President Trump has privately described the GOP repeal-and-replace bill that recently passed the House as “mean,” and has said he hopes the Senate version has more “heart.” In one sense, Trump will get his wish.

Republicans are releasing the Senate bill Thursday, and it will in narrow ways allow Trump and Republicans to argue that it has more “heart.” But in reality, the Senate bill will be at least as bad as the House bill over time. What we’re really seeing here is an elaborate shell game: The Senate bill moves money around in a largely superficial way that enables Senate Republicans to vote for the same fundamental underlying policy priorities embedded in the House bill, while pretending not to. Here’s the gist:

  1. The House GOP bill gives the wealthy an enormous tax cut, financed (relative to current law) largely by hundreds of billions in cuts to health-care spending on poor people.

The Senate bill is different from the House bill, in that it phases out that spending on poor people a bit slower in the near term, but gets to the same place as the House bill in the long term. It rejiggers the subsidies for working- and middle-class Americans in ways that could help lower-income people (relative to the House bill), but it still reduces spending on them relative to the Affordable Care Act.


Paige Winfield Cunningham has the details on the forthcoming Senate version of the bill. The tax cuts would still remain. Senate Majority Leader Mitch McConnell (R-Ky.) needs to hold on to moderate GOP senators who don’t want to be seen voting for something as cruel as the House bill, which cuts $800 billion in Medicaid spending over 10 years, leaving 14 million fewer covered by that program (and 23 million fewer overall). So while the Senate bill, too, will phase out Obamacare’s Medicaid expansion, and replace it with a system of caps on federal money provided to states, it will end the expansion more slowly — in five years.

What’s more, the Senate bill cuts more deeply into Medicaid than the House bill does over time by using a slower growth formula to regulate spending on it. That wouldn’t kick in until seven years from now — which, conveniently enough, would come “well past moderate senators’ next reelection battles,” as Cunningham puts it. But it, too, would almost certainly result in many millions fewer poor people covered. Worse, as Margot Sanger-Katz notes, the Medicaid cuts go well beyond merely phasing out the ACA’s expansion: By imposing a system of caps, they radically restructure the whole program, which also helps many millions of poor children and disabled people, and this would force states to decide whether to find more money somewhere else or to cut the program or move people off of it.


The Senate bill also tweaks the House bill’s formula for subsidies for lower-income people who make more than those receiving Medicaid and get insurance on the individual market. Instead of an aged-based formula, the Senate bill preserves the ACA’s income-based formula. This would shift some spending toward lower-income people, relative to the House bill. But the Senate bill still cuts off the subsidies at a lower income level (350 percent of the poverty line) than the ACA does (400 percent). “Like the House bill, this is clearly moving backward,” Judy Solomon of the Center on Budget and Policy Priorities told me.


As Jonathan Chait puts it, the tax cuts are, at bottom, what drive the bill’s “inescapable cruelty.” They are also what necessitates the Senate bill’s fiscal sleight of hand to cover up this fundamental truth. Here’s how Larry Levitt, a senior vice president at the Kaiser Family Foundation, explained the whole thing to me this morning:

The House bill cuts about a trillion dollars in federal spending on health care for poor people, in exchange for substantial tax cuts, primarily for the wealthy. If the tax cuts remain in the Senate bill, then all they can do is rearrange the cuts in federal health spending on low income people. But their overall magnitude has to be the same.
On Medicaid, the Senate bill’s phase-out of the expansion would appear to be slower, in exchange for a more stringent formula for cuts over time. The Senate bill would get to the same or potentially even deeper Medicaid reductions as the House bill would over time. On the subsidies, there is a redistribution, but it’s fundamentally still a significant reduction in help for low income people. They cut off subsidies for higher income people, in exchange for an increase in subsidies for lower income people — relative to the House bill. But overall, health care would still be much less affordable for low income people than it is currently under the ACA.

Moderate Republican senators, however, will be able to employ some kind of clever talking point about the fact that the Medicaid expansion phaseout will be slower. Look for a lot of recitations of the phrases “slower glide path” and “softer landing.” And Trump will say the bill is no longer “mean.” But at bottom, it’s all basically a cruel, cynical shell game.


Update: The full draft of the Senate bill has now been released.

* McCONNELL DISMISSES SECRECY COMPLAINTS AS ‘LAUGHABLE’: Laura Litvan and Sahil Kapur report that Senate Majority Leader Mitch McConnell (R-Ky.) is pushing back on complaints about the super-secret health bill process. Then they debunk his claim in one sentence:

“I do find it particularly laughable the complaints about process,” he said Tuesday. McConnell said final details of Obamacare were worked out in then-Majority Leader Harry Reid’s office as he struggled to get enough Democrats to back it. Still, the Obamacare proposal had undergone multiple committee hearings before that final stage, unlike the Senate Republicans’ emerging plan.

Nice try, Mitch, but nope.

* McCONNELL QUIETLY ABANDONS LANGUAGE OF ‘REPEAL’: A nice catch by the Atlantic’s Russell Berman:

McConnell has quietly abandoned the language of “repeal-and-replace” that his office originated seven years in the immediate aftermath of the ACA’s enactment. In more than a dozen speeches on health care that McConnell has delivered on the Senate floor since the House passed its bill in early May, he hasn’t uttered the word “repeal” a single time, according to transcripts provided by the majority leader’s office. Nor has he repeated his own pledge to rip out Obamacare “root and branch.”

The GOP bill will leave a lot of poor people without coverage, while giving the rich a huge tax cut, but it will still leave the ACA’s basic structure in place, much to the chagrin of conservatives.

* GOP SENATOR SAYS REPUBLICANS DON’T WANT DEMOCRATIC INPUT: Sen. Mike Enzi (Wyo.) tells the Washington Examiner that Democratic efforts to reach out to Republicans during the debate over Obamacare were insincere, then adds:

Plus, Enzi said, running the Senate GOP bill through committee would probably ensure that its passage is delayed until 2018, a timeline most Republicans would find unacceptable.
“We’re not trying to give the impression that we’re going to listen to them. They never listened to us,” said Enzi.

The idea that Democrats didn’t reach out is nonsense. That aside, note that Enzi is admitting that Republicans don’t want Democrats’ cooperation and that the rushed timeline requires no debate.

* TOP INTEL OFFICIALS DETAIL TRUMP’S REQUEST: CNN reports that two top intelligence officials have now told investigators that Trump did ask them to go public and say he personally was not under investigation for collusion with Russia:

Director of National Intelligence Dan Coats and National Security Agency Director Adm. Mike Rogers described their interactions with the President about the Russia investigation as odd and uncomfortable, but said they did not believe the President gave them orders to interfere, according to multiple sources familiar with their accounts. … Both men … were surprised the President would suggest that they publicly declare he was not involved in collusion, sources said.

The fact that the two apparently did not feel pushed to go public may be relevant to whether Trump obstructed the inquiry. But regardless of whether his conduct amounts to obstruction, the already-known fact pattern is deeply troubling.


* TRUMP AIDES UNAWARE OF ANY COMEY TAPE: Trump’s team has said he will make a decision on those tapes of his conversations with former FBI director James B. Comey this week. But the Associated Press reports:

Several outside advisers who speak to Trump regularly said the president has not mentioned the existence of tapes during their conversations. White House aides have been known to grimace when the subject comes up, and more than a half-dozen staffers said they were unaware of any recording devices. All demanded anonymity to speak about private discussions with the president.

What happens if the tapes turn out not to exist?

* GOP RUNNING OUT OF WAYS TO CUT SPENDING: The Wall Street Journal reports that Republicans are split on how to fund the government after October, with some wanting to boost defense spending, even as there is little room left to cut to offset that:

Most Republicans, however, wouldn’t support increased military spending without corresponding cuts to other parts of the budget. The problem is that Republicans have spent years slimming down nondefense discretionary spending, leaving less to trim at this point. Many of them balked at cuts that … Trump’s budget proposed to popular programs and agencies … “While there is obviously waste and duplication, there are a lot of important things the federal government does, from defense, food safety, medical research, lots of things,” said Rep. Frank Lucas (R., Okla.).

Yes, it turns out that spending pays for government programs that Republicans secretly like. Shocker!

* AND TRUMP CROWDS STILL CHANT, ‘LOCK HER UP!’ A few choice moments from Trump’s rally in Iowa late yesterday:

“They have phony witch hunts going against me,” Mr. Trump said nearly an hour into a speech that veered off script repeatedly. “All we do is win, win, win. We won last night.” … When he mentioned Hillary Clinton, the crowd lustily chanted, “Lock her up,” as if the election had not taken place.

Maybe if Trump shouts at his supporters loudly enough about Clinton, winning and “witch hunts,” he can make the special counsel and congressional probes disappear (in supporters’ minds, anyway).