservative and centrist camps.

His suggestion that he and his colleagues might instead try to bolster the insurance exchanges created under the ACA is at odds with Republican talking points that they are beyond repair. The marketplaces were built for people who do not have access to affordable coverage through a job, and at last count slightly more than 10 million Americans had health plans purchased through the exchanges. More than 8 in 10 customers bought their plans with federal subsidies the law provides.

Until now, both congressional Republicans and the Trump administration have contended that the “collapse” of the ACA marketplaces is a main reason to erase much of the 2010 law.

* * *

Yet the Fourth of July recess has not bolstered the political prospects for McConnell’s legislation; GOP senators have been peppered with questions by constituents anxious about the potential impact on their coverage. In the past several days, some senators have implied that considerable work would still be required before the Better Care Reconciliation Act could pass the Senate.

Sen. Patrick J. Toomey (R-Pa.), a conservative who has played a key role in the chamber’s health-care negotiations this year, said Wednesday during an appearance before a live audience at WHTM-TV in Harrisburg, “We’re still several weeks away from a vote, I think.”

On Thursday Sen. Ted Cruz (R-Tex.), who opposed McConnell’s original draft bill, also voiced skepticism about the chances of reaching a consensus. “If we cannot bring the conference together and agree on repeal legislation, then I think President Trump’s absolutely right that we should pass a clean repeal,” Cruz told reporters, adding such a repeal should be delayed “either a year or two years” to allow time for a replacement.

Earlier in the day, Cruz said in an interview with KTSA radio in San Antonio that though he was feeling hopeful, “I don’t know if we get it done or not.” The situation, he said, “is precarious.”

Meanwhile, Sen. Jerry Moran (R-Kan.) told a town hall meeting in rural Palco that “there are people who tell me they are better off” with the ACA, “and I believe them.” Moran, who said last week he did not support the GOP measure in its current form, called for “a national debate that includes legislative hearings. . . . It needs to be less politics and more policy.”

President Trump has repeatedly pronounced the ACA “dead.” And in contrast with their predecessors in the Obama administration, who talked up the law’s marketplaces, Health and Human Services officials have been issuing maps, detailing in red the number of U.S. counties in danger of being without marketplace offerings for 2018. The most recent map, released Wednesday, showed 40 “bare” counties in Ohio, Indiana and Nevada.

More here.

As GOP buckles down on health care, conservative media loses interest

David Weigh, reporting for the Washington Post:

On Tuesday, the fate of the Republicans’ attempt to undo the Affordable Care Act dominated news out of Washington. Phones rattled with alerts about the decision to delay a vote until mid-July. Camera crews jostled for shots of senators meeting with President Trump, then boarding a bus that took them past jeering protesters.

A viewer tuning into Fox News that night hardly saw any of it.

The network’s prime-time shows, ratings kings of cable news, ignored the health-care story. Fox’s 8 p.m. and 10 p.m. shows began with stories about a sting video that caught a CNN producer dismissing his network’s coverage of Russia and the 2016 election. “The Five,” Fox’s 9 p.m. show, began with the “bombshell” news that President Barack Obama had said — in October 2016 — that it would be “impossible” to rig the election. Nine minutes were spent on the Senate bill before a segue way into the CNN story.

The lack of “Obamacare repeal” coverage, unthinkable just six months ago, reflected a general decline of conservative interest in what had united Republicans for seven years. Conservative grass-roots groups have either ignored the latest health-care details, like Americans for Prosperity, or lobbied against the bill, like the Club for Growth.

Meanwhile, the White House and a symbiotic conservative media have largely moved on to other topics of media bias and cultural warfare. Fox’s multiple segments on the CNN sting came after White House spokeswoman Sarah Huckabee Sanders told reporters to watch it. Rush Limbaugh, whose dominant talk show was live during the Senate news, barely mentioned it at all.

“It’s not that surprising,” said Charlie Sykes, a former talk radio host from Wisconsin who has condemned what he sees as a move toward tribalism on the right. “You look at the trajectory of conservative media and it’s not been policy-oriented for a long time. It’s about whether you get the win or not. There’s nothing for Rush Limbaugh to sex up about a bill that’s neither repeal nor reform.”

It was not always like that — not when it came to “Obamacare.” Coverage of the bill’s passage, at the height of the tea party movement, was generally robust, if focused on details that irritated Democrats. (Democratic House leader Nancy Pelosi’s infamous promise that people would “know what’s in the bill” after it was passed was about “the fog of controversy” churned up by conservatives.)

As a grass-roots movement, the tea party has largely disappeared or shifted its focus to states, where it has won real victories against the ACA. Since the start of the year, it has been outnumbered by “resistance” activists who continue to crowd town hall meetings and rally outside of congressional offices. Despite the struggles of the repeal bill, pro-repeal protesters have been rare.

“It’s pretty quiet,” said Rep. Mark Sanford (R-S.C.), one of the few Republican members of Congress who has held and advertised open town hall meetings — which have been swarmed by Democrats. “There’s some hope that we will be able to change this on a wholesale level; other folks are saying no, the handwriting’s on the wall. It’s a fairly one-sided political equation in my district and in the districts I’m familiar with.”

Coverage on Fox News has captured the shift in real time. On the network, the only one that has scored presidential interviews this month, the repeal fight is covered as a priority of President Trump that his allies in Congress are doing a poor job of managing. In a friendly weekend interview, Fox contributor Pete Hegseth framed the health-care fight as a battle between unhinged Democrats and a careful president. He asked just one question about the bill itself: “Are Republican senators doing enough to have your back to get that health-care bill through?”

More here.

‘Repeal and replace’ was once a unifier for the GOP. Now it’s an albatross.

Dan Balz, reporting for the Washington Post:

For Republicans, Obamacare was always the great unifier. In a fractious party, everyone agreed that the Affordable Care Act was the wrong solution to what ailed the nation’s health-care system, with too much government and too little freedom for consumers.

Replacing Obamacare has become the party’s albatross, a sprawling objective still in search of a solution. The effort to make good on a seven-year promise has cost the Trump administration precious months of its first year in office, with tax restructuring backed up somewhere in the legislative pipeline, infrastructure idling somewhere no one can see it and budget deadlines looming.

Republicans have been here before on health care, on the brink and scratching for votes. The House eventually found a way through this political and substantive maze. Now it’s left to Senate Majority Leader Mitch McConnell (R-Ky.) to find the puzzle pieces and President Trump, perhaps, to supply some muscle, lest the GOP be forced to admit failure on the party’s top legislative priority.

Was it only Monday that Majority Whip John Cornyn (R-Tex.) boldly declared there would be no turning back this week, that the Senate health-care bill would be put to a vote before lawmakers leave for the July 4 recess? “I am closing the door,” he tweeted. “We need to do it this week.” So much for that.

If it was a bluff by the leaders, other Republican senators called it. McConnell, a shrewd legislative poker player, quickly folded Tuesday. Instead of moving forward, the bill is now on ice. The original Senate leadership plan called for negotiations in secret by a small group, springing the results on the other members and forcing a quick vote before outside opponents could mobilize. Instead, the calculation that time was of the essence crashed into the reality of vote counting. The new calculus is that delay is better than defeat.

But will more time help to melt away the opposition? It did in the House, after the sudden and spectacular collapse of the leadership’s bill hours before a scheduled vote in late March. By early May, after weeks of negotiations between Freedom Caucus conservatives and members of the less-conservative Tuesday Group, the House approved a bill. The president was so hungry for even a partial victory that he held a ceremony of celebration with House members in the Rose Garden. Later, he privately and then publicly called that House bill “mean,” and it was left to the Senate to make amends.

In a worst-of-all-worlds environment, Republicans continue to struggle with what they’re selling, beyond the stated goal of repealing or revising the Affordable Care Act. Whatever overarching arguments they hope to make on behalf of their legislation have been lost in a welter of competing claims and demands among senators with different priorities and dissimilar ideological viewpoints.

Much more here.

Who’s afraid of Trump? Not enough Republicans — at least for now.

Philip Rucker, Robert Costa and Ashley Parker, reporting for the Washington Post:

Scrambling to line up support for the Republican health-care bill, President Trump got on the phone Monday with Sen. Mike Lee (R-Utah) and urged him to back the measure.

The president’s personal plea was not enough. On Tuesday, Lee said he would vote against the bill. Senate GOP leaders later postponed the planned health-care vote because too many other Republican senators also opposed — for now, at least — legislation that would deliver on Trump’s campaign promise to scale back the law known as Obamacare.

Trump had hoped for a swift and easy win on health care this week. Instead he got a delay and a return to the negotiating table — the latest reminder of the limits of his power to shape outcomes at the opposite end of Pennsylvania Avenue.

History suggests that presidents who have governed successfully have been both revered and feared. But Republican fixtures in Washington are beginning to conclude that Trump may be neither, despite his mix of bravado, threats and efforts to schmooze with GOP lawmakers.

The president is the leader of his party, yet Trump has struggled to get Republican lawmakers moving in lockstep on health care and other major issues, leaving no signature legislation in his first five months in office. The confirmation of Supreme Court Justice Neil M. Gorsuch is his most-cited achievement to date.

“This president is the first president in our history who has neither political nor military experience, and thus it has been a challenge to him to learn how to interact with Congress and learn how to push his agenda better,” said Sen. Susan Collins (R-Maine), who opposes the current health-care bill.

The Senate could pass a revised version of the bill once lawmakers return from their July 4 recess and pick up deliberations. Still, some Republicans are willing to defy their president’s wishes — a dynamic that can be attributed in part to Trump’s singular status as a disrupter within his party.

“The president remains an entity in and of itself, not a part of the traditional Republican Party,” said Rep. Carlos Curbelo (R-Fla.), a moderate who represents a district Trump lost by 16 percentage points. “I handle the Trump administration the same way I handled the Obama administration. When I agree, I work with them. When I oppose, I don’t.”

In private conversations on Capitol Hill, Trump is often not taken seriously. Some Republican lawmakers consider some of his promises — such as making Mexico pay for a new border wall — fantastical. They are exhausted and at times exasperated by his hopscotching from one subject to the next, chronicled in his pithy and provocative tweets. They are quick to point out how little command he demonstrates of policy. And they have come to regard some of his threats as empty, concluding that crossing the president poses little danger.

“The House health-care vote shows he does have juice, particularly with people on the right,” Sen. Lindsey O. Graham (R-S.C.) said. “The Senate health-care vote shows that people feel that health care is a defining issue and that it’d be pretty hard for any politician to push a senator into taking a vote that’s going to have consequences for the rest of their life.”

Asked if he personally fears Trump, Graham chuckled before saying, “No.”

More here.

Trump likely to break many of his health-care promises — no matter what happens

John Wagner, Abby Phillip and Jenna Johnson, reporting for the Washington Post:

Donald Trump set himself apart from other Republican presidential candidates when it came to health care. Before taking office, he vowed “insurance for everybody” that would be “much less expensive and much better” and explicitly promised not to touch Medicaid, which millions of his working-class supporters rely upon to cover doctor’s visits and medication.

But as Republicans in the Senate press ahead with legislation that would dramatically cut Medicaid and scale back the Affordable Care Act marketplaces, it is increasingly clear that President Trump is almost certain to fall well short of fulfilling those promises.

Trump and congressional Republicans will likely hail any bill that reaches the president’s desk as the fulfillment of a long-standing pledge to “repeal and replace” the ACA, former president Barack Obama’s signature health-care law. But if the House and Senate agree on legislation along the lines of what is now being debated, millions — including some of Trump’s most ardent supporters — are projected to lose coverage, receive fewer benefits or see their premiums rise.

And if the health-care push stalls or falls apart, the president who campaigned for the White House as the ultimate dealmaker will be dealt a serious political blow — another example of Trump’s inability to move major legislation through Congress.

“He’s going to own it either way, whether he signs a bill or doesn’t get a bill,” said Michael Steele, the former chairman of the Republican National Committee. Steele said passage of the legislation could hurt Trump politically as much as its failure. “You’re going to have a whole generation of people who had health care losing health care, and in many instances, they’re Trump voters. I think that’s a very risky play.”

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“Conservatives should embrace the goal of universal coverage, and this bill makes enormous progress towards that goal,” said Avik Roy, a health-care expert who was critical of the House bill but supports the Senate’s version.

“Does this bill have heart?” Roy asked, citing a standard Trump recently articulated. “It absolutely does.”

Polls suggest Trump has a long way to go to make that case to voters.

Only 16 percent of adults believe that House bill is a good idea, while 48 percent say it’s a bad idea, according to an NBC News/Wall Street Journal poll released last week. Even Republican respondents are lukewarm, with 34 percent viewing the bill positively and 17 percent viewing it negatively.

Doug Heye, a Republican consultant, argued that the president badly needs a legislative victory and that achieving a high-profile win should override concerns about the legislation’s impact.

“Those who are strong Trump supporters have remained so despite the controversies,” Heye said. “They still see Trump as someone willing to take on their fights.”

Interviews with Trump supporters who attended his campaign rally in Cedar Rapids suggest that many of them are dissatisfied with their health care — and many suspect Trump won’t fully deliver on his promises. But so far, they don’t seem inclined to blame him.

Much more here.

From Worse to Bad on Health Care

Ross Douthat, writing in the New York Times:

THE Obamacare replacement that the House sent to the Senate might as well have had a note scrawled across its pages: Save us from ourselves.

And the Senate bill, which just emerged from Mitch McConnell’s underground laboratories into the light of day, does indeed improve uponthe House’s bill in several important ways. But is that enough to make the new version an electoral winner for Republicans? Probably not: At best one might say that it’s a political suicide attempt that’s somewhat less likely to succeed. Is it enough to make it sound public policy? Again, I think not: There are good ideas worked in, but still too much needless callousness.

The best argument for the bill is twofold. First, it officially reconciles the Republican Party to the idea that the government should provide support for working-class health insurance — a necessary and overdue reconciliation. Second, it takes part of Obamacare’s basic structure — tax credits, pegged to income, to enable the lower-middle class and near poor to afford coverage — and uses it to further two of the more compelling conservative health policy objectives: higher-deductible plans (which tend to reduce health care cost inflation) rather than comprehensive ones (which exacerbate it), and subsidies for private insurance rather than Medicaid for the near-poor, because private coverage may deliver better health.

So far, so reasonable. Also reasonable: a loosening of age-based price controls to make the exchanges more viable, and the fact that the Senate’s bill’s income-based credits are less stingy than the House bill’s flat credit, and thus less likely to leave the poor and old with impossible premiums to pay.

But stinginess is still the essential problem for the Senate’s alternative. High-deductible insurance plans make less sense the poorer you get, which is why they should ideally be encouraged from the top of the income ladder down — through a cap on the tax subsidy for employer-provided insurance, ideally, a sound conservative idea left at the altar by this bill.

Pushing them from the bottom of society only makes sense if you’re also willing to pre-fund health savings accounts for the near-poor, so that they can actually hope to pay their out-of-pocket costs. But this costs money that Republicans prefer to reserve for tax cuts. So the bill’s attempted transition from Medicaid to private coverage would inevitably leave the people transitioning worse off, with deductibles that they couldn’t pay even if their choice of doctors were technically better.

Meanwhile the middle-class Americans most justifiably aggrieved by Obamacare — the people just above the subsidy cutoff, buying unsubsidized insurance that Obamacare made less affordable — will gain little from the bill, and because the subsidy ceiling is lowered (from 400 percent of poverty to 350 percent) their ranks will actually increase.

The House bill, flawed in so many respects, at least made an effort on this front, since its flat subsidy was available to the people currently getting hosed by Obamacare prices. But maintaining a smaller version of that subsidy would have, once again, cost money, so instead the health care law’s biggest losers will continue to lose out.

Politically, then, it’s very hard to see a clear constituency for this bill, apart from the mostly wealthy voters who will appreciate its rollback of Obamacare’s tax increases. Because it preserves more reasonable subsidies than the House bill and because its Medicaid drawdown happens in the distant 2020s — which is to say, perhaps never — it might not be an outright political catastrophe. But it’s still the act of a party dedicated primarily to rescuing the rich from their tax rates, rather than stewarding the common good.

The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume. That analysis lends support to some of the provisions in this bill. But a more holistic, less plutocratic conservatism would not stop there: In an environment where de-industrialization and social breakdown have driven the working class Trumpward, saying we should not oversubsidize their health insurance should be followed by saying so that we can find other ways to help them.

More here.

McConnell May Have Been Right: It May Be Too Hard to Replace Obamacare

Jennifer Steinhauer and Robert Pear, writing in the New York Times:

Shortly after President Trump took office, Senator Mitch McConnell of Kentucky, the majority leader, met privately with his colleagues to discuss the Republican agenda. Repealing the Affordable Care Act was at the top, he said. But replacing it would be really hard.

Mr. McConnell was right.

The many meetings Republicans held to discuss a Senate health care bill have exposed deep fissures within the party that are almost as large as the differences between Republicans and Democrats. Elements of a bill that passed the House this month have divided Republicans.

Mr. McConnell faces an increasingly onerous math problem. He can afford to lose only two Republicans if he is to get a bill through the Senate, and that would require the help of Vice President Mike Pence, who would have to cast the tiebreaking vote. But at least three senators in the party are diametrically opposed to the views of at least another three, so the path to agreement is narrow.

Republicans are roughly split over whether the expansion of Medicaid under the Affordable Care Act should be rolled back or continued, at least in the short run. They disagree about how the federal government should grant states more control over setting insurance standards.

They are also divided over a critical portion of the House bill, which would allow states to obtain waivers from two of the most important federal mandates: a requirement to provide a minimum set of health benefits, and a prohibition against charging higher prices to people with pre-existing medical conditions.

The challenges facing Senate Republicans are so great that overhauling the tax code as Mr. Trump has proposed — by slashing the corporate rate to 15 percent from 35 percent, reducing the number of brackets for individuals to three from seven, and doubling the standard deduction — is starting to look easier by comparison. “I allow that’s a possibility,” said Senator Patrick J. Toomey, Republican of Pennsylvania, who is closely involved in negotiating both issues, and favors a rollback of the Medicaid program.

This week, the normally circumspect Mr. McConnell conceded that it was going to be difficult to get the votes needed from Republicans to pass a health care bill. A Congressional Budget Office report on the House bill, forecasting an increase of 23 million Americans without insurance in a decade and significantly higher premiums for older and sick people, bolstered the resolve of Republican senators who have been skeptical of the House effort.

Most Republicans in Congress would like to keep their vow to repeal and replace the Affordable Care Act, but they face a more urgent challenge: to stabilize insurance markets that, in some states, are in danger of melting down next year.

Every week brings word of insurers seeking big rate increases or announcing plans to pull out of another market in 2018. It is conceivable that the two parties could, at some point, work together on short-term fixes outside the repeal process.

“I don’t think we want the market to fail,” said Senator Orrin G. Hatch, Republican of Utah and the chairman of the Finance Committee, which is responsible for tax legislation and much of the Affordable Care Act. “We don’t want premiums to be so high that people can’t afford them.”

Republicans could pass a repeal measure and return to the health care system that was largely in place before the Affordable Care Act became law. But Speaker Paul D. Ryan, among others, has repeatedly stated that his party has a plan to make the system better, which would require the replacement part of the repeal-replace equation.

With health care negotiations sputtering, many Republicans are quietly turning their attention to changes in the tax code as a possible path for legislative success. Generally, Republicans are more unified around the fundamentals of a tax overhaul than on the details of health policy. The White House team working on tax issues is far less ideological than the team directing health care efforts, and it has worked harder to build early momentum, Republican aides say.

Though Republicans have been calling for a repeal of the health care law almost since President Barack Obama signed it in 2010, those calls have become more urgent as some of the insurance exchanges have struggled.

But with millions of Americans newly insured under the law, many governors, including some Republicans, are loath to roll it back, and many senators agree. Twenty Republican senators come from states that have expanded Medicaid under the Affordable Care Act.

More here.

G.O.P. Senators, Pulling Away From Trump, Have ‘a Lot Less Fear of Him’

Jennifer Steinhauer, reporting for the New York Times:

Senate Republicans, increasingly unnerved by President Trump’s volatility and unpopularity, are starting to show signs of breaking away from him as they try to forge a more traditional Republican agenda and protect their political fortunes.

Several Republicans have openly questioned Mr. Trump’s decision to fire the F.B.I. director, James B. Comey, and even lawmakers who supported the move have complained privately that it was poorly timed and disruptive to their work. Many were dismayed when Mr. Trump seemed to then threaten Mr. Comey not to leak negative information about him.

As they pursue their own agenda, Republican senators are drafting a health care bill with little White House input, seeking to avoid the public relations pitfalls that befell the House as it passed its own deeply unpopular version. Republicans are also pushing back on the president’s impending budget request — including, notably, a provision that would nearly eliminate funding for the national drug control office amid an opioid epidemic. And many high-ranking Republicans have said they will not support any move by Mr. Trump to withdraw from the North American Free Trade Agreement.

So far, Republicans have refrained from bucking the president en masse, in part to avoid undermining their intense push to put health care and tax bills on his desk this year. And the Republican leadership, including Senator Mitch McConnell of Kentucky, the majority leader, and the House speaker, Paul D. Ryan of Wisconsin, remains behind Mr. Trump.

But with the White House lurching from crisis to crisis, the president is hampering Republicans’ efforts to fulfill his promises.

“All the work that goes into getting big things done is hard enough even in the most tranquil of environments in Washington,” said Kevin Madden, a Republican operative who worked for John A. Boehner when he was the House speaker. “But distractions like these can become a serious obstacle to aligning the interests of Congress.”

When Congress and the White House are controlled by the same party, lawmakers usually try to use the full weight of the presidency to achieve legislative priorities, through a clear and coordinated vision, patience with intransigent lawmakers and message repetition. Mr. Trump’s transient use of his bully pulpit for policy messaging has upended that playbook.

“It does seem like we have an upheaval, a crisis almost every day in Washington that changes the subject,” Senator Susan Collins, Republican of Maine, who has been trying to advance health care legislation, said in a television interview on Thursday night.

The latest subject-changing crisis has been the fallout from Mr. Trump’s sudden dismissal of Mr. Comey, who was leading the F.B.I.’s investigation into contacts between the Trump campaign and Russia. Mr. Trump suggested last week that he might have surreptitiously taped his conversations with Mr. Comey, and on Sunday two Republican senators, Mike Lee of Utah and Lindsey Graham of South Carolina, said the president should turn over any such tapes, if they exist.

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In the days after Mr. Trump’s election victory, the mood was different, as Republicans expressed high hopes that they could move quickly on a conservative agenda that merged with Mr. Trump’s. “We’re going to be an enthusiastic supporter almost all the time,” Mr. McConnell said of Mr. Trump in November.

But Republicans have so far achieved few of their legislative priorities, like repealing the Affordable Care Act or cutting taxes. When Mr. Trump suggested this month that the Senate should change its rules to make it easier for Republicans to push bills through, Mr. McConnell firmly rejected the idea.

Lawmakers are also bucking the president by pushing ahead with bipartisan measures on sanctions against Russia. And this month, Republicans rejected many of the administration’s priorities in a short-term spending measure, including money for a wall along the border with Mexico.

Two Republican senators who face potentially tough re-election fights next year — Dean Heller of Nevada and Jeff Flake of Arizona — have been unabashed in their criticism of Mr. Trump and his administration, which they have clearly begun to view as a drag on their political prospects.

“In Arizona, we grow them independent,” Mr. Flake said, noting the unpopularity in his state of Mr. Trump’s views on the border wall and Nafta. “I expect people want someone who will say, ‘I’m voting with Trump on the good stuff and standing up to him on the not good stuff.’”

Some Republicans, like Mr. Ryan, have preferred to keep the focus firmly on the good stuff. Mr. Ryan has remained in harmony with the president, last month calling him “a driven, hands-on leader, with the potential to become a truly transformational American figure.”

Much more here.

Yes, House Republicans, the heartless health-care vote will define you

E.J. Dionne, Jr., writing in the Washington Post:

We should never forget May 4, 2017.

It should forever be marked as the day when the House of Representatives descended to a new level of cruelty, irresponsibility and social meanness.

The lower chamber has always claimed to be “the people’s house.” No more. It should now come to be known by other names: the house of selfishness, the house of suffering, the house of the wealthy, the house of expediency, the house of untreated illness. Perhaps also: the house of Trump.

The Anti-Health-Care Bill passed on Thursday bids to be the most remarkable redistribution of income in congressional history, from the poor and middle class to the very wealthy. An earlier version of the legislation, according to the Congressional Budget Office (CBO), would have thrown 24 million Americans off health insurance. This spiteful abomination is worse.

Republicans from Speaker Paul D. Ryan (Wis.) on down, who complained that insufficient study was given to Obamacare (despite more than a year of debate), rushed this bill through without scrutiny or a CBO score. They thought that having no numbers would make it easier for them to conceal the damage it would do to the American people — and get away with it. But their lies will be exposed.

They promised to improve Obamacare. Instead, they are bringing back the very problems that Obamacare actually fixed. One of the most popular provisions of the Affordable Care Act — supported by 87 percent of Americans in a March CNN/ORC poll — barred insurance companies from discriminating against those with preexisting conditions. This bill guts those protections.

Were you born with a heart defect? You’re out of luck. Did you have an illness in your teens that might come back? Tough. Other victims hidden in the fine print include kids in special ed programs, which could face severe cuts in Medicaid funding.

It gets worse. This bill would cut $880 billion over a decade from Medicaid, which provides health care to about 74 million Americans — the poor, the disabled, the elderly — and another $300 billion that now goes to helping those who cannot afford it buy health insurance. See why it’s the Anti-Health-Care Bill?

Then the Republicans turn right around and plow roughly $595 billion of this money into tax cuts, mostly for the very wealthy. And that’s the real point. The initiators of this bill don’t care a whit about what they do to the health-care system or how their bill will endanger the lives of many Americans, including those of a lot of their own supporters.

“Conservatism is something more than mere solicitude for tidy incomes,” Russell Kirk, one of the founding philosophers of modern conservatism, wrote in 1954. We can now say, 63 years later, that Ryan-style conservatism is only about solicitude for tidy incomes.

“This is who we are,” Ryan told his colleagues this week. “This will define us.”

Yes, it will. So please, Mr. Ryan, have the decency to stop giving those speeches in which you tell us about the depth of your concern about the poor and how you became interested in poverty “at a young age.” No one who would risk throwing so many poor people off health insurance with those enormous Medicaid reductions to score a political victory can claim any real interest in the welfare of the neediest Americans. Stick to tax cuts. At least you have convictions about those.

And then there is President Trump, who has absolutely no idea what’s in this bill and couldn’t care less. He hailed a measure that dumps people off the insurance rolls by saying that “we will have great, great health care for everyone in our nation.” And then he praised the Australian health-care system, which covers everyone and is the antithesis of the bill he had just praised.

For the benefit of this empty man, House Republicans, you just sold your social consciences.

It is said that the Senate will save House Republicans from the consequences of their craven heartlessness. No one should count on this in light of the hatred in the GOP for a law named after Barack Obama; the misguided fantasy that “the market” can cure whatever ails our health care system; the insatiable desire to keep shoveling money to the wealthiest Americans in tax relief; and the eagerness to slash and slash where programs for low-income Americans are concerned. On all these matters, pay heed to Paul Ryan: This is who they are. This defines them.

And the rest of us should never forget it.