A majority is a terrible thing to waste.
On the cusp of a historic failure, the party has begun the finger-pointing, and it’s hard to argue with any of it.
- The establishment is right that Trump is incapable of true legislative leadership.
- The Trumpists are right that the establishment is ineffectual.
- Conservatives are right that moderates don’t really want to repeal Obamacare, whatever they’ve said in the past.
- And pragmatists are right that a few conservatives are beholden to a self-defeating purity.
.. At least Collins, an ideological outlier in the Republican Conference, has been consistent. She voted against the repeal-only bill in 2015, and the GOP leadership never thought she was gettable.
.. For Rand Paul, clearly, a perhaps once-in-a-generation opportunity to significantly reform two entitlement programs isn’t as important as scoring cheap points against his colleagues in the cause of getting as many cable hits as possible.
.. it’s particularly important that the Utah senator keep the big picture in view; torpedoing the entire effort over a relatively technical question about the insurance risk pools — Lee’s current posture — would be a disastrous mistake.
A vocal conservative opponent of the measure, Sen. Rand Paul, predicted the delay would strengthen critics’ position by giving them more time to mobilize against the bill.
“The longer the bill is out there, the more conservative Republicans are going to discover it is not repeal,” Paul (R-Ky.) said Sunday in an interview with CBS’s “Face the Nation.”
Paul said he spoke with Trump on Friday and suggested the president support repealing the Affordable Care Act and deciding the details of a replacement plan later if the latest version of the bill does not pass.
.. Trump administration officials failed to gain support from influential Republicans such as Nevada Gov. Brian Sandoval (R). Opposition from Sandoval and others will make it easier for undecided Republican senators from those states to vote “no” on the bill, potentially further endangering its prospects.
.. (63 percent) believes it is more important for the government to provide health coverage to low-income people compared with cutting taxes (27 percent). Among Republicans, 48 percent favored cutting taxes, compared with 39 percent who favored providing health coverage for low-income people.
.. “President Trump and I believe the Senate health-care bill strengthens and secures Medicaid for the neediest in our society,” Pence said
.. Collins strongly disagreed in an interview Sunday with CNN.
“You can’t take more than $700 billion out of the Medicaid program and not think that it’s going to have some kind of effect,” she said during an appearance on “State of the Union.”
.. “This bill imposes fundamental, sweeping changes in the Medicaid program, and those include very deep cuts that would affect some of the most vulnerable people in our society, including disabled children and poor seniors. It would affect our rural hospitals and our nursing homes, and they would have a very hard time even staying in existence.”
.. Pence’s speech was criticized by Democrats, health-care advocates and even some Republicans for mischaracterizing the possible ramifications of the GOP bill.
.. During the same speech, the vice president went after Ohio Gov. John Kasich (R), a critic of the legislation, by suggesting his state’s expansion of Medicaid left nearly 60,000 residents with disabilities “stuck on waiting lists, leaving them without the care they need for months or even years.”
The claim alienated many at the meeting, partly because waiting lists for Medicaid’s home- and community-based services were not affected by the program’s expansion under the ACA, and partly because many interpreted Pence’s remark as an overly aggressive shot at Kasich. The Ohio governor’s stance against the bill could shape the position of Sen. Rob Portman (R-Ohio), a pivotal vote for Republicans who is undecided on the current version. Some fear Pence missed an opportunity to woo Portman with his remark against Kasich.
.. Collins estimated Sunday that there are eight to 10 Republican senators with “serious concerns”
.. Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, worked to undermine that report and a forthcoming analysis by the Congressional Budget Office showing the legislation’s cost and insurance impact.
.. The Avalere study projected marked reductions in federal Medicaid funding to all 50 states, ranging from 27 percent to 39 percent by 2036.
Will the most conservative members of Congress accept that the politics of health care have changed?.. Will they acknowledge that any reform must include continued protections for pre-existing medical conditions?.. two camps of defectors from the Senate’s reform bill. One consists of Republican moderates— Rob Portman, Dean Heller, Susan Collins, Lisa Murkowski —who claim the bill is too mean to poor and sick people... With the stakes this high, the Senate leadership will gladly shuffle some money toward opioid treatment, rural health-care providers or Medicaid. So getting the “moderates” on board is simple and transactional. They name a price, they get pork, they vote yes... Sens. Ron Johnson, Mike Lee, Rand Paul and Ted Cruz have been clear from the start that any bill must lower premiums, which involves getting rid of costly ObamaCare mandates. And there is no question that among the most expensive mandates are those designed to protect individuals with pre-existing conditions—in particular “community rating,” which requires insurers to charge the same prices regardless of health status.
The House Freedom Caucus was so intent on getting rid of community rating that it nearly derailed the bill. Only after the conference added an amendment allowing states to apply for waivers from community rating did the most conservative members finally came on board...Freedom Caucus members tend to hail from inordinately conservative (and safe) congressional districts, whereas senators represent entire statewide populations. And a sizable majority of the public strongly supports retaining protections for pre-existing conditions...every American remembers two particular provisions of the law—pre-existing conditions and coverage for children up to 26. These policies are simple and sound good. And they have become over the years a new standard in most people’s minds...Conservatives will argue their side just needs to do a better job explaining how these mandates drive up costs for everyone, or lower the quality of care...conservatives face a choice. They can work with their colleagues to minimize the costs of the mandates (there are innovative ways to do this) and build in different free-market reforms to lower premiums.
When it comes to managing Republicans’ best interests, Senator Mitch McConnell of Kentucky, the majority leader, rarely loses. So it is possible that Mr. McConnell views the potential failure of a hastily written health care bill as an eventual boon.
.. As Democrats immediately took to the Senate floor to excoriate the bill and the secretive process in which it was put together, few Republicans, even those involved in crafting it, came to defend it.
.. Four others went further. Senators
all said they would not vote for the bill as currently proposed.
.. Mr. McConnell and many of his aides are also eager to get to the business of changing the tax code, which they view as less difficult than health care, and have been working with the White House behind the scenes to get that effort started. For Mr. McConnell, cutting taxes is a much higher priority than health care