House Republicans' plan to revise Obamacare has been released. Sort of.
For one, it's not really “House Republicans'” plan in that many House Republicans don't seem terribly impressed with it. And secondly, the overall plan is out, but it doesn't explain its cost or how many people will lose coverage.
Both of those are very significant points and spell trouble for the legislative battle ahead. But they aren't the only things that could be problems for Republicans and the Trump White House.
Below are a few reasons this is looking increasingly dicey.
1. Obamacare is more popular than ever
If you are a moderate Republican worried about defending your district in 2018 in what is historically a very tough first midterm election for the president's party, these numbers will frighten you.
Two weeks ago, a Pew Research Center poll showed, for the first time, that a majority of Americans liked Obamacare (54 percent) vs. 43 percent who disliked it. This is a law that for years had more opposition than support.
A Kaiser Family Foundation poll last month also showed the law had its highest level of support since implementation — 48 percent favorable vs. 42 percent unfavorable.
No, these are not world-beating numbers. But they do suggest the prospect of losing the Affordable Care Act has caused some middle-of-the-road Americans to do some soul-searching.
And for Republicans in moderate districts — 23 of them represent districts that voted for Hillary Clinton last year, according to Daily Kos Elections — that makes it a much tougher calculus.
2. Some Republicans quickly said 'no'
The skepticism among Republicans after the plan was released Monday evening was palpable.
Rep. Jim Jordan (R-Ohio), an influential member of the tea party-aligned House Freedom Caucus, laid into the proposal, calling it “subsidies for unaffordable health care, subsidies for unaffordable premiums,” according to The Post's Dave Weigel. Sen. Rand Paul (R-Ky.) and Rep. Justin Amash (R-Mich.), both libertarian-leaning Republicans, quickly labeled it “Obamacare Lite” and “Obamacare 2.0.”
The opposition also came from the middle. A group of four Senate Republicans quickly drew a line in the sand, telling Senate Majority Leader Mitch McConnell (R-Ky.) that they would oppose any bill that reduced the insurance rate. (That's a likely outcome of the new bill, given it swaps out the individual mandate — a penalty for not having health care coverage — for a surcharge on those going more than two months without coverage. This would ostensibly allow those who would prefer not to pay for coverage to simply avoid it.
This group of four GOP senators, it bears noting, could kill any health-care bill. Republicans have 52 seats in the Senate, meaning that if Democrats vote in unison, Republicans can only afford two defections.
A big part of the problem for Republicans is that, as with entitlement programs, once you give the American people a benefit they didn't previously have, it's difficult to take it away. So the new bill seeks to allay concerns about taking away benefits people enjoy — like the Medicaid expansion and the “Cadillac tax” on high-quality plans — but also alienates small-government conservatives in the process.
“Keep the Cadillac tax in place? Keep Medicaid in place until 2020?” Jordan said Monday. “We didn’t have Medicaid expansion in the bill we sent to President Obama, but we have it in the one we send to President Trump? That makes no sense to me.”
Meanwhile, you've got these more-moderate Republicans who fear their constituents crying foul over those very same lost benefits. Try squaring that circle.
3. The White House doesn't sound like it's going to twist arms
The White House's statement on the House GOP notably didn't include a statement of support, but rather paints the introduction of the bills as a “step” toward repealing and replacing Obamacare.
“Obamacare has proven to be a disaster with fewer options, inferior care, and skyrocketing costs that are crushing small businesses and families across America,” White House press secretary Sean Spicer said. “Today marks an important step toward restoring health care choices and affordability back to the American people. President Trump looks forward to working with both Chambers of Congress to repeal and replace Obamacare.”
Perhaps even more notably — and related to the point above — it sounds as though Trump and his team aren't really going to use the power of the presidency to get skeptical Republicans on board.
The calculus is clear here. Trump and his team know how difficult this will be, and attaching themselves to it at this early date risks making it their failure if it goes down. But that also makes actually passing the bill much more difficult for House Speaker Paul D. Ryan (R-Wis.).
4. And all that comes before the price tag and the potential drop in insurance rate
As mentioned at the top, the most potentially troublesome aspects of the bill released on Monday aren't even known yet: the price tag and the number of people who will lose coverage.
The Associated Press is already reporting that it's “likely” many will lose coverage. As for the cost, we will have to wait a week or more for an estimate from the Congressional Budget Office.
Trump, ever fond of promising voters the world, has already pledged that the Obamacare replacement will cover everyone and do so at far-reduced costs. There is a great chance that estimates will say that this bill doesn't do at least one of those — and possibly both. Failing at one of those things would make passage tough; failing at both would make it seemingly impossible.
Unless, of course, Republicans convince people that these estimates are bogus. Even then, though, they will own the eventual product, and if those things do eventually happen, Republicans know they'll pay the price.
And they needn't look far to see how a poorly received health-care bill can haunt a party for years. Democrats paid big for theirs in 2010 and, arguably, in 2014, too.
5. They've backed themselves into a corner
Trump is fond of saying that the easiest thing for Republicans to do would be to let Obamacare fall under its own weight. And there's some truth to that.
The problem is that the GOP has pledged for years and years to repeal the law, and failing to do so would represent a massive unkept promise to their voters. At this point, they've backed themselves into a corner where they need to do something about the law yet aren't comfortable doing so without a replacement (because of the potential for chaos). And as the Democrats' own experience on passing health-care reform showed, that second part is just not an easy thing to do.
Republicans have the added pressure of putting themselves under the gun and coming up with a replacement rather quickly. That huge challenge has already led to plenty of fits and starts and disagreements over precisely how to accomplish this massive task.
And rest assured: The bloodletting will continue in the days and weeks ahead.