This money is basically chump change, relative to the massive coverage loss the bill would produce, and if moderates were going to remain true to their own previous criticisms of that coverage loss, they would not allow themselves to be “bribed” by it. But there are grounds for thinking it has a chance of working.
The reason is perfectly captured in a behind-the-scenes anecdote that took place among Republican senators, when they learned about the Congressional Budget Office score of the Senate bill, which projected that 15 million fewer people would be covered by Medicaid due to its enormous cuts to the program. CBO found that a total of 22 million fewer people would be covered by 2026.
The Post has a long look at the “awkward moments” that have gone on between President Trump and GOP senators in the lead-up to Senate Majority Leader Mitch McConnell’s (R-Ky.) decision to put the bill on hold while he tries to secure 50 votes for it. I wanted to flag this moment:
A lobbyist close to Senate Republicans said the score was a devastating blow to McConnell. Senators felt they had been “sold a bill of goods,” the lobbyist said, and had expected the Senate bill to have greater distance from the House bill.“It knocked the wind out of all the sails,” said a GOP aide.Senators began to shift into two camps: those who wanted to attack the CBO’s methodology, and those who realized it would not matter once people back in their states heard the numbers.
If GOP senators expected the Senate bill to achieve “greater distance” from the House bill, then they were either not reckoning with the fundamental underlying realities of what GOP health reform is trying to accomplish, or they were hoping for some magical formula to materialize that would obscure those realities from view. Here is the basic math: If you are going to cut Obamacare’s taxes on rich people by hundreds of billions of dollars, you are going to have to roll back an enormous chunk of the law’s massive coverage expansion.
The Senate bill keeps the House bill’s tax cuts, so the coverage loss was inevitably going to be extremely large, just as the House bill’s was (the House bill’s coverage loss was projected at 23 million, 14 million from Medicaid). It’s hard to say what could have achieved “more distance” from this, but no amount of actually achievable distance would blunt the large-scale impact of that basic set of priorities in any serious way.
The thing is that we know some Republican moderates already knew this to be the case. The compromise proposal introduced by Sens. Susan Collins, Bill Cassidy and Shelley Moore Capito would have kept the Affordable Care Act’s Medicaid expansion more or less in place while allowing states more leeway to structure their individual markets in their own ways. As health policy expert Nicholas Bagley put it, this proposal was designed to “[retain] the ACA’s taxes and funding streams.” The very thing that made this a compromise is that it did not seek to achieve the interrelated huge tax cuts for the wealthy and draconian coverage rollback for the poor and lower-middle-class that the Senate and House bills do. This is also the very thing that led most Republicans to ignore it. Republicans of course understood this to be the trade-off at the core of their reform agenda.
Yet the Post report indicates that Republican senators were surprised to learn that the CBO concluded that their bill would indeed carry out this trade-off. And they responded by dividing into two camps — one that would attack the purveyor of dispassionate, empirical analysis that had confirmed this to be the case; and one that thought this was futile, because the argument could not be won, once voters back home learned how many people would lose coverage under their bill. But why did they expect any other outcome in the first place?
This is another reminder that, as Jonathan Chait notes, the health-care debate has been gripped throughout by a refusal on the part of Republicans to forthrightly acknowledge or defend their own actual priorities. In some cases, this has been deeply cynical, with Republicans claiming that no one will be worse off because everyone will have “access” to insurance, or even that the bill wouldn’t cut Medicaid at all. In the case of President Trump, it’s hard to disentangle his cynicism from his seemingly impenetrable ignorance. Trump has complained behind closed doors that the House bill is “mean,” and has called for “more money” to be added, which suggests he dimly grasps that cutting health-care spending on poor people will hurt them. On the other hand, he was reportedly surprised to learn that his bill would accomplish this while deeply cutting taxes on rich people, so perhaps he doesn’t fully grasp the basic trade-off here. Regardless, Trump has now been informed by the CBO that the Senate bill is just as “mean” as the House bill, yet he continues to champion it, anyway.
In a sense, moderate Republicans have ripped the lid off this whole routine. A number of them have condemned the Senate bill’s Medicaid cuts as unacceptably draconian toward the vulnerable, which has had the effect of conceding that the bill would effect the massive rollback of coverage that the CBO says it would. Yet they still appear to be persuadable with buy-offs that would do relatively little to mitigate the human toll that this rollback would bring about. This suggests that to some degree they remain in the same place as the senators who were supposedly surprised by the CBO score: They are still hoping to find some magical escape hatch from a political and moral predicament that is inextricably linked to the unmovable fact that the GOP reforms would do exactly what they are supposed to do. But here’s the thing: Either moderate Republicans are for huge tax cuts for the rich that will cost double-digit millions their coverage, or they are against them.
* A FEW REPUBLICANS RETHINK TAX CUTS FOR RICH: Bloomberg Politics reports that a handful of GOP senators (such as Susan Collins of Maine) are beginning to question their health bill’s huge tax cuts for the rich. Note this from Bob Corker of Tennessee:
“I want to make sure that we’re not in a situation where we’re cutting taxes for the wealthy and at the same time, basically, for lower income citizens, passing a larger burden on to them,” Corker said. Told that what he described is what the CBO projects would happen, he responded, “So that needs to be overcome then, doesn’t it?”
Overcome? That would be great, but does Sen. Corker know what party he belongs to?
* HOUSE TO GIVE TRUMP A BIG WIN TODAY: CNN reports that the House is expected Thursday to pass a bill that would raise the maximum prison sentence to 10 years for people with a felony conviction or who illegally enter the country after being deported three or more times:
Critics say the bill would aggressively criminalize even non-criminal undocumented immigrants. Being in the country illegally carries only civil penalties. They also accuse the administration of unfairly and inaccurately portraying immigrants as criminals …
CNN notes this would be a “win” for Trump. It will be interesting to see how many Senate Democrats from states Trump won feel compelled to support this.
* GOP FAILURE ON HEALTH CARE COULD IMPERIL TAX REFORM: The Associated Press reports that if the Senate health bill fails, it could put tax reform — which many Republicans view as even more important — at risk of failure, too:
The health bill provides nearly $1 trillion in tax cuts that won’t add to the nation’s mounting debt. Republicans are counting on those tax cuts to help them write a new tax code that raises less money.Also, Republicans are using a complicated rule that enables the Senate to pass both a health bill and a tax package with a simple majority. … Under the rule, Congress has to resolve health care — by either passing a bill or killing it — before lawmakers can pass a tax package.
It would be tragic if the failure of the first round of huge GOP tax cuts for the rich ended up scuttling the second round of huge GOP tax cuts for the rich.
* HOUSE RUSSIA PROBE WILL INTERVIEW TRUMP’S BODY MAN: ABC News reports that the House Intelligence Committee probing Russian meddling and possible collusion now wants to interview Keith Schiller, Trump’s longtime bodyguard-turned-White House aide:
It’s the latest indication that the government’s multiple investigations are touching Trump’s inner circle. … The growing list of other Trump associates the committee has said they want to meet includes former national security adviser Michael Flynn, Trump son-in-law and senior adviser Jared Kushner and former Trump campaign chairman Paul Manafort. … Several White House aides expressed privately to ABC News that they are expecting to hear from Congress or the special counsel.
Maybe if Trump tweets the words “FAKE NEWS” and “DEM HOAX” in capital letters enough times, he can make all this disappear.
* THE GOAL OF GOP’S ‘UNCERTAINTY’ STRATEGY: Health policy experts Craig Garthwaite and Nicholas Bagley have a great piece explaining the GOP strategy of refusing to guarantee cost-sharing subsidies to insurers and sowing uncertainty about the ACA in other ways:
Even with protective policies in place, insurers took a big risk entering the markets. At a minimum, insurers that took the plunge deserved the support promised in the law. Congressional Republicans, however, chose instead to sow uncertainty at every turn, hoping that a damaged reform law would be easier to repeal. … Because insurers don’t know whether the government will honor its commitment to pay those subsidies, they’ve had to ask for double-digit rate increases.
Put another way, Republicans are deliberately trying to destabilize the markets in ways that could leave millions without coverage to build political support for leaving still more millions in the lurch.
* FORGET FANTASIES ABOUT BIPARTISANSHIP ON HEALTH REFORM: E.J. Dionne Jr. has a great column explaining that there’s no way Democrats can cooperate with Republicans in fixing the health-care system until the latter let go of their priorities:
There is no getting around it. You can’t do what the GOP wants to do without hurting a lot of people. This is why pious pleas for the parties to work together are, for now, empty. Of course it would be far better for Democrats and Republicans to agree on ways to improve our health system, and it’s nice to hear a few GOP senators saying so.To get to that point, Republicans would have to abandon the fiction that they can slash spending on subsidies and Medicaid without anyone paying a price.
Indeed, this fundamental ideological difference is exactly why Republicans are pursuing their bill on a partisan basis.
* AND REPUBLICANS WORRY TRUMP COULD TURN ON THEM: Julie Pace reports that some Republicans are worried that Trump’s suggestion that the health bill is “mean” could portend bad things later:
One Republican congressional aide said that comment left some lawmakers worried that the president — who had no real ties to the GOP before running for the White House — could turn on them if a bill passes but the follow-up becomes politically damaging. The official insisted on anonymity in order to describe private discussions.
Seems like a personally reasonable fear, doesn’t it?