Are they … trying to kill the bill in the Senate? Or are they trying to save the bill in the House and choosing to worry about the Senate later?
The White House is privately lining up behind conservative calls to roll back Obamacare’s Medicaid expansion sooner than the health care reform bill currently calls for, two senior administration officials and a senior House conservative aide told CNN on Thursday…
Ending the Medicaid expansion sooner could complicate prospects for the bill in the Senate. And it would likely infuriate Republican governors in states that accepted federal funds for the expansion, who face the prospect of many people losing coverage they gained under Obamacare…
“This could kill the bill in the Senate and make it even more complicated in the House,” the aide said…
The move would gain the support of hardline conservatives, but could still doom the bill by losing a similar number of moderates in the House. One moderate Republican immediately said he knew of four other Republicans who would switch from “yes” to “no” if the bill ended the Medicaid expansion in 2017.
On Monday, the day the House bill was leaked, four Republican senators (Portman, Capito, Gardner, and Murkowski) issued a statement warning that “We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services… We also believe a gradual transition is needed to ensure states have the time to successfully implement these new changes.” That complaint was aimed at the House insurance reform proposal that was circulating on February 10th; the new draft that emerged this week proposed keeping O-Care’s Medicaid expansion intact until 2020 and grandfathering in anyone who enrolls before that deadline. It’s unclear if Portman et al. find that sufficient to address their concerns — but it stands to reason that the White House’s new scheme, which would accelerate the rollback to 2018 in order to make conservatives happy, will only make those four moderates less likely to support the current House bill. And those are four votes the party can’t afford to lose. If they make the bill conservative enough on Medicaid to please Rand Paul, Mike Lee, and Ted Cruz, they risk failing in the Senate anyway if Portman’s crew votes as a bloc against it. The moderates count too in this process.
The calculation here, I think, is that while the moderates count too, the conservatives are more of a risk in the House, the first obstacle to passage. Moving the Medicaid rollback to 2018 might lose Trump and Ryan a few moderate House Republican votes while gaining dozens of Freedom Caucus members who’d otherwise be leery of supporting the bill. Anything that needs to be done to clear the first hurdle, House passage, will be done. And what happens when the bill reaches the Senate and Portman and Murkowski start frowning? That’s when Trump goes to work:
Trump confident health care will pass House but for Senate he plans "football stadium rallies" in red states to prod vulnerable Dems. https://t.co/xr6Xvagf0k
— Jim Acosta (@Acosta) March 9, 2017
The fact that the House will have passed the bill at that point and the president will be in campaign mode might, in theory, make Portman’s group and red-state Democrats like Joe Manchin afraid of voting no and stopping it. But the politics are tricky. Although Trump won Portman’s home state of Ohio by eight points, Portman himself won reelection to his Senate seat on the same day by nearly 22 points. (He also received more raw votes than Trump did.) Capito’s home state of West Virginia was one of the strongest Trump strongholds on the map, handing him a 41-point victory, but Capito won her Senate election by 27 points in 2014. She’s in no trouble. Meanwhile, Trump didn’t win Gardner’s home state of Colorado at all, losing to Hillary Clinton by six points in a rare swing-state failure. Gardner won his seat in this increasingly bluish state in 2014 by two points over a Democratic incumbent. And Murkowski won her Senate race in Alaska last year by a margin nearly identical to Trump’s win statewide, with each just shy of a 15-point advantage. All of which is to say, none of these people are in any imminent danger by crossing Trump on this. They’re all as strong as, or stronger than, him in their home states except for Capito, who won in a landslide anyway. And importantly, none of them will face the voters again until 2020 at the earliest. There’s no 2018 pressure for Trump to apply to get them to bend on the bill.
That’s why he’s focused on campaigning against red-state Democrats: It may be that McConnell has already written off these four votes and concluded that he’ll have to replace two of them with Democrats, which is a very heavy lift for a bill that’s getting less generous on Medicaid as the days wear on. Democrats will be running in 2018 on a message that TrumpCare slashes subsidies for the middle class, especially the aging middle class, while crunching the poor. Does Joe Manchin want to vote “yes” on that in a famously blue-collar state, with a gazillion liberals nationwide hollering at him not to, even with Trump on the stump in his state urging him to support the bill? If you’re trying to gauge what sort of backlash might be in the offing here, read Nate Cohn’s analysis of how TrumpCare, ironically, might hit Trump voters hardest:
Older, poorer, rural Americans — a.k.a. Trump nation — should bear the brunt on reduced subsidies. Not so on the Medicaid rollback, as Medicaid recipients in the 32 expansion states broke for Hillary by a 20-point margin. But that raises a new question about Trump’s “football stadium” strategy to get the bill through the Senate: How intimidated will senators from expansion states be, really, knowing that a lower-class backlash may await if they do Trump’s bidding and vote for the House bill? Outflanking Trump’s populism by running against the bill on grounds that it’s a giveaway to the rich might be enough to deflect his attacks. And if it is, the GOP’s chances in the Senate are very thin.
Here’s Tom Cotton yesterday warning that the GOP’s attempt to ram the House bill through is oddly similar to the right-wing complaints against ObamaCare.