Opinion writer

(Win McNamee/Getty Images)


The Senate’s health-care bill is on the verge of collapse, multiple reports tell us this morning, with numerous GOP senators balking at the brutal new Congressional Budget Office analysis, which found that the bill would leave 22 million more uninsured by 2026, 15 million of them in the next year alone.

But the bill is far from dead. The big question now is whether Senate Majority Leader Mitch McConnell (R-Ky.) can buy off a few moderate senators with “side deals.” Politico reports that such discussions are well underway as we speak.

But what the CBO report really tells us is this: No side deal can actually rescue the bill in any meaningful sense from the moral criticism that these moderate Republicans themselves have lodged against it. A few moderates may end up backing the bill — and it may even pass — but if so, they will be largely embracing priorities that they basically asked us to believe they reject as unacceptable.

The CBO analysis is mostly unsparing. It finds that the Senate bill would cut Medicaid by $772 billion over 10 years, resulting in 15 million fewer covered by that program (out of a total of 22 million fewer covered). Republicans are touting the fact that the CBO found that premiums would decrease on average over time. But as Margot Sanger-Katz notes, this is because, by allowing states to waive minimum standards for coverage, it would make the insurance itself less comprehensive and valuable, and many Americans with serious conditions would end up paying much more out of pocket. And as Jonathan Cohn explains, the bill would also cut about $400 billion in subsidies for the working poor and lower middle class, and allow higher premiums on older people, compounding the damage to the less fortunate.

Ultimately, the CBO confirmed the bill’s profound regressiveness. It would slash health spending on poor people by hundreds of billions of dollars to facilitate an enormous tax cut for the rich.

The nonpartisan Congressional Budget Office released its analysis of the Senate GOP's health-care bill on June 26. Here are its key estimates for how the plan would impact Americans' health insurance coverage and costs. (Jenny Starrs,Daron Taylor/The Washington Post)

The latest whip count shows that at least six moderate Republicans — Susan Collins (Maine), Dean Heller (Nev.), Shelley Moore Capito (W.Va.), Lisa Murkowski (Alaska), Rob Portman (Ohio), and Bill Cassidy (La.) — oppose or have serious concerns about the bill. Collins has balked at the Medicaid cuts harming the “vulnerable.” Heller has decried tens of millions losing insurance. Capito, Murkowski and Portman have all expressed varying concerns about their states’ Medicaid expansion population losing coverage. (Four conservatives also are leaning against the bill; a total of three “no” votes would sink it.)

It’s true that some, such as Capito and Portman, have said they’re open to a slow Medicaid expansion phase-out, such as that in the Senate bill. But Capito has said she wants those displaced from Medicaid to continue to have access to insurance, and Portman has said he wants to continue protecting “the most vulnerable.” And we now know that the CBO has concluded that 15 million of these “most vulnerable” people would be left without coverage. The total of 22 million equates to the “tens of millions” that Heller drew as his line.

How can any “side deal” make up for this? Politico reports that another key CBO finding — that the Senate bill would reduce the deficit by a few hundred billion dollars — has left McConnell some money with which to make these deals. Among the ideas being mulled: putting more money into Medicaid; adding more funding to treat the opioid epidemic that has worried some of these moderates.

But this money cannot go very far in mitigating the massive coverage rollback that this bill would produce. And that rollback is a function of a simple fact: The bill cuts taxes enormously on the rich. Nicholas Bagley, a health policy expert at the University of Michigan, emails me:

The Senate bill cuts taxes by $700 billion, largely on the wealthy. Offsetting those tax cuts requires commensurately large cuts to Medicaid and the Obamacare subsidies. You can cut all the side deals you want — opioid funding, an extension of the Medicaid phase-out, more market stabilization money, whatever — but without the tax revenue, you don’t have enough money to play with to put much of a dent in the coverage numbers. That’s just math.

Even if these side deals brought down the number who would lose coverage by a few million — and that is unlikely — the profound, overriding regressiveness of this bill would basically remain undisturbed. It is possible, of course, for Republicans to defend such a large coverage loss on principle — by arguing that the tax cuts and deregulation will have other positive effects on the country that make the rollback of coverage worth the trade-off, or by arguing that those who lose Medicaid will benefit from having to find insurance on the private market.

But these moderates are not prominently making those arguments. They are on record saying, in one form or another, that coverage losses of the enormous magnitude the GOP bill would produce — which have now been officially projected by the CBO — are not acceptable outcomes. They asked us to believe that they reject the GOP bill’s deeply regressive priorities. Perhaps they will harbor other reasons to vote for the bill  — and justify it by saying the “side deals” have marginally improved it. But if so, those side deals will be largely meaningless relative to the pain the bill will produce and to the larger scheme of values they will have embraced. And their previous moral protestations will have basically been rendered lies.

* MEDICAID CUTS WOULD GET MUCH WORSE OVER TIME: The CBO found the Senate bill would cut spending on Medicaid by $772 billion over 10 years, leaving 15 million fewer covered on that program. The Post write-up adds this:

In a briefing for reporters, CBO staff members said that they had not analyzed the bill’s effects on Medicaid cuts beyond the coming decade but that the reductions inevitably would be greater for a second decade.

This is due to the Senate bill’s use of a more stringent funding formula over time than the one in the House bill, and it would put states in a terrible bind.

* RYAN PREDICTS VINDICATION IN 2018: House Speaker Paul D. Ryan (R-Wis.) tells the Washington Examiner that if Republicans pass their health-care bill, the voters will come to appreciate the results over time:

“Whether or not it’s being perceived well, or understood fairly, is not the question so much as: Do we achieve the result? That means we have to pass our policies to achieve good results and let the results speak for themselves,” Ryan said. “Whether or not we can communicate in the fog of the moment is not as important as: Do our policies make a difference and do they solve the problem? And, the answer is, ‘yes.’ And, that’s why we have to see it through.”

The GOP bill would cut health spending on the poor by hundreds of billions of dollars while giving the rich a huge tax cut. Maybe, from Ryan’s point of view, that solves “the problem.”


Obamacare has seen its support increase in polls this year, while the Republican bill has consistently proven to be unpopular. Several GOP operatives have privately said that failure would not be a total disaster for the party, since no one loves the bill, and moderates could avoid being burdened by it.

It’s often said that the GOP base will rise up in a fury if repeal-and-replace doesn’t go through, but is that even true?

* MCCONNELL WARNS FELLOW REPUBLICANS: Axios reports that McConnell is warning fellow Republicans that there will be a big price to pay if the GOP health bill fails:

Senators are being told it’s not possible to just let Obamacare fail — that if the Better Care bill fails, Rs will have to work with Ds (horrors!) later this year to help shore up the exchanges. That would require Republicans making big concessions on important priorities.

It’s unclear what concessions would be required for Republicans to join Democrats in improving the exchanges, but if this is right, it’s telling that McConnell doesn’t see letting the ACA “fail” as an option.

* WARREN URGES DEMS TO RUN ON SINGLE PAYER: Sen. Elizabeth Warren (D-Mass.) tells the Wall Street Journal that Dems should run on single payer in the next few elections:

“President Obama tried to move us forward with health-care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts. Now it’s time for the next step. And the next step is single payer.”

If the GOP bill passes, the pressure on Dems from the left to officially adopt this position will get very intense.

* GOP POLLSTER: TRUMP VOTERS ‘TUNE OUT’ ALL CRITICISM: The Associated Press reports that Democrats are planning to escalate their attacks on Trump’s policies for favoring the rich and shafting his own voters. But:

“His supporters pay attention to what he’s saying, and less so to either the Democrats or the press,” Republican pollster Neil Newhouse said in an email. “Simply put, Democrats can criticize his health care plan and tax plan as much as they want, but it falls on deaf ears with Trump voters, as they simply tune it out.”

No doubt that’s true of Trump’s hardcore supporters. But will this last forever among those who voted reluctantly for him, especially if the horrifically unpopular health bill passes?