This morning, a new Quinnipiac poll found that only 36% of American voters say Republicans in Congress should try again to repeal and replace Obamacare, the 2010 Affordable Care Act, while 60% say the Republicans should "move on." What's more, voters disapprove 65-29% of the way Trump is handling health care. According to an earlier poll, just 17% of Americans supported Ryan's TrumpCare proposal. In fact, it was so unpopular that dozens of Republicans told the GOP House leadership they couldn't vote for it. So Ryan pulled the bill. At first, Trump was happy and said it was time to move on to "tax reform," meaning giving massive tax breaks to multimillionaires and billionaires. Then someone told Trump the money they would have saved by kicking 24 million people off health care was the money they needed for the tax breaks. So suddenly he was demanding Ryan go back to the drawing board and rework TrumpCare and get it passed. This week-- while Congress was on Easter break and Republicans were being booed and heckled at town hall meetings across the country-- "the GOP" came up with the "new" TrumpCare proposal. Short version: it's far worse than the original.Freedom Caucus head-man Mark Meadows (R-NC), whose goal is to end government's role in healthcare entirely, and hapless New Jersey conservative Tom MacArthur worked out a "compromise." The stand-out provision is getting rid of protections for people with pre-existing conditions. These:Matt Fuller and Jonathan Cohn pointed out in their HuffPo coverage that "with Republicans effectively going back on their repeated promises to guarantee coverage for people with pre-existing conditions, the amendment could lose a number of Republicans who already supported the legislation. In short, even though the Tuesday Group and the Freedom Caucus think they have a deal, Republicans writ large might have nothing."
Leadership is expected to discuss the amendment on a conference call this Saturday with GOP members, but public opinion might also affect the landscape. Republicans are trying to say their amendment will cover people with pre-existing conditions-- because, first, the legislation still claims those people can’t be denied coverage, and second, because there will be high-risk pools for those people if insurance costs dramatically go up for them.The reality, however, is that insurers would be able to effectively deny coverage by pricing sick people out of the market.“This effectively allows states to eliminate the ACA’s guarantee of access to insurance at a reasonable price for people with pre-existing conditions, in the interest of lowering premiums for people who are healthy,” Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, said upon seeing a description of the proposal. “It seems to tilt heavily towards what the Freedom Caucus has been looking for.”Republicans argue that the high-risk pools would then cover those people, taking them out of the regular insurance pool and lowering prices for everyone else, but high-risk pools have traditionally been underfunded by states and the federal government, resulting in poor coverage and high costs for those who need insurance the most.Those concerns may be significant enough that, even with MacArthur’s blessing, the deal does not win over moderates. The concessions also might not be enough for some conservatives, who have expressed issue with Republicans establishing an advance refundable tax credit to help pay for insurance.Republicans need 216 votes to pass their health care bill, and based on statements from GOP members, even with the support of the entire Freedom Caucus for the amendment, there may be enough moderate hold-outs to prevent passage anyway. (MacArthur doesn’t count as a convert; he supported the last bill, albeit reluctantly.)The amendment wouldn’t seem to address the big concerns moderates have expressed-- like raising the cap on how much insurers can charge seniors or cutting $880 billion from Medicaid. These changes are among the reasons that the Congressional Budget Office predicted the House health care legislation would increase the number of people without insurance by 24 million within a decade.Many Republicans-- particularly in the Senate-- have said such deep cuts are not acceptable. Just this week, Sen. Tom Cotton (R-Ark.) said he couldn’t support a proposal that jeopardized coverage for the approximately 300,000 people in his state dependent on the Affordable Care Act’s Medicaid expansion.Public opinion has also shifted since the repeal effort began in earnest-- and it has shifted decisively against Republicans and their cause. The Affordable Care Act is more popular than ever, and in a recent Pew Research Center poll, 54 percent of Americans said they trusted Democrats more than Republicans on health care, while just 35 percent said they trusted Republicans more. That’s the biggest advantage for Democrats on health care since 2009.In short, some leaders in the GOP conference might think they have a deal, but they also might have just found a way to make the bill even more unpalatable for Republicans, thus bringing Congress no closer at all.
This sour news came out on the same day that the Urban Institute reported that veterans too young for Medicare made tremendous gains in health insurance coverage under the Affordable Care Act. "[U]ninsurance among veterans," they report, "fell from 9.6 percent in 2013 to 5.9 percent in 2014, a nearly 40 percent drop. That's 429,000 veterans under the age of 65 who gained health insurance coverage during the first two years of ACA implementation, primarily through Medicaid expansion, privately purchased plans and marketplace coverage. Although expansion of coverage transcended all demographic lines, vets with the lowest incomes saw the greatest increase in coverage, especially in states that adopted Medicaid expansion. 20% of the uninsured vets live in Republican-controlled states like Texas and Florida that attempted to sabotage the Affordable Care Act by refusing to expand Medicaid. If TrumpCare is implemented these coverage advances would be wiped out, leaving hundreds of thousands of vets without coverage again.MacArthur did a town hall for seniors this week. An airplane kept flying around the eventMeadows' very gerrymandered and very backward western North Carolina district voted for Trump overwhelmingly-- 63.2% to 34.0%. Even in a massive anti-Trump/anti-GOP tsunami, his seat would likely be safe. A 20 point swing away from the Republicans-- like KS-04 experienced last week-- would leave Meadows spewing his extremist claptrap in Congress in 2019. Not so in NJ-03, Tom MacArthur's South Jersey district. It voted for Trump as well-- but more narrowly: 51.4% to 45.2%. Even a 10% swing would leave MacArthur out in the cold, if the DCCC had a plausible candidate. In 2016 they didn't and they have signaled that they're not going to be targeting MacArthur in 2018. So far there is no candidate running against him.Tom MacArthur makes a deal to screw vets out of healthcare
