THE MORNING PLUM:
House Republicans have finally rolled out their long-awaited bill repealing and replacing the Affordable Care Act. It’s anyone’s guess whether it will actually pass. But even if it does, the structure of the GOP replacement all but ensures that the Obamacare wars will continue right through the 2018 and 2020 elections — in ways that numerous Republicans might come to regret. Bigly.
The GOP plan repeals the Medicaid expansion and replaces it with a system of per capita grants that would dole out a fixed sum per Medicaid recipient — which could result in cuts over time and freeze out those who want to enroll later. It replaces the ACA’s system of subsidies with tax credits allotted by age, with larger ones going to older people, but they would mean less assistance for those with lower incomes. It repeals the ACA’s tax hikes, without saying how the plan would be paid for.
The plan has yet to be scored by the Congressional Budget Office, but it would likely result in untold numbers losing coverage over time, and many others not being eligible for coverage where they otherwise would have been. As Margot Sanger-Katz puts it, the GOP plan “shifts a lot of benefits from the poor to those who earn more,” by slashing “funding to states that cover poor adults through their Medicaid program” and “financial assistance for relatively low-income insurance shoppers,” while offering “new financial benefits for the upper-middle class and the rich.” What a surprise!
But note the timing here. The changes to the Medicaid expansion and the subsidy system would take hold at the beginning of 2020. That means their actual impact might be felt during the 2020 elections — the presidential and Senate races. Democratic candidates will be able to blast Republicans who voted for the GOP replacement, on the grounds that it is resulting in their states’ residents getting tossed off of coverage, while vowing to replace the spending.
Some GOP senators up for reelection in 2020 in swing states also happen to represent states that already opted into the Medicaid expansion. That includes Joni Ernst in Iowa and Cory Gardner in Colorado. There’s also Thom Tillis in North Carolina (which didn’t expand Medicaid but could lose a lot in subsidies).
“The Republican health-care plan as it stands today would certainly endanger some Republican incumbents up in 2020,” Jennifer Duffy, who tracks Senate races at the Cook Political Report, tells me. Some of these senators got elected by campaigning against the ACA’s rollout problems amid the shriveled midterm electorate of 2014 and will now face reelection in a presidential year, as repeal’s impact takes hold. It’s no accident that the GOP senators who are already objecting to the GOP plan come from states that expanded Medicaid.
As Philip Klein points out, this could create a looming “fiscal cliff”-type scenario right in the middle of the 2020 contests, and could conceivably create an incentive to pass some kind of extension, punting the issue until after the elections. If Democrats won back control, what would happen next is anyone’s guess — repeal-and-replace might be reversed or mitigated.
This could also matter in the 2018 gubernatorial contests. In 2018, three dozen seats are in play, most held by the GOP. The GOP-held seats include Medicaid expansion states like Ohio, Michigan, Iowa, Nevada, Illinois and Maryland. The new House GOP plan also reduces the share of Medicaid money per capita that the feds would pay. This could put GOP state budgeteers in a quandary — beginning in 2020, they may end up kicking recipients off Medicaid rather than put up the state’s share of the cash. Thus, looming Medicaid cuts could be a big issue in some 2018 contests.
It’s telling that some GOP governors from Medicaid expansion states are already expressing qualms about the GOP plan. But if it passes, they’ll be stuck preparing to deal with the concrete fallout from changes passed into law by their party. And those 2018 gubernatorial outcomes could have consequences that reach into the next decade.
A caveat: There was a time when I’d confidently predict that GOP lawmakers responsible for kicking untold numbers of their constituents off health coverage would pay a price. I’m no longer confident of that. But it could happen. As Duffy points out to me, the ACA’s implementation created a new round of political problems for Democrats in 2014 — problems that “stretched over years.” The same could happen as Republicans transition from raging against the ACA in the abstract to carrying out the implementation of repeal and replace.
* REPUBLICANS CRAVE HEALTH-CARE GUIDANCE FROM PRESIDENT TRUMP: The New York Times’ write-up of the new GOP heath-care legislation observes:
Mr. Trump has expressed only vague goals for how to repeal the Affordable Care Act and improve the nation’s health care system. On Capitol Hill, lawmakers and their aides are waiting to see whether he uses his platform, Twitter account and all, to press reluctant Republicans to get behind the House plan.
How will Trump react when the Congressional Budget Office scores the new bill? If it kicks millions off insurance, does Trump endorse it, given his pledge of “insurance for everybody”?
* CONSERVATIVES MAY REJECT GOP REPLACEMENT: Axios reports on the reaction of conservative Republicans to the GOP’s health-care bill:
They … threatened to vote against anything less aggressive than the 2015 repeal bill, which this definitely is. Freedom Caucus chairman Mark Meadows said on Hannity last night that “we’re making progress,” but other early signs aren’t good: Rep. Jim Jordan reportedly doesn’t like it, a Republican Study Committee memo calls it a “Republican welfare entitlement,” and Rep. Justin Amash tweeted that it was “Obamacare 2.0.”
After all, the plan still spends federal money to cover people, which cannot be tolerated. In the end, though, I expect that they will miraculously find a way to vote for it anyway.
* OBAMACARE’S POLITICAL PROBLEM, IN ONE POLL FINDING: The new CNN poll finds:
Overall, 50% oppose removing the requirement to obtain coverage or pay a penalty, while 48% favor it.
A broad majority, 87%, support maintaining Obamacare’s protections for those with pre-existing conditions.
There you have it: Everyone wants the protections for preexisting conditions, but not the mandate that makes them possible. Even so, it’s notable that slightly more favor it.
* TECH COMPANIES OPPOSE TRUMP’S NEW BAN: CNN reports that a number of tech companies are already blasting Trump’s new version of the travel ban, which would make it harder for them to recruit skilled workers from abroad:
More than 100 companies joined a legal fight last month against Trump’s original travel ban. … Tech companies and trade groups are still in the process of parsing through the updated immigration order and figuring out the right response, according to industry sources.
Expect them to join legal efforts to block the new ban. No doubt this proves Trump’s ban is sticking it to globalist elites.
* NEW BAN EXCLUDES COUNTRIES WHERE TRUMP DOES BUSINESS: Bloomberg makes a good point here:
The new order excludes Iraq, which fell under the first ban. … But one thing hasn’t changed: His proposed list doesn’t include Muslim-majority countries where his Trump Organization has done business or pursued potential deals. Properties include golf courses in the United Arab Emirates and two luxury towers operating in Turkey.
This underscores once again that there is no serious national security rationale for the ban.
* THE NEW BAN HAS NO RATIONALE: The Post has a good editorial skewering the new version of the travel ban:
It is still the case, as a report last month from the Department of Homeland Security reiterated, that few people from the banned countries have mounted or tried to mount terrorist attacks in the United States. It is still the case that most of those convicted or killed attempting such attacks in recent years were U.S.-born citizens. … The ban … aids the recruitment efforts of the Islamic State and other extremist groups by substantiating their case that anti-Islamic bigotry thrives in the United States.
Remember, top Trump advisers believe we’re already embroiled in a global showdown with Islamo-fascism, making it impossible for arguments like that last one to even penetrate.
* AND OUR PRESIDENT TAKES HIS CUES FROM BREITBART: The Post reports that reporters grilled White House press secretary Sean Spicer over Trump’s charge that Obama wiretapped his phones, which the White House has now called on Congress to investigate. Note this:
Asked whether he could unequivocally say that Trump’s tweet was based on more than a talk radio report and the Breitbart article, Spicer declined, again referring to his calls for the intelligence panels to take the lead.
Simply amazing. Not only is the president basing this charge solely on conservative media conspiracy-mongering; the White House is now demanding that Congress clean up the mess.