President’s turbulent week fuels frustration in his party, though core supporters remain loyal
President Donald Trump’s tumultuous past week has widened rifts in his party, between those who vocally support the president’s combative style and others who bridle at it ..
.. After a week that included the president attacking his attorney general, the collapse of a GOP health bill, a surprise effort to bar transgender people in the military and a White House staff shakeup, divisions that were largely set aside at the start of 2017 have emerged anew.
.. Signs are emerging that the intraparty battle could threaten the party’s standing in the 2018 elections and the president’s beyond that. Mr. Jolly, the former Florida congressman, said he is part of a group discussing how to put together a primary challenge to Mr. Trump in 2020... Michael Steele, a former Republican National Committee chairman and lieutenant governor of Maryland, said “the president is in his element when in front of a crowd of 40,000 instead of behind his desk dealing with the minutiae of governing. That’s not governing, that’s theater, a reality TV presidency.”
The Republican Health-Care Fiasco
Senator John McCain cast the deciding vote to jettison Republicans’ latest Obamacare reform effort, handing a victory to Lisa Murkowski of Alaska and Susan Collins of Maine, moderates whose opposition to any substantive health-care reform has become nearly intractable. But the legislation for which Republican leaders asked their conference to vote was so unpalatable, and the process so objectionable, that it is almost difficult to fault him. The Congressional Budget Office suggested that the “skinny” health legislation on which the Senate voted would raise premiums by as much as 20 percent. It assumed that since the legislation ended the fines for going without insurance, many healthy people would drop coverage, and premiums would have to pay for a sicker population. The estimate may be too high, since the CBO has repeatedly overestimated the impact of the fines. But it almost certainly had the basic story right.
Senator McCain may have been taken aback as well by the CBO’s projection that the bill would result in 16 million fewer people having insurance coverage — something Democrats nearly unanimously portrayed as “taking away” insurance from all of those people. In fact, this projection is based almost entirely on the end of the fines. The CBO estimates that once they can make a decision free of the threat of fines, 15 million people will forgo coverage.
.. We are willing to bet that McCain didn’t know any of this. A lot of health-policy experts are unaware of it too. The legislation was unveiled, after all, only a few hours before the vote. There were no hearings on it. The CBO had only provided the relevant numbers the same day, with the inferences we have made above left unstated.
Republican leaders such as Mitch McConnell were asking senators to vote for a poorly understood bill that would likely raise premiums in the expectation that something better would emerge from a conference committee between the House and the Senate. But there was a chance that the House would end up just passing the skinny bill. And if the conference committee was capable of coming up with something better that could get 51 votes in the Senate, why couldn’t the Senate come up with that “something better” itself?
.. Here Senator McCain deserves criticism for naïveté. He believes that there should be bipartisan reforms to Obamacare (which is a far cry from what he had previously campaigned on).
But the Democrats have made it clear that the only “reforms” that interest them are increased taxpayer commitments to shoring up the program, including increased subsidies to the insurers. In practice, this option would amount to higher spending and, at best, a fig leaf of reform; it would become law through the votes of nearly all Democrats and a handful of Republicans.
.. Option three, the “let it burn” approach, is simply untenable.
.. Option three is likely, then, to be option two in slow motion.
.. Consideration of the alternatives should bring Republicans back to option one. Try, try again, but this time with more deliberation.
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.
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.