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.”

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.

Despite Deep Policy Divides, Europe Trip Seen by Buoyant Trump as High Point

Glenn Thrush, reporting for the New York Times:

The rumble of police helicopters and armored riot trucks shook President Trump’s suite deep inside the convention center, but his staff found unexpected comfort as they watched on TV as protesters rampaged through the streets of Hamburg.

The anger outside, they noted with relief, was mostly directed at globalism, the Group of 20 and European leaders, not at Mr. Trump.

The president’s second trip to Europe since taking office was, on its surface, a turbulent and disquieting couple days. He visited a continent scrambling to cope with a profoundly altered power dynamic under his disruptive leadership, as the United States challenges the region’s liberal governments on climate change, defense, trade and immigration. Cars burned, diplomats fumed.

Yet to Mr. Trump and his battered band of advisers, the discord inside and around the complex housing the summit meeting was someone else’s problem.

It was by no means an unqualified success.

Mr. Trump’s hard-line policy against abiding by international limits on greenhouse gas emissions made him an outlier among many of the other G-20 leaders here. His pressure on Germany over its contributions to NATO and his positions on immigration and trade have made him wildly unpopular here. His threat to impose tariffs on foreign steel prompted European officials to float the idea of taxing American bourbon imports. And he continued to flout tradition by trashing American institutions overseas, criticizing the press in the presence of leaders who have cracked down on the media in their own countries.

“This trip puts into stark relief how the U.S. has relinquished its role as the indispensable nation,” said Brian Fallon, the press secretary for Hillary Clinton’s 2016 presidential campaign.

To much of the rest of the world, the gathering underscored the administration’s growing distance with, and isolation from, the other G-20 members.

But from the perspective of Mr. Trump’s team, the trip to Poland and Germany turned out to be a surprising early high point in his presidency, providing a brief but welcome respite from the forever wars in Washington. It left the president, who had been less than enthusiastic about coming, buoyant and feeling that there might still be a market for his hard-edge brand of conservative nationalism in supposedly inhospitable Europe after all.

“This week’s trip gave the country a very clear sense of the president’s foreign policy philosophy and reiterated the long-term objective of restoring America’s greatness on the world stage,” said Jason Miller, a former Trump campaign aide who still advises the president and his staff informally.

Mr. Trump returns to a deteriorating domestic situation, facing months of investigations into whether people in campaign colluded with Russia and what appears to be the decreasing likelihood that a deeply divided Senate majority can quickly pass a repeal of the Affordable Care Act.

But he’ll always have Warsaw. The apex of the trip from the president’s perspective — and one of the most personally satisfying episodes of his term so far — was Mr. Trump’s powerful invocation of Western exceptionalism to a crowd of like-minded Polish nationalists on Thursday.

The speech was a blunt expression of Western defiance in the face of radical Islamic terrorism. It cast Mr. Trump as a modern-day inheritor of that struggle, a willing warrior in a clash of civilizations.

“The fundamental question of our time is whether the West has the will to survive,” said Mr. Trump, dwarfed by a huge monument to ragtag Polish partisan army soldiers wearing helmets taken from dead German soldiers. “Do we have the confidence in our values to defend them at any cost? Do we have enough respect for our citizens to protect our borders? Do we have the desire and the courage to preserve our civilization in the face of those who would subvert and destroy it?”

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.

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.”

* * *

“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.

The GOP’s hard, messy options for destroying Trumpism

Michael Gerson, reporting for the Washington Post:

Nearly 150 days into the Trump era, no non-delusional conservative can be happy with the direction of events or pleased with the options going forward.

President Trump is remarkably unpopular, particularly with the young (among whom his approval is underwater by a remarkable 48 percentage points in one poll). And the reasons have little to do with elitism or media bias.

Trump has been ruled by compulsions, obsessions and vindictiveness, expressed nearly daily on Twitter. He has demonstrated an egotism that borders on solipsism. His political skills as president have been close to nonexistent. His White House is divided, incompetent and chaotic, and key administration jobs remain unfilled. His legislative agenda has gone nowhere. He has told constant, childish, refuted, uncorrected lies, and demanded and habituated deception among his underlings. He has humiliated and undercut his staff while requiring and rewarding flattery. He has promoted self-serving conspiracy theories. He has displayed pathetic, even frightening, ignorance on policy matters foreign and domestic. He has inflicted his ethically challenged associates on the nation. He is dead to the poetry of language and to the nobility of the political enterprise, viewing politics as conquest rather than as service.

Trump has made consistent appeals to prejudice based on religion and ethnicity, and associated the Republican Party with bias. He has stoked tribal hostilities. He has carelessly fractured our national unity. He has attempted to undermine respect for any institution that opposes or limits him — be it the responsible press, the courts or the intelligence community. He has invited criminal investigation through his secrecy and carelessness. He has publicly attempted to intimidate law enforcement. He has systematically alarmed our allies and given comfort to authoritarians. He promised to emancipate the world from American moral leadership — and has kept that pledge.

For many Republicans and conservatives, there is apparently no last straw, with offenses mounting bale by bale. The argument goes: Trump is still superior to Democratic rule — which would deliver apocalyptic harm — and thus anything that hurts Trump is bad for the republic. He is the general, so shut up and salute. What, after all, is the conservative endgame other than Trump’s success?

This is the recommendation of sycophancy based on hysteria. At some point, hope for a new and improved Trump deteriorates into unreason. The idea that an alliance with Trump will end anywhere but disaster is a delusion. Both individuals and parties have long-term interests that are served by integrity, honor and sanity. Both individuals and the Republican Party are being corrupted and stained by their embrace of Trump. The endgame of accommodation is to be morally and politically discredited. Those committed to this approach warn of national decline — and are practically assisting it. They warn of decadence — and provide refreshments at the orgy.

So what is the proper objective for Republicans and conservatives? It is the defeat of Trumpism, preferably without the destruction of the GOP itself. And how does that happen?

Creating a conservative third party — as some have proposed — would have the effect of delivering national victories to a uniformly liberal and unreformed Democratic Party. A bad idea.

A primary challenge to Trump in the 2020 presidential election is more attractive, but very much an outside shot. An unlikely idea.

It is possible — if Democrats take the House in 2018 — that impeachment will ripen into a serious movement, which thoughtful Republicans might join (as they eventually did against Richard Nixon). But this depends on matters of fact and law that are currently hidden from view. A theoretical idea.

A Democratic victory in the 2020 election would represent the defeat of Trumpism and might be a prelude to Republican reform. But Democrats seem to be viewing Trump’s troubles as an opportunity to plunge leftward with a more frankly socialistic and culturally liberal message. That is hardly attractive to Republican reformers. A heretical idea.

Or Republicans and conservatives could just try to outlast Trump — closing the shutters and waiting for the hurricane to pass — while rooting for the success of a strong bench of rising 40-something leaders (Marco Rubio, Mike Lee, Nikki Haley, Tom Cotton, Ben Sasse). This may be the most practical approach but risks eight years of ideological entrenchment by Trumpism, along with massive damage to the Republican brand. A complacent idea.

Whatever option is chosen, it will not be easy or pretty. And any comfort for Republicans will be cold because they brought this fate on themselves and the country.

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.

Comey’s dismissal may turn the anti-Trump wave into a tsunami

Dana Milbank, reporting for the Washington Post:

This will not stand.

President Trump performed his latest impersonation of a Third World strongman, firing FBI Director James B. Comey late Tuesday in ham-handed fashion as it was becoming clear that the FBI probe into Trump’s ties to Russia, which Comey was overseeing, was becoming a bigger problem for Trump while new testimony exposed dubious behavior by the president himself.

The sacking brought immediate outrage and obvious comparisons to President Richard Nixon’s Saturday Night Massacre, when the scandal-engulfed president ordered the Watergate prosecutor fired in a doomed attempt to keep that probe from ensnaring him. Trump, like Nixon, will fail, for a simple reasons: The institutions he is assaulting daily are stronger than he thinks. His autocratic instincts have been checked every step of the way. Trump will, inevitably, be spanked again.

He attempted a variant of the “Muslim ban” he spoke of during the campaign, ordering a halt to travel by people from certain Muslim-majority nations. He was shot down in court.

He ominously questioned the legitimacy of “so-called” judges because of the ruling and said they should be blamed for terrorist attacks, while his White House said his authority “will not be questioned.” The courts begged to differ; his revised travel ban, too, is snarled in court.

He recklessly escalated tensions with North Korea and Iran and snubbed a key ally in Germany’s Angela Merkel. But cooler heads in the Pentagon and the State Department have calmed jittery allies and restored some measure of stability, conveying to them that Trump is not really in charge.

He injected himself into the French presidential elections with his praise for far-right candidate Marine Le Pen — and French voters rejected her by 2-to-1, following Dutch voters’ rejection of another far-right populist in the Trump mold.

He released a budget that slashed major government functions and domestic programs. But American public opinion has turned sharply against Trump, making it easier for Democrats to oppose him. In the spending bill that Congress passed last week, Democrats successfully repelled Trump’s border wall, deportation force and cuts to Planned Parenthood, the National Institutes of Health, the Environmental Protection Agency and more.

The plain truth is Trump’s clumsy assaults on democratic norms are being resoundingly rejected. The Cook Political Report is already talking about the possibility of a “midterm wave” against Republicans, and it shifted ratings in 20 House races — all in Democrats’ direction. At town-hall meetings, House Republicans who were badgered by the White House into voting for “Trumpcare” last week are already backpedaling.

At Monday’s hearing on the Trump administration’s ties to Russia, only six Republicans spoke (versus nine Democrats) and not one of them attempted a real defense of the president’s actions on disgraced former national security adviser Michael Flynn and Russia. Sen. Lindsey Graham (R-S.C.), the panel’s chairman, openly mocked Trump’s claims that the election hacking might not have been done by Russia but by a “400-pound guy sitting on a bed or any other country.”

More here.

Jimmy Kimmel slams critics of his emotional health-care plea, calls out Newt Gingrich

Emily Yahr, writing in the Washington Post:

A week after Jimmy Kimmel shared the news about his newborn son’s heart defect — and made an emotional plea about preexisting conditions amid the health-care debate — he returned to his late-night show on Monday to huge applause from his studio audience.

“I made an emotional speech that was seen by millions. And as a result of my powerful words on that night, Republicans in Congress had second thoughts about repeal and replace…I saved health insurance in the United States of America,” Kimmel said triumphantly. He paused, then was “shocked” to discover the controversial bill passed in the House. “What’s that? I didn’t? I didn’t save it? They voted against it anyway?! I really need to pay more attention to the news.”

Anyway, Kimmel said, his son Billy is doing well. Kimmel also thanked viewers for their support. Then he noted that some people were very critical of his health-care comments. As you might expect, he did not hold back.

“I know this is gonna shock you — there were also some not-so-nice things that people said online about me, including members of the media,” said Kimmel, showing headlines from the New York Post (“Jimmy Kimmel’s obscene lies about kids and medical care”) and the Washington Times (“Shut up Jimmy Kimmel, you elitist creep.”)

Kimmel said he was proud of that label, because when he was growing up drinking powdered milk when his family couldn’t afford the liquid, his dream was to become an out-of-touch Hollywood elitist. “I guess it came true!” he exclaimed.

He continued the sarcasm. “I would like to apologize for saying that children in America should have health-care. It was insensitive,” Kimmel deadpanned. “It was offensive and I hope you can find it in your heart to forgive me.”

He saved most of his ire for Newt Gingrich, the former speaker of the House. “There are some very sick and sad people out there. Here’s one of them, his name is Newt Gingrich,” Kimmel said. He ran a clip of Gingrich on “Fox News Sunday” criticizing Kimmel’s comments and saying that when a newborn has a heart problem, doctors will help immediately, and not wait until the family cuts a check.

“Yes, it is true that if you have an emergency, they will do an operation. And that’s terrific if your baby’s health problems are all solved during that one visit. The only problem is that never, ever happens,” Kimmel shot back. “We’ve had a dozen doctors appointments since our son had surgery. You’ve got a cardiologist, the pediatrician, surgeon, some kids need an ambulance to transport them. That doesn’t even count the parents who have to miss work for all this stuff. Those details, Newt forgot to mention. I don’t know if the double layers of Spanx are restricting the blood flow to his brain.”

Kimmel wasn’t finished. “And not only is Newt Gingrich an expert on sick children, turns out he also knows a thing or two about the late-night comedy business,” he smirked. He rolled a clip of Gingrich saying, “The problem you have with humor in America today is that Hollywood is so enraged at Donald Trump that they can’t be funny,” adding that late-night comedians are consumed with anger.

“Gee, I wonder why we’re so angry. Maybe it has something to do with, I don’t know, you?” Kimmel said. “Listen, Newt Gingrich does know a lot about comedy. This is the guy who helped lead the impeachment effort against Bill Clinton for trying to cover his up his affair — while he was having an affair. That’s hilarious. Come on. Whatever you want to say about him. Thank you, Newt. There’s a reason he’s named after a lizard, and that was it.”

Kimmel then segued into an interview with Sen. Bill Cassidy (R-La.), who was asked in a TV interview last week whether insurance companies should be able to cap payouts. “I ask, does it pass the Jimmy Kimmel test? Would a child born with congenital heart disease be able to get everything he or she would need in that first year of life?” Cassidy said at the time.

Cassidy appeared on Monday’s show via satellite; the two went back and forth for several minutes. “Why are the vast majority of Republican politicians against making sure Americans are truly covered when it comes to health-care?” Kimmel asked. Cassidy responded that President Trump said he wants all Americans to be covered; take care of preexisting conditions without mandates; and lower premiums, because middle-class families can’t afford them.

Later, Cassidy added that the bill passed by the House last week actually raises premiums: “Which is why, on the Senate side, we need to make it work.” He urged viewers to call their senators and tell Democrats “don’t just sit on the sidelines, engage” and tell Republicans “we’ve got to fulfill President Trump’s contract, lowering premiums with coverage that passes the Jimmy Kimmel test.”

“If we do that, we get an American plan…that’s where we need to be,” Cassidy said as the audience applauded.

Kimmel offered a suggestion for his namesake test. “The Jimmy Kimmel test, I think should be, no family should be denied medical care, emergency or otherwise, because they can’t afford it,” he said, as the audience cheered again. “Can that be the Jimmy Kimmel test? As simple as that? Is that oversimplifying it?”

Much more here.

House Republicans Go Off the Cliff

Ross Douthat, writing in the New York Times:

OVER the last seven years, the Republican Party has engaged in increasingly elaborate political suicide attempts. The G.O.P. has nominated cranks and erstwhile witches and Todd Akin in winnable Senate races. It has engaged in Somme-esque trench warfare within its own congressional caucus, shut down the government without a strategy for winning anything out of it, and campaigned on a sub-Ayn Randian narrative about the heroic businessman and the mooching 47 percent. And then, after all its prior efforts at seppuku failed, the party nominated Donald Trump for the presidency.

You know how that turned out.

So it would be a foolish prognosticator indeed who assumed that Thursday’s House vote for the American Health Care Act, a misbegotten Obamacare quasi-replacement with the favorable ratings of diphtheria and the strong support of almost nobody on the right who cares about health policy, will necessarily be the undoing of the congressional G.O.P.

Perhaps House Republicans will be saved by masterly policy-making in the Senate (don’t laugh). Republican senators are basically promising to start from scratch with their own health care bill, which could lead to anything from the Bill CassidySusan Collins proposal to allow red states to use Obamacare money for non-Obamacare experiments while blue states keep things as they are, to an A.H.C.A. rewritten to make it reasonably defensible as policy and non-suicidal in its politics.

Such a rewriting is theoretically possible: All you need to do is spend substantially more money on insurance subsidies than the House bill does, offer substantially more money to states for high-risk pools if they want to opt out of the pre-existing condition rules, and generally make the bill look less like a self-parodic exercise in cutting Medicaid to fund tax cuts for the rich. Since liberals tend to overestimate how much people value health insurance and how much effect it has on health, a better-funded alternative to Obamacare could lead to modest coverage reductions and still be less politically disastrous than some Democrats expect.

Alternatively, maybe the Senate will simply wrangle and argue and finally do nothing, and like the Waxman-Markey cap-and-trade bill of 2009 the American Health Care Act will simply evaporate. In which case House Republicans will be able to say, hey, we tried to fix Obamacare, its ongoing problems are the Democrats’ fault, and have you checked out the unemployment rate?

So there are ways in which the House G.O.P. might yet escape the consequences of voting for such a lousy and unpopular piece of legislation. But it would not be an escape that they deserve.

Much more here.