Trumpcare Megathread: It's dead (for now)

[The_Doctor]

Dylan Scott thinks Mitch McConnell is setting up the bill to fail. I agree. I think the political capital to sustain the Trump Administration in the wake of revelations and the AHCA is too high. They have to pick and choose. Read the interview here.

Specifically:

Referring to behind-the-scenes work among Senate Republicans on a healthcare bill, McConnell said, "I don't know how we get to 50 (votes) at the moment. But that's the goal."

[...]

On the other hand, he said, prospects for passage of major tax legislation were "pretty good." While this too will be difficult, McConnell said, it is "not in my view quite as challenging as healthcare."

[The_Doctor]

People, look at when major laws were passed. Look at the President's popularity at the time. And now put on top of this the investigation. Trump is at 39-55% and unable to effectively champion the AHCA or any variation of it.

This is dead in the Senate. The Republicans' best interest is to patch the law and make it work to claim credit, not pass the AHCA or anything similar to it.

[The_Doctor]

So does this fit the reconciliation criteria or do they need to go back to the drawing board?

Depends on the Byrd Bath, now. It can go to the Senate but the Parliamentarian may strike portions of it or the Senate could amend to be Byrd compliant.

[The_Doctor]

TrumpCare may very well be dead:

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As I translate it, they plan to tell McConnell this anyway. They know the town halls will be full of anti-AHCA stuff. "Several" suggests it's a planned action. However, Topher Spiro is a liberal advocate, right?

So I wouldn't necessarily buy in.

EDIT: Yeah, he's a liberal advocate. I don't know why the GOP Senators would be telling him and not a reporter who would not already have leaked that.

[The_Doctor]

Bloomberg putting Cassidy as the hardest GOP Senator who won't vote aye. Louisiana expanded Medicaid under Gov. Edwards, and it's a populist Southern state. So, automatically, with Collins and Cassidy out, they're at 50, and this is with Heller and Flake agreeing to go with the current (I'm not seeing it). Ditto Capito, who comes from one of the poorest states - West Virginia.

The biggest thing for the GOP Senators is going to be Medicaid's expansion and the preexisting clause/community ratings. These go to the heart of the repeal and it's going to be extraordinarily difficult to repeal them without a viable replacement. The House barely passed it in the hopes the Senate would fix the law.

We'll see, but the Constitution has put the Senate, historically, as the "cooling chamber," e.g, the chamber that doesn't pass laws without broad based support. The ACA took a year to pass and it had like break even support (and they had unified GOP support and a President who had break even approval ratings). This law doesn't' even have near that level of support.

I'm just not seeing the win here happening.

The bigger problem is that if the Senate kills it, the House was hung out to dry without a bill to pass. They passed what they did with the expectation the Senate would clean up the mess. This really puts a lot of pressure on House Republicans to force Senate Republicans to pass a bill.

How they reconcile these two mutual facts is beyond me. The most logical solution is to patch the ACA and hope the base swallows it. It would also strongly be in their best interests to work with the Democrats to pass a fix to cover their behinds.

Oh, a lovely wrinkle. The default vote may be in July, meaning the Democrats may extort the ACA  staying alive as their pound of flesh since the House Freedom Caucus, for some amazing reason, is trying to extort the GOP leadership.

[The_Doctor]

I suggest that we add more dollars to Healthcare and make it the best anywhere. ObamaCare is dead - the Republicans will do much better!
https://twitter.com/realDonaldTrump/status/868979531641741313


problem solved.

What is he talking about...?

[The_Doctor]

Isn't the Senate bill barred from having more money than the House plan? E.g if it saves $119 billion that's how much it must save under reconciliation?

[The_Doctor]

Meadows says that the Senate bill isn't conservative enough to pass in the House.

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This all feels like they're setting up the bill to fail. Collins seems to have been the one to signal the mood is now about ACA stabilization. But it's too close to call.

I think Ron Johnson is for the bill. Paul, Murkowski, Heller, Collins all have major reasons to oppose the law based on their state profiles and when they're up for reelection. I think Capito might be able to vote yes.

Also on my radar: Flake of Arizona. He's from a marginal Trump state. With lots of old people.

[The_Doctor]

Meadows says that the Senate bill isn't conservative enough to pass in the House.

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This all feels like they're setting up the bill to fail. Collins seems to have been the one to signal the mood is now about ACA stabilization. But it's too close to call.

I think Ron Johnson is for the bill. Paul, Murkowski, Heller, Collins all have major reasons to oppose the law based on their state profiles and when they're up for reelection. I think Capito might be able to vote yes.

Also on my radar: Flake of Arizona. He's from a marginal Trump state. With lots of old people.

Flake supports it, and Murkowski and Paul don't really have a real electoral reason to oppose it. Opposing it may make them the 51st vote that saved Obamacare. That wouldn't be good for a primary

True. I don't know .

But Collins' Twitter statement specifically alludes to shoring up ObamaCare. I don't know but if she - a 2020 - is making that statement I am starting to think that the 2020 people are figuring the healthcare markets won't be stable enough by then. It makes me think she said it specifically because she knows there isn't support for the law within the Senate. She's not supposed to be on the pass list as she's up in Maine and she's a fairly loyal Republican.

She wouldn't be doing this if she didn't calculate the numbers. She's not one to go on a limb alone. With the other statements coming right after her I suspect a stampede to say no. The senators, I feel, want an off ramp now.

But I could be wrong…

[The_Doctor]

But what do Republicans tell their base if they give up on it? They can't just do literally nothing in the lead up to 2018 and have the audacity to ask for more power then

If you asked me point blank they would basically say they couldn't pass it and they would rather reform the law to make it better. Basically the pool of angry voters seeing higher premiums and losing insurance outweighs the number of people in the Republican base…

The base had to demonstrate strong support for their position in 2016. Clearly they couldn't so (judging by popular vote and House %) maybe you argue that Republican senators are making the cold calculation that their base will swallow hard and move on, especially if the economy is okay or recovering by 2019… a matter of simple arithmetic…

Trump's #s also make the whole thing worse. It's just better to keep that log off the flames. The base may understand this and take what they can get.

[The_Doctor]

To expand on this why would the GOP want to own the AHCA and be saddled with it instead of removing it as an issue? They would be hammered for it based on the CBO score and they would instantly be the party defending the law. Why not just fail the AHCA, cut a deal with Democrats, and then move onto tax reform?

The numbers all strongly suggest that the GOP is better off with this strategy than passing this law and being beaten with a 2x4 on the law from now until 2024.

[The_Doctor]

Funny thing is Democrats will play ball with them if the GOP is serious about fixing the ACA problems. And the media and public love bipartisanship, so they will ignore the GOP's hypocrisy on this issue the last 8 years.

Exactly. The Democrats have incentive here to enshrine the law and make it permanent and remove the ACA as a political football. So they would play ball.

Once again the Republican Congress doesn't have a good reason to pass this beyond the Republican base and the White House. In the White House's case, since Trump's constantly turning on a dime, he's unreliable (as Graham said). His approval ratings aren't giving the Republican caucus cover either so they're vulnerable.

Why not cut a deal and be done with it? It neuters the base, the White House, and the issue as a political weapon. It allows them to move onto (deficit raising) tax cuts. And it allows them to focus on friendlier ground.

I would say my gut is that the bill fails the motion to get to debate as Republican senators push the White House to shore up the markets and stabilize the exchanges. That's the big priority and providing stability right now is the big issue so a deal could come several months from now. But I could be wrong…

Reconciliation authority also needs to be swapped out for tax reform too to salvage the legislative year.

[The_Doctor]

But what do Republicans tell their base if they give up on it? They can't just do literally nothing in the lead up to 2018 and have the audacity to ask for more power then

Sure they can.  Voters don't care about policy wins.  I think Bill Scher is largely right on this:

"Trump isn't accomplishing anything, but his voters don't care."

Nate Silver points out Trump's voters aren't enough for the Republican Party. They need more than just that which affects their political calculation.

[The_Doctor]

But what do Republicans tell their base if they give up on it? They can't just do literally nothing in the lead up to 2018 and have the audacity to ask for more power then

Sure they can.  Voters don't care about policy wins.  I think Bill Scher is largely right on this:

"Trump isn't accomplishing anything, but his voters don't care."

Nate Silver points out Trump's voters aren't enough for the Republican Party. They need more than just that which affects their political calculation.

OK, but swing voters wouldn't be happy with AHCA passing either.

What I was suggesting was that the idea that the GOP electorate in particular is going to be mad if Congress fails to pass ACA repeal seems unlikely to me.  I don't think it's true.  I don't think voters care that much about policy as such.  They care about what happens to them.  There was anti-Obamacare passion on the right, but that was really just anti-Obama passion.  Now that Obama himself is gone, I doubt many Republican voters rate it as a high priority issue.

Congress failing to repeal the ACA isn't going to turn normal Republican voters against either Trump or Republicans in Congress.  In fact, it wouldn't surprise me if, a year from now, a large percentage of the electorate won't even be able to correctly answer a poll question on whether Obamacare has been repealed or not.

Sorry for being unclear. I actually agree. Republican base voters don't care as long as it doesn't negatively impact them. When Iraq began affecting the lives of young soldiers from Bush country Republican voters began turning against the war, for example. Years later they tossed Jeb Bush for his brother's presidency during the Great Crash.

So yeah I agree.

[The_Doctor]

So let's do a look.

Murkowski has PP issues. Moore Capito and Portman have opioid and Medicaid issues. Heller is generally vehemently opposed. Paul thinks it's too liberal. Cruz and Lee ditto, but are more gettable. Moran, just a general statement. Collins wants to shore up the law.

The problem is that the Medicaid expansion is way too difficult. Capito Moore and Portman now are on record saying that they want to essentially preserve it. Ditto Heller and Collins. But any move leftwards endangers the bill from the House conservatives.

The Senate GOP has taken the tactic that polarization isn't enough to save them here. They don't want to be haunted by the law. They appear to believe that any law passed will be ongoing and litigated legally and politically. This is relevant for the 2020 folks and possibly 2022 too.

My feel is that the statements this afternoon were put out to basically kill the bill and make it impossible for McConnell to craft a compromise on Friday.

Collins, Heller, Murkowski, and Moore Capito have essentially made statements that are very hard for 51 Republican senators and 218 House Republican Congressmen and women to get behind.

I could be wrong. But that's how I'm reading it.

[The_Doctor]

Additionally -- and this is entirely Trump's fault -- today shows that the 2020 people are now unsure if 2020 will be a Republican year. Collins isn't up until 2020 and neither is Moore Capito. That they said this implies that Trump's approval rating and behavior as president is weighing on their minds and they're not sure they want to add healthcare to a possible lousy 2020.

They wouldn't be behaving like this as much if they assumed Trump would win the reelect or even have a decent shot. The last six months is showing that they're better off not making healthcare an issue rather than rolling the dice. There's way too much uncertainty here.

[The_Doctor]

Lastly don't underestimate the GOP governors revolting here. Any law will need to survive the GOP governors too.

The bigger picture is that universal health care will come with the realignment.

[The_Doctor]

Anyway one more missive.

What's the most important thing for the GOP Senators voting on this? Avoiding controversy and uncertainty. All Senators and politicians hate controversy, because it puts them in a position to be unseated by someone, either within a primary or in a general election.

Take West Virginia. First term GOP Senator Moore Capito might not care in the slightest about WV's problems. But she will care about West Virginia's problems if the headlines continue to be damaging and talk up about how West Virginia's premiums have gone up for older people, and if the uninsurance rate has gone up. Now, she's the first Republican Senator in West Virginia in maybe, 100 years. She does care if negative headlines dog her in 2018 to 2020.

So, if you read her tweetstorm today, she's deliberately agitating over the Medicaid expansion and signaling she doesn't want it to end for West Virginia.

A ton of GOP senators were indicating they didn't want to move on this because neither they or their staffs could get their hands around the burgeoning controversy or uncertainty. Here's the thing to know. That won't change in a week. That, more than polarization, puts these Senators in a position where they're high profile political targets and forced to defend the controversy and contend with the unknown. No matter how many amendments there are, the number of uninsured will not go down to 0 - it will be a tens of millions of people losing insurance.

So, if I had to guess, that's a huge negative for the bill.

As far as a realigning election is concerned, which is probably one of the next 3 Presidential elections, healthcare's struggles in the 2010s probably set the winning Democrat with a mandate to solve the lingering issue of both Medicaid, Medicare, and private insurance in a grand bold progressive move. Now that both sides have failed to, within the Reagan Revolution's framework, solve the thorny issue of health care, that President is probably going to come in with this political and economic history in the issue and decide to do a "sweeping" change.

The Republican coalition can't solve healthcare because the rules of the Reagan realignment don't allow them to. Limited government means no more major welfare programs or major entitlement programs. It's always been about stopping the future expansions, and preserving what we have. So, the GOP can't deal with skyrocketing premiums and health care becoming a major political and economic issue. The best they can do at this point is patch the ACA, imperfect as it is, because their political options are capped.

The Democratic Left, as the minority coalition that is about to become the majority coalition, probably has a lot of running room and options to explore as they start teeing up the groundwork for the winning President to implement broad and major health care reform. I would pay attention to what the Democratic think tanks and the left is chattering on about and what they decide is feasible and what isn't. Because their consensus will become the national consensus between 2021 and 2029.

Whatever happens (most likely failure, but cannot rule out passage) - the health care debate will go on and sap the GOP of political energy the longer it remains on the table. It will guarantee about 45-50% of the electorate will continue voting Democratic (including a number of whites, who will conclude that for whatever reason, they are better off in supporting the Democratic Party for their health care needs).

[The_Doctor]

"And in today's news, the Trump administration came out for single payer, stunning news observers. House and Senate Republicans swiftly fell in line, however, and extolled the virtues of single payer as the rabid Republican base suddenly discovered the virtues of single payer."

[The_Doctor]

seems like it is coming apart.

several senators now complaining about the tax cuts for the rich.

how is the freedom caucus going to swallow that?

Which senators? What's the twitter saying?

[The_Doctor]

seems like it is coming apart.

several senators now complaining about the tax cuts for the rich.

how is the freedom caucus going to swallow that?

Which senators? What's the twitter saying?

https://www.bloomberg.com/news/articles/2017-06-28/key-republicans-want-to-scrap-health-bill-s-tax-cuts-for-wealthy

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I see GOP Senators are now in "kill the bill" phase. If they phased out these cuts they might as well as keep the ACA, right? It will be interesting to see what Mitch McConnell decides to do in response by Friday.

Axing these tax cuts would probably kill the bill in the House too. Which seems the point too. These senators are being vocal about the tax cut side, which implies they're no longer interested in negotiation but in killing the bill. Tax cuts are integral to the point of repeal.

[The_Doctor]

Sen. Flake comes out in FAVOR of the Cruz amendment. Theory: he knows it won't pass, but can use this to defend himself in the upcoming Republican primary.

Flake may be giving a giant F U to the bill and Trump here by advancing the Cruz amendment, which he knows Capito, Heller, and Collins hate.

[The_Doctor]

actually Flake is my sleeper pick to have problems in both primary and general. He won AZ by just 5 points in the 2012 election despite Romney winning Arizona by 10. This was for a GOP held seat and it was an open seat but still. Flake had been a House member. So actually I think Jeffry has more problems than just a primary. He's probably facing in the midterms the same type of electorate that he faced in 2012 (where he didn't clear a majority of the electorate, by the way).

He can / will probably win but I am also saying it might be close in both.

[The_Doctor]

They don't have the votes. They delayed the beginning of the recess by two weeks, if I'm reading right. Will they have the votes?

I'd say 95% No. Lindsey Graham's statement definitely suggests that there is a measure afoot to stabilize the law.

[The_Doctor]

Basically read this:

https://www.macpac.gov/wp-content/uploads/2016/06/Trends-in-Medicaid-Spending.pdf

Now tell me again, that Heller is voting yes. 200,000 Nevadans didn't get on Medicaid by choice. A lot of the expansion is to mop up those who were hurt the Great Recession.