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.
GOP opponents to Senate health-care bill see vote delay as an advantage
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.
Mitch McConnell just blew up one of Trump’s biggest lies
McConnell will be employing at least two tactics. First, he will use several hundred billion dollars that CBO says the bill would save to try to buy off moderate opponents with side deals, such as increased funding for Medicaid or opioid treatment.
Second, McConnell will press the argument that if this bill does not pass, Republicans will have no choice but to negotiate over the future of the Affordable Care Act with Democrats. Multiple reports have said that McConnell has privately warned Republicans that failure would mean they must enter into talks with Democrats on ways to shore up the individual markets, which would effectively mean that a chance to pass a partisan repeal bill is gone... But, in making this latter argument — which will likely gain more scrutiny in the days ahead — McConnell is effectively destroying one of President Trump’s most cherished false narratives... Trump has spent months making several intertwined claims. He has relentlessly asserted that Obamacare is collapsing on its own. He has offered a variation on this by threatening to cut off the cost-sharing reductions to insurers that subsidize out-of-pocket costs for lower-income people, which would drive insurers out of the markets; Trump has said this threat will force Democrats to the table to “deal” with him... concedes a number of points. It concedes that, despite Trump’s claim of a desire for talks with Democrats, Republicans cannot work with Democrats, as long as Republicans remain wedded to their own priorities — that there is simply no bipartisan consensus possible.. McConnell is basically conceding that Republicans can’t just let the ACA implode, as Trump seems to believe... The Trump administration is likely to continue trying to sabotage the exchanges if this happens, by employing, among others, tactics such as continually refusing to clarify whether it will renew cost-sharing reductions and generally sowing uncertainty over the ACA’s future.
This dirty little secret is the real reason why repeal is so hard for Republicans
The Affordable Care Act has widely been held aloft as one of the leading drivers of the deepening polarization of American political life — it has been bitterly fought over for years and has loomed as a great embodiment of all that ideologically divides the two parties. Yet in a strange twist, the GOP debate over repeal has actually revealed that there is a surprising amount of hidden consensus on health care.
.. nutshell, what the debate has really shown is that the passage and implementation of the ACA has given rise to a latent majority in Congress — or at least one in the Senate — that has more or less made peace with the ACA’s spending and regulatory architecture and its fundamental ideological goals
.. GOP Sen. Jerry Moran of Kansas that neatly illustrates the point. Moran is a GOP loyalist who previously headed the GOP Senate campaign arm and sits firmly in the mainstream of today’s GOP. Yet even he is having trouble supporting the GOP bill.
.. He did not describe the task facing Republicans as repeal; it was “repair, replace, whatever language people are using.”
Pressed by activists and voters, Moran said that he did not want to cut back Medicaid. “I have concern about people with disabilities, the frail and elderly,” Moran said. “I also know that if we want health care in rural places and across Kansas, Medicare and Medicaid need to compensate for the services they provide.”
After the town hall meeting, Moran told reporters the version of the GOP’s bill that he opposed put too much of Medicaid at risk.
.. He is suggesting that, while able-bodied adults might allegedly be scamming their way onto the Medicaid expansion, this issue should not be taken to justify the deeper cuts to Medicaid. And this, as Weigel notes, unfolded in one of “the reddest parts of a deep red state.”
.. The bottom line is that Republicans who currently oppose the Senate bill object to it because it would roll back federal spending in a way that would hurt millions and millions of people. This includes Moran and moderates such as Dean Heller of Nevada, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Rob Portman of Ohio, all of whom have made variations of this argument. Some, such as Collins and Sen. Bob Corker of Tennessee, have even objected on the grounds that this would finance a massive tax cut for the wealthy, and that this is indefensible.
.. All of this is dramatically at odds with the ludicrous spin coming from GOP leaders such as John Cornyn of Texas and House Speaker Paul D. Ryan of Wisconsin, who argue that the millions left uncovered under the GOP bill will be choosing that plight, because they will have been liberated from the hated ACA mandate.
.. To summarize, Republicans are arguing both that
- millions won’t actually be hurt by these Medicaid cuts, either because they aren’t really cuts, or because everyone will have “access” to health care later; and that
- if many millions of people go without coverage who would otherwise have been covered, they did so by choice.
it is of course possible to make a principled argument against the mandate, Republicans are doing something else entirely: They are hiding behind their arguments against the mandate to evade acknowledging the true human toll their proposed Medicaid cuts would inflict.
What this really means is that they are basically fine with rolling back the ACA’s massive coverage expansion to facilitate a massive tax cut for the rich, but just won’t say so out loud.
But all indications are that moderate Republican senators — and even senators such as Moran — are not fine with this outcome.
Now, these objecting senators may still end up supporting a revised GOP bill in the end, due to party pressures and other factors. But if they do, they will only justify it by pretending that a few additional last-minute dollars (in relative terms) added to the bill would put a meaningful dent in the enormous coverage loss
.. This would mean their current objections were insincere.