Margot It’s definitely a mix. You can see different changes designed to appeal to different groups. The changes would make tax cuts take effect sooner and would allow some changes to Medicaid favored by conservatives, so those are plays for the right.
But the changes don’t feel major to me. I can’t tell if they’re big enough to bring along Freedom Caucus members who are committed to full repeal or moderates who are worried about increases in the uninsured rate. Who do you think are the most gettable of the “no” votes, and what do they need?
Nate I’m not sure which group is most “gettable,” but I think it’s interesting that the changes weren’t clearly focused toward any one group, since most changes to make the bill more amenable to moderates would tend to push away the Freedom Caucus, and vice versa.
Regardless, the reality of the vote count is that the Freedom Caucus is the immediate barrier. Right now, a large bloc of the Freedom Caucus says they’re opposed. I don’t think it’s plausible to get down to fewer than a handful defections among non-Freedom Caucus Republicans.
So they need to win at least some of these Freedom Caucus defectors. But what can they really offer them at this point?
Margot I think this problem really highlights the narrow path to passage for this bill. Changes that would really please the Freedom Caucus — like getting rid of the tax credits altogether — would be nonstarters with moderates. Paul Ryan said that President Trump will close the deal. Does he have enough leverage?
Nate I guess we’ll find out. One thing that’s interesting, though, is that most of the “no” votes are from fairly conservative districts. The primary is the only potential electoral vulnerability for a lot of these representatives, but they’re still saying “no.” So it’s hard to look at the defectors and conclude they’re especially afraid of Trump.
As for the Freedom Caucus, who knows what they’ll do. But even if it gets past the Freedom Caucus and through the House, the bill will need to make it through the Senate.
It’s clear the Senate isn’t passing this bill, certainly not as written. How much different do you think the Senate bill would need to be to have a chance? Do they need modest or fundamental changes? At this point, I feel like the best bet for both chambers is to ignore the other and take it to conference.
Margot Even though the House vote count looks tight, the current legislation seems as if it was written with the politics of the House in mind.
The Senate has more of a moderate problem than the House, it appears. There are two senators — Lisa Murkowski and Susan Collins — who don’t like that the bill defunds Planned Parenthood. There are a few senators from states that expanded Medicaid who are worried about changes to that program. There are also some concerns about the generosity of tax credits, particularly for older Americans.
But here’s the thing: The Senate passed a partial repeal bill in 2015 that would have led to much more dire policy consequences — 32 million people losing insurance according to the Congressional Budget Office. So I do wonder if there will be pressure to find some sort of Obamacare repeal to pass.
It seems like the overall G.O.P. strategy on this bill is just to go as fast as possible. House committees marked up the bill without a C.B.O. score. Mitch McConnell has vowed to take a bill right to the Senate floor, perhaps as soon as next week. What do you think of that approach?
Nate I think there are two big forces behind the progress of this bill. One is that no one wants to be responsible for its failure. So I agree that if the House passes something, there will be a lot more pressure for the Senate to figure something out. They might not be able to do it, but they might really try.
Two is that the speed is good for the Republicans. It has a better chance of passing if they move quickly, before public opinion turns against it. It’s better for the Republicans if it fails quickly, because they can move on to other things.
It’s a sound approach. What’s problematic is that they launched into this without any groundwork: no pre-existing consensus on the broad outlines of the plan, no interest group backing, etc.
Margot My sense is that there’s just no policy consensus about health care among Republicans. Even John Boehner said they could never agree — he joked last month that they wouldn’t pass a bill. There were white papers and the bill two years ago, but the effort to write this bill, in a hurry, with a jumble of provisions, seems to suggest that they are just trying to find something that can pass, as opposed to articulating a clear policy vision for what they want health care to look like in this country. I think they would need that kind of vision and consensus to get something ready in advance.
One question I keep coming back to: In the end, is it politically worse for Republicans to go home to voters in 2018 having failed to pass Obamacare repeal after running on it for so many years — or to come home having taken away some of their constituents’ health insurance? The C.B.O. is pretty clear that this bill is going to make a mess of insurance markets in the next two years, so people will start to feel some pain pretty quickly.
Nate What happens before the midterms?
Margot The individual mandate would go away immediately. Even though some people will like not being required to buy insurance, the C.B.O. says that the havoc it would create in the markets would cause 14 million people to lose their insurance next year. And premiums would spike by 15-20 percent more than they would under Obamacare. (That’s before the bill’s new tax credit system kicks in, in 2020). I also think there is a risk that there will be places in the country where no insurers will want to play.
Nate That does not sound good.
I think the Republicans are in a tough spot either way, but I think they’re better off if the bill fails. They’ll get bad press, but voters have fairly short memories and I think the Republicans will move on. They’ll still be able to blame problems on Obamacare, even if it will be less credible.
If they pass this plan, I have no idea how they intend to defend it. And I think hurting vulnerable Americans would go against the core of Trump’s appeal to the decisive Obama-Trump vote in the Midwest and Northeast, with little benefit.
I think the best position for a lot of Republican members is to vote for the bill, but hope it fails. On the other hand, if the bill passes, it will be nice to be among the Republicans who voted against it.
Margot Will be interesting to see. But I strain to imagine Republican voters forgetting all about those promises to repeal Obamacare.
Nate What do you think they’re going to do, vote for Democrats?
Margot Do you think they would vote for Democrats if it passed and the results look like what C.B.O. predicts?
Nate The Republicans who would be upset about the G.O.P. failing to repeal Obamacare? No.
But I think that this plan — both passing it and the fallout — would be a huge risk to Trump’s hold on low-income white-working class voters — registered Democrats, in many places — who don’t support cutting Medicaid, and genuinely don’t think the G.O.P. will take away health coverage from millions of people.
Which, by the way, was another Trump promise.