As Republicans push out new revisions to save their health-care plan, The Post's Paige W. Cunningham explains the sticking points spurring on the internal fighting over the bill. (Jenny Starrs/The Washington Post)

THE MORNING PLUM:

House GOP leaders are confidently forging ahead with the repeal-and-replace vote today, and they are laughing off questions as to why they would go forward despite their willfully premature and dim understanding of how the measure might impact millions of Americans and one-sixth of the U.S. economy. They are doing this without seeing a nonpartisan analysis of their new bill from the Congressional Budget Office — which will, conveniently, allow them to conceal the full truth of what they are voting for from their constituents.

But this is likely to backfire. Here’s why: The Congressional Budget Office score of the bill is coming, anyway — as soon as next week. And it will land after an untold number of House Republicans have committed themselves to the bill.

A Democratic leadership aide tells me that the CBO has confirmed to Democratic leaders that the CBO score will be completed and delivered next week or the week after. This means moderate and vulnerable House Republicans who are already worried about explaining to their constituents why they voted for the bill — which guts protections for the sick and rolls back coverage for millions of poor and working-class people while delivering a huge tax cut to the rich — will have to justify it again, in light of a nonpartisan analysis spelling out the grisly details of what they really voted for.

To be sure, Republicans have their own stated reasons, if you can call them that, for rushing this vote. GOP leaders want to hold this vote before Republicans go on recess, which could sap momentum, and the White House has been putting extreme pressure on them to get this done.


(Cliff Owen/Associated Press)

Meanwhile, the justifications for the rushed vote coming from individual Republicans have rapidly devolved into low comedy. One GOP congressman, when asked how he knows what’s in the bill without a CBO score, claimed: “I just know.” Another, in a moment of accidental candor, said: “I would prefer to have it scored, but more than that I want it to pass.” (Does this mean that the former is a threat to the latter? Probably!) A third claimed that the rushed vote is no big deal, because the CBO already scored the last version of the bill, and the new one is “substantially similar.”

But it’s perfectly plausible that the new CBO score could show that the new version is substantially worse than the last one. The old CBO score found that the last bill could leave 24 million people without coverage — 14 million of them due to the phaseout of the Medicaid expansion — while driving up premiums in the near term for older people. The new bill won over conservatives by allowing states to waive the requirement that insurers cover essential health benefits and refrain from jacking up premiums on people with preexisting conditions.

Many analysts have pointed out that the latter provision could lead to soaring costs for the sick, potentially pushing them off coverage. To deal with this, GOP leaders agreed to a last-minute change to the bill that would provide a paltry additional $8 billion to help those people. This may have succeeded in giving moderates the fig leaf they need to vote for it.

But the new CBO score could illustrate with new vividness the true impact of the new bill’s relaxation on protections for preexisting conditions — and show that this last-minute change is not going to mitigate the damage it could do to them in any meaningful sense. As it is, most analysts already agree that it won’t, but the CBO could enshrine this in a great deal more detail. Nicholas Bagley, a health policy expert and law professor at the University of Michigan, emails me:

A CBO score would give us some sense of how relaxing the ban on discriminating against people with preexisting conditions would affect coverage. It would also show moderate Republicans just how little difference an infusion of $8 billion will make to the overall coverage figures. Congressional Republicans are shooting in the dark here. They may not like what they find when CBO turns on the lights.

Harold Pollack, a public policy professor at the University of Chicago, adds that the new CBO score could demonstrate that premiums are going to rise for the sick in spite of the latest GOP efforts to throw a few pennies (relatively speaking) at that problem:

The new CBO score could easily show even higher premiums for people with costly conditions, not withstanding efforts to paper over these difficulties. It could also show even greater numbers of people losing coverage relative to current law. There are also substantial risks that CBO would simply find embarrassing errors due to the rushed and slipshod process through which AHCA was produced and repeatedly modified. The new CBO score could easily show fewer people covered, more difficulties with insurance markets, and higher premiums for people in greatest need of help.

If this happens, it will put moderate and vulnerable Republicans who supported the bill in an odd spot. They will be at home on recess, hearing from their constituents, and they will have to justify their vote for something that threatens to inflict all the harm that the new CBO score has now projected it will inflict.

What’s more, they will also have to explain in retrospect why they rushed the vote in advance of a CBO score detailing its impact, even though it was only a few days away — and is designed to help them make a more informed choice about what it is they were truly voting for. At that point, though, it will be too late. They will already be on the hook for it.

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* HERE ARE THE WHIP COUNTS ON THE GOP BILL: The Post counts 20 Nos or lean Nos, and 35 who are undecided or unclear. The New York Times counts 18 Nos and 33 who are undecided or unclear. CNN counts 21 Nos and 15 who are undecided. HuffPost counts 16 Nos, 3 lean Nos and 14 undecided. The Hill counts 18 Nos and 52 undecideds.

Presuming all members vote, and presuming all Democrats vote No, Republicans can lose no more than 22 votes, or it goes down.

* GOP LEADERS SAY THEY HAVE THE VOTES: The Post reports that GOP leaders appear certain of passage:

Republican leaders huddled in the office of House Speaker Paul D. Ryan (R-Wis.) on Wednesday evening…Several said they would hold a vote this week only if they felt certain it could pass — meaning they now think they have the votes. Exiting the relatively brief leadership meeting, House Majority Leader Kevin McCarthy (R-Calif.) guaranteed victory. “Do we have the votes? Yes. Will we pass it? Yes,” he told reporters.

A vote is expected in the early afternoon. Remember, however: There is no telling what will survive of this bill in the Senate, yet House moderates will be on the hook for supporting it, anyway.

* HERE’S WHAT A WAVERING MODERATE LOOKS LIKE: The New York Times spotlights the wavering of Rep. Carlos Curbelo (R-Fla.), a former No who may vote Yes, thanks to the amendment added by Rep. Fred Upton (R-Mich.) that adds a paltry $8 billion for preexisting conditions:

In a Twitter post on Thursday morning, he said he had just told House Republican leaders that the bill “in its current form fails to sufficiently protect Americans with pre-existing conditions.” In a late afternoon interview, he said, “I do not yet have a position on the bill.” He wanted to hear more from Mr. Upton, a respected Republican voice on health care.

Curbelo is now saying a big state like his is not going to seek a waiver from banning jacked-up premiums on preexisting conditions. Really? And what about all the other red states?

* PELOSI VOWS TO MAKE REPUBLICANS PAY: Nancy Pelosi sent her Democratic House colleagues a letter last night that said this:

Maliciously, with only hours’ notice and without a CBO score, Republicans will attempt to destroy the health care and coverage of the American people — all of this to inflict a $600 billion transfer of wealth from working families to corporations and the richest people in the country. Republicans are fraudulently claiming that Trumpcare covers Americans with pre-existing conditions. It does not!!…Together, we will once again expose Trumpcare’s disastrous consequences for hard-working families and seniors across America.

Maintaining Democratic unity will be key. This is a small preview of what millions of dollars in ads attacking House Republicans will look like.

* THE TRUTH ABOUT GOP BILL AND PREEXISTING CONDITIONS: House Speaker Paul Ryan and other Republicans claim their bill will still protect people with preexisting conditions, but Glenn Kessler has a deep dive into all of the uncertainties those people will face if the GOP bill ever becomes law. Bottom line: “Despite Ryan’s tweet that people with preexisting conditions are protected, there is no guarantee that they will not face higher costs than under current law.”

And of course, “higher costs” could lead many to be priced out of the market, and shunted into high-risk pools that are underfunded, also slap them with high costs, or leave them uncovered entirely. As Kessler demonstrates, there are all kinds of unknowns that lie ahead.

* REPUBLICANS QUIETLY GEARING UP FOR MAJOR SPENDING CUTS: Bloomberg Politics reports that House Republicans are quietly taking preliminary procedural steps to lay the groundwork for big cuts to mandatory spending. Such programs include Medicare, Medicaid, unemployment benefits and food stamps.

But wait, you say, didn’t Donald Trump promise not to touch entitlements? Well, yes, he did. And maybe he’ll still stick by that. Or maybe he won’t.

* RED-STATE DEMOCRATS SURVIVING IN TRUMP ERA: Politico offers an interesting look at how Senate Democrats up for reelection in states carried by Trump — such as Sherrod Brown, Heidi Heitkamp, Joe Manchin and Bob Casey — are quietly racking up wins they can tout. Among them: pet items in the spending bill and a permanent extension of health benefits for miners.

The backstory here is that many of these Democrats are not showing any political fear of Trump and are sticking with their party in bucking his agenda. Compiling accomplishments may be key to whether they can hang on for reelection in spite of that.