washington, dc

The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Ed Kilgore

May 4: Trumpcare Will Also Do Damage In Blue States That Don’t Seek Exemptions From Obamacare Requirements

After today’s narrow House passage of the American Health Care Act, it really began to bug me that so any people were focused to the exclusion of everything else on the effect of the bill in conservative states that seek waivers from Obamacare regulations. That was, in fact, the key issue that seemed to separate House Republicans. But as I explained at New York, damage from the bill would be severe in blue states, too.

Trumpcare, at least in its current form, will allow states to decide whether to carry on with something resembling the systems in place under Obamacare, or to opt out of various key requirements under current law — including the one protecting people with preexisting conditions. It seems safe to assume that most blue states will not even consider applying for waivers to screw over their own most vulnerable citizens. But at the same time, there are many provisions in the revised American Health Care Act that will affect people everywhere, often not in a good way.

States like New York, California, Illinois, Massachusetts, Pennsylvania, and Virginia — states with Democratic governors and/or legislatures — are not going to seek exemptions from Obamacare requirements affecting the essential benefits health plans must offer, or prohibiting discrimination on the basis of health conditions. And there may be other states that don’t accept the poisoned chalice of health-policy autonomy. One of the House Republicans who seems to be coming around to a vote for Trumpcare, Carlos Curbelo, offered that excuse, even for his own red state of Florida:

“I would highly doubt that any governor, especially the governor of a large state like Florida, would seek a waiver. I just don’t think that any state would want to carry the burden of managing health care more than they already do, through Medicaid.”

Actually, it’s not clear that most of the people priced out of the individual health-care market by preexisting conditions would qualify for Medicaid, particularly in non-expansion states like Florida. But it is true that applying for the waivers that the House Freedom Caucus demanded will at least be controversial in the states that consider it.

For many of Trumpcare’s provisions, however, there’s not really much state flexibility at all. Indeed, blue states — most of which took advantage of Obamacare’s optional expansion of Medicaid — will be most affected by the bill’s abrupt termination of enhanced federal funds for the expanded population. Indeed, of the 24 million Americans the Congressional Budget Office estimated would lose health coverage under the original Trumpcare bill, 14 million would lose Medicaid coverage.

Some of the Obamacare regulations Trumpcare seeks to revoke and/or replace also are not optional, including the expansion of allowable price discrimination based on age and the elimination of the individual purchasing mandate (to be replaced by a surcharge on people who wait to buy insurance until they are sick).

Trumpcare also gets rid of the tax subsidies set up by Obamacare, and creates its own tax-credit system, with arguably very insufficient credit amounts, especially for low-income and older people. None of this can be waived for any states.

And the cost-sharing-reduction subsidies that have been critical in keeping insurers offering coverage under the Obamacare exchanges — the subsidies the administration has been threatening off and on to withhold — would be formally killed as well.

Finally, there are all sorts of little-recognized side effects of Trumpcare — such as the unraveling of benefit requirements for employer-sponsored health insurance — that do not discriminate by geography. And there is one big national provision that could do vast damage to women’s health care, especially in rural areas: the prohibition on any federal funds for Planned Parenthood.

It is worth watching closely the special provisions cooked into this legislation that affect certain states exclusively. The original AHCA (and hence its successors) included a deal to secure votes from upstate New York GOP House members that shifted Medicaid costs from county to state taxpayers. More of that sort of home cooking could be tucked into the legislation later.

We have no way of knowing what the Senate will do to the “state flexibility” provisions that have been so important to Trumpcare’s struggle towards House passage. On the one hand, there may be some “moderate” GOP resistance to how far conservative states will be allowed and encouraged to go in messing with poorer and sicker people who have benefited from Obamacare. On the other hand, some Republican senators—notably Bill Cassidy and Susan Collins—want to go much further in allowing states to go their own way, to the point of letting blue states keep most of Obamacare in place.

For blue-state progressives, this may be a tempting approach insofar as it insulates them from much of the damage wrought by an Obamacare replacement. But they need to ask themselves if they are willing to sell vulnerable red-state people down the river and accept a sort of health-policy apartheid. Republicans may not actually give them a lot of choice, but it’s important for everyone to understand the trade-offs involved in getting this unwieldy beast of a health-care bill to Donald Trump’s desk.


Trumpcare Will Also Do Damage In Blue States That Don’t Seek Exemptions From Obamacare Requirements

After today’s narrow House passage of the American Health Care Act, it really began to bug me that so any people were focused to the exclusion of everything else on the effect of the bill in conservative states that seek waivers from Obamacare regulations. That was, in fact, the key issue that seemed to separate House Republicans. But as I explained at New York, damage from the bill would be severe in blue states, too.

Trumpcare, at least in its current form, will allow states to decide whether to carry on with something resembling the systems in place under Obamacare, or to opt out of various key requirements under current law — including the one protecting people with preexisting conditions. It seems safe to assume that most blue states will not even consider applying for waivers to screw over their own most vulnerable citizens. But at the same time, there are many provisions in the revised American Health Care Act that will affect people everywhere, often not in a good way.

States like New York, California, Illinois, Massachusetts, Pennsylvania, and Virginia — states with Democratic governors and/or legislatures — are not going to seek exemptions from Obamacare requirements affecting the essential benefits health plans must offer, or prohibiting discrimination on the basis of health conditions. And there may be other states that don’t accept the poisoned chalice of health-policy autonomy. One of the House Republicans who seems to be coming around to a vote for Trumpcare, Carlos Curbelo, offered that excuse, even for his own red state of Florida:

“I would highly doubt that any governor, especially the governor of a large state like Florida, would seek a waiver. I just don’t think that any state would want to carry the burden of managing health care more than they already do, through Medicaid.”

Actually, it’s not clear that most of the people priced out of the individual health-care market by preexisting conditions would qualify for Medicaid, particularly in non-expansion states like Florida. But it is true that applying for the waivers that the House Freedom Caucus demanded will at least be controversial in the states that consider it.

For many of Trumpcare’s provisions, however, there’s not really much state flexibility at all. Indeed, blue states — most of which took advantage of Obamacare’s optional expansion of Medicaid — will be most affected by the bill’s abrupt termination of enhanced federal funds for the expanded population. Indeed, of the 24 million Americans the Congressional Budget Office estimated would lose health coverage under the original Trumpcare bill, 14 million would lose Medicaid coverage.

Some of the Obamacare regulations Trumpcare seeks to revoke and/or replace also are not optional, including the expansion of allowable price discrimination based on age and the elimination of the individual purchasing mandate (to be replaced by a surcharge on people who wait to buy insurance until they are sick).

Trumpcare also gets rid of the tax subsidies set up by Obamacare, and creates its own tax-credit system, with arguably very insufficient credit amounts, especially for low-income and older people. None of this can be waived for any states.

And the cost-sharing-reduction subsidies that have been critical in keeping insurers offering coverage under the Obamacare exchanges — the subsidies the administration has been threatening off and on to withhold — would be formally killed as well.

Finally, there are all sorts of little-recognized side effects of Trumpcare — such as the unraveling of benefit requirements for employer-sponsored health insurance — that do not discriminate by geography. And there is one big national provision that could do vast damage to women’s health care, especially in rural areas: the prohibition on any federal funds for Planned Parenthood.

It is worth watching closely the special provisions cooked into this legislation that affect certain states exclusively. The original AHCA (and hence its successors) included a deal to secure votes from upstate New York GOP House members that shifted Medicaid costs from county to state taxpayers. More of that sort of home cooking could be tucked into the legislation later.

We have no way of knowing what the Senate will do to the “state flexibility” provisions that have been so important to Trumpcare’s struggle towards House passage. On the one hand, there may be some “moderate” GOP resistance to how far conservative states will be allowed and encouraged to go in messing with poorer and sicker people who have benefited from Obamacare. On the other hand, some Republican senators—notably Bill Cassidy and Susan Collins—want to go much further in allowing states to go their own way, to the point of letting blue states keep most of Obamacare in place.

For blue-state progressives, this may be a tempting approach insofar as it insulates them from much of the damage wrought by an Obamacare replacement. But they need to ask themselves if they are willing to sell vulnerable red-state people down the river and accept a sort of health-policy apartheid. Republicans may not actually give them a lot of choice, but it’s important for everyone to understand the trade-offs involved in getting this unwieldy beast of a health-care bill to Donald Trump’s desk.


May 3: GOP Congressman Says Sick People Whose States Kill Coverage Should Move

The latest in many a revealing quote from GOP Members of Congress on health care policy came from North Carolina’s Rep. Robert Pittenger. I wrote about it at New York with some real anger.

It is not quite down there in the hall of shame with his Alabama colleague Mo Brooks’s suggestion that sick people often don’t deserve health coverage because they’ve brought it all down on themselves with bad habits. But North Carolina Republican representative Robert Pittenger was similarly cavalier about people with preexisting conditions who might lose affordable coverage if their state chose to waive protections for them under the terms of the revised American Health Care Act that the White House and Republican congressional leaders are trying to get through the House this week.

Quoth Pittenger: “People can go to the state that they want to live in. States have all kinds of different policies and there are disparities among states for many things: driving restrictions, alcohol, whatever,” he continued. “We’re putting choices back in the hands of the states. That’s what Jeffersonian democracy provides for.”

Seems Pittenger thinks the sick should vote with their feet, or their other afflicted parts, to live in a place that doesn’t view their health as a disposable asset.

I do believe we had a civil war over the proposition that states can do any damn thing they want with people, and the proponents of the states’-rights version of “Jeffersonian democracy” lost. It’s true that the victims back then did not always have the option to move elsewhere (there was this thing called the Fugitive Slave Act), but it should be beyond argument now that some rights and privileges of citizenship ought to be national in scope. Maybe health insurance is one of them, and maybe it’s not, but Pittenger’s glib assertion that the theoretical option of flight for poor, sick people makes it okay to discriminate against them is morally and politically obtuse.

This is not Pittenger’s first or worst comment of this nature. Last year, after protests broke out in Charlotte (a city partially represented by Pittenger) when an African-American man (Keith Lamont Scott) was fatally shot by police, here’s what he had to say:

“The grievance in their minds — the animus, the anger — they hate white people, because white people are successful and they’re not,” Pittenger told BBC Newsnight when he was asked about what is driving heated protests in Charlotte.

He later apologized for the nasty racist slur, but perhaps he should have moved to a different state.


Republican Congressman Says Sick People Whose States Kill Coverage Should Move

The latest in many a revealing quote from GOP Members of Congress on health care policy came from North Carolina’s Rep. Robert Pittenger. I wrote about it at New York with some real anger.

It is not quite down there in the hall of shame with his Alabama colleague Mo Brooks’s suggestion that sick people often don’t deserve health coverage because they’ve brought it all down on themselves with bad habits. But North Carolina Republican representative Robert Pittenger was similarly cavalier about people with preexisting conditions who might lose affordable coverage if their state chose to waive protections for them under the terms of the revised American Health Care Act that the White House and Republican congressional leaders are trying to get through the House this week.

Quoth Pittenger: “People can go to the state that they want to live in. States have all kinds of different policies and there are disparities among states for many things: driving restrictions, alcohol, whatever,” he continued. “We’re putting choices back in the hands of the states. That’s what Jeffersonian democracy provides for.”

Seems Pittenger thinks the sick should vote with their feet, or their other afflicted parts, to live in a place that doesn’t view their health as a disposable asset.

I do believe we had a civil war over the proposition that states can do any damn thing they want with people, and the proponents of the states’-rights version of “Jeffersonian democracy” lost. It’s true that the victims back then did not always have the option to move elsewhere (there was this thing called the Fugitive Slave Act), but it should be beyond argument now that some rights and privileges of citizenship ought to be national in scope. Maybe health insurance is one of them, and maybe it’s not, but Pittenger’s glib assertion that the theoretical option of flight for poor, sick people makes it okay to discriminate against them is morally and politically obtuse.

This is not Pittenger’s first or worst comment of this nature. Last year, after protests broke out in Charlotte (a city partially represented by Pittenger) when an African-American man (Keith Lamont Scott) was fatally shot by police, here’s what he had to say:

“The grievance in their minds — the animus, the anger — they hate white people, because white people are successful and they’re not,” Pittenger told BBC Newsnight when he was asked about what is driving heated protests in Charlotte.

He later apologized for the nasty racist slur, but perhaps he should have moved to a different state.


April 28: The “Ten Commandments Judge” Now Wants to Go To Washington To Lend Trump a Hand

An old, notorious name returned to the news today, and I wrote it up for New York:

Robert Bentley recently resigned the governorship of Alabama in a plea deal after years of fighting a losing battle against heavy evidence of an extramarital affair with a staffer that went over the line into misappropriation of state funds and attempted intimidation of witnesses. But before he left office the septuagenarian “Love Gov” had the opportunity to appoint a temporary U.S. Senate replacement for new U.S. Attorney General Jeff Sessions. He chose state Attorney General Luther Strange, ignoring rumors the new senator had given the Bentley scandal a wide berth in exchange for this supreme favor. Now the voters of Alabama will get to weigh in via a special election (the primary is in August and the general election is in December), and thanks to his Bentley connection, Strange is far from being a shoo-in.

This week the Alabama Senate race went from being overshadowed by peculiar things to being a peculiar thing in itself when Roy Moore, the twice-elected, once-removed, and once-suspended chief justice of the Alabama Supreme Court, and perhaps America’s most prominent theocrat, declared his candidacy. Moore pledged to help Donald Trump “make America great again” by first returning the country to fidelity to God and the traditional family. In case this left anyone in doubt that the man once called “the Ten Commandments Judge” had not changed, he offered this pithy observation:

“I know and I think you do too that the foundations of the fabric of our country are being shaken tremendously….Our families are being crippled by divorce and abortion. Our sacred institution of marriage has been destroyed by the Supreme Court, and our rights and liberties are in jeopardy.”

So Moore is not running on what you’d call an upbeat, “right track” message.

But he never really has. After a West Point education and some odd experiences as a kickboxer and an Australian cowboy, Moore settled into a reasonably quiet legal and judicial career in eastern Alabama. He first came to national attention in the 1990s as a state circuit court judge who was sued by the ACLU for posting the Ten Commandments in his courtroom and holding pretrial prayers. He eventually prevailed on appeal, but more important, was able to use his attempted martyrdom by godless liberals to get himself elected chief justice of the Alabama Supreme Court in 2000 after winning a highly competitive Republican primary. In an early concurring opinion on a case involving a lesbian mother who was trying to win custody of her children from an allegedly abusive ex-husband, Moore threw down the gauntlet to the tyranny of sodomites everywhere:

“Homosexual behavior is a ground for divorce, an act of sexual misconduct punishable as a crime in Alabama, a crime against nature, an inherent evil, and an act so heinous that it defies one’s ability to describe it. That is enough under the law to allow a court to consider such activity harmful to a child. To declare that homosexuality is harmful is not to make new law but to reaffirm the old; to say that it is not harmful is to experiment with people’s lives, particularly the lives of children.”

Soon Moore became embroiled in a dispute with a federal judge over his continued display of the Ten Commandments — this time via a large monument he commissioned — and after defying the judge’s orders and arguing the “Judeo-Christian God” reigned over church and state alike, he was finally removed from his position by a state commission and became a national conservative evangelical martyr for real.

Moore inevitably entered electoral politics, but in part because of his poor fundraising skills, he fell short in two gubernatorial elections in 2006 and 2010. In 2012, though, after a brief feint toward a Republican presidential run, he made a triumphal return to the state Supreme Court, being elected chief justice again. True to form, by 2016 Moore managed to get himself suspended (a sanction just short of removal) for fighting implementation of the Supreme Court decision legalizing same-sex marriage.

Quite a career, eh? And now Moore will take his virtually universal name recognition and his hard-core Christian-right base of support into a low-turnout multicandidate Senate race where almost anything can happen. At least one Alabama political observer, John Archibald of the Birmingham News, thinks Moore will at least make a runoff.

If he does even better than that, Moore would become a figure who might even stand out in Donald Trump’s Republican Party.

The one sure thing is that if Moore fails in his third statewide non-judicial race, he cannot follow it up with a third run for the Supreme Court and perhaps a third effort to get himself tossed off the bench. At the age of 70, Moore is under Alabama law too old to run for that position. So this Senate race could be his last hurrah, praise the Lord.


The “Ten Commandments Judge” Now Wants to Go to Washington To Lend Trump a Hand

An old, notorious name returned to the news today, and I wrote it up for New York:

Robert Bentley recently resigned the governorship of Alabama in a plea deal after years of fighting a losing battle against heavy evidence of an extramarital affair with a staffer that went over the line into misappropriation of state funds and attempted intimidation of witnesses. But before he left office the septuagenarian “Love Gov” had the opportunity to appoint a temporary U.S. Senate replacement for new U.S. Attorney General Jeff Sessions. He chose state Attorney General Luther Strange, ignoring rumors the new senator had given the Bentley scandal a wide berth in exchange for this supreme favor. Now the voters of Alabama will get to weigh in via a special election (the primary is in August and the general election is in December), and thanks to his Bentley connection, Strange is far from being a shoo-in.

This week the Alabama Senate race went from being overshadowed by peculiar things to being a peculiar thing in itself when Roy Moore, the twice-elected, once-removed, and once-suspended chief justice of the Alabama Supreme Court, and perhaps America’s most prominent theocrat, declared his candidacy. Moore pledged to help Donald Trump “make America great again” by first returning the country to fidelity to God and the traditional family. In case this left anyone in doubt that the man once called “the Ten Commandments Judge” had not changed, he offered this pithy observation:

“I know and I think you do too that the foundations of the fabric of our country are being shaken tremendously….Our families are being crippled by divorce and abortion. Our sacred institution of marriage has been destroyed by the Supreme Court, and our rights and liberties are in jeopardy.”

So Moore is not running on what you’d call an upbeat, “right track” message.

But he never really has. After a West Point education and some odd experiences as a kickboxer and an Australian cowboy, Moore settled into a reasonably quiet legal and judicial career in eastern Alabama. He first came to national attention in the 1990s as a state circuit court judge who was sued by the ACLU for posting the Ten Commandments in his courtroom and holding pretrial prayers. He eventually prevailed on appeal, but more important, was able to use his attempted martyrdom by godless liberals to get himself elected chief justice of the Alabama Supreme Court in 2000 after winning a highly competitive Republican primary. In an early concurring opinion on a case involving a lesbian mother who was trying to win custody of her children from an allegedly abusive ex-husband, Moore threw down the gauntlet to the tyranny of sodomites everywhere:

“Homosexual behavior is a ground for divorce, an act of sexual misconduct punishable as a crime in Alabama, a crime against nature, an inherent evil, and an act so heinous that it defies one’s ability to describe it. That is enough under the law to allow a court to consider such activity harmful to a child. To declare that homosexuality is harmful is not to make new law but to reaffirm the old; to say that it is not harmful is to experiment with people’s lives, particularly the lives of children.”

Soon Moore became embroiled in a dispute with a federal judge over his continued display of the Ten Commandments — this time via a large monument he commissioned — and after defying the judge’s orders and arguing the “Judeo-Christian God” reigned over church and state alike, he was finally removed from his position by a state commission and became a national conservative evangelical martyr for real.

Moore inevitably entered electoral politics, but in part because of his poor fundraising skills, he fell short in two gubernatorial elections in 2006 and 2010. In 2012, though, after a brief feint toward a Republican presidential run, he made a triumphal return to the state Supreme Court, being elected chief justice again. True to form, by 2016 Moore managed to get himself suspended (a sanction just short of removal) for fighting implementation of the Supreme Court decision legalizing same-sex marriage.

Quite a career, eh? And now Moore will take his virtually universal name recognition and his hard-core Christian-right base of support into a low-turnout multicandidate Senate race where almost anything can happen. At least one Alabama political observer, John Archibald of the Birmingham News, thinks Moore will at least make a runoff.

If he does even better than that, Moore would become a figure who might even stand out in Donald Trump’s Republican Party.

The one sure thing is that if Moore fails in his third statewide non-judicial race, he cannot follow it up with a third run for the Supreme Court and perhaps a third effort to get himself tossed off the bench. At the age of 70, Moore is under Alabama law too old to run for that position. So this Senate race could be his last hurrah, praise the Lord.


April 27: No Love in the Senate for Zombie Trumpcare

As Republicans battled to get enough votes to bring the revised American Health Care Act to the House floor, I took a look ahead and the prospects for this legislation in the Senate. It was not a pretty sight, as I explained at New York.

Normally in a situation like this, where a party’s president is 100 percent invested in a piece of legislation, you would look for scattered signs of internal opposition among that party’s senators and speculate as to whether the White House could wear it down. But there is nothing scattered about Senate Republican misgivings over Trumpcare: It appears to be endemic, as Politico reports:

“The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

“Not to mention that some Senate conservatives still seem opposed to the emerging House deal.”

They sure are. Rand Paul and Ted Cruz, who helped derail the original “replace and delay” strategy that might have at least temporarily papered over GOP differences of opinion over health-care policy, are making discouraging noises about Zombie Trumpcare. Paul in particular seems determined to quash any happy-talk about consensus:

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

The more any eventual bill has to shift in the direction of Senate conservatives, of course, the less support there will be from moderates. And lest we forget, the GOP can only lose two senators to pass health-care legislation, barring any support from Democrats — and there are zero signs of any Democrats even considering a defection so long as the bill is being pushed on a party-line basis via budget-reconciliation rules that prohibit filibusters.

The rules governing the reconciliation procedure present another potentially big problem for Senate Republicans. The House bill, and particularly the new version with its authorization of state waivers of existing Obamacare regulations, is very likely to run afoul of the Senate parliamentarian’s enforcement of the Byrd Rule prohibiting non-budget-germane provisions in budget bills. If such provisions have to be struck, the compromises that have made it possible for the House to revive Trumpcare could quickly unravel.

And then there is the strong possibility that the Congressional Budget Office will “score” the House bill in a manner that makes its negative impact on health-care coverage vivid. The House itself may be able to avoid terrible publicity on the “score” by racing to a vote before CBO’s analysis comes down. But that evasion will not be possible for senators.


No Love in the Senate For Zombie Trumpcare

As Republicans battled to get enough votes to bring the revised American Health Care Act to the House floor, I took a look ahead and the prospects for this legislation in the Senate. It was not a pretty sight, as I explained at New York.

Normally in a situation like this, where a party’s president is 100 percent invested in a piece of legislation, you would look for scattered signs of internal opposition among that party’s senators and speculate as to whether the White House could wear it down. But there is nothing scattered about Senate Republican misgivings over Trumpcare: It appears to be endemic, as Politico reports:

“The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

“Not to mention that some Senate conservatives still seem opposed to the emerging House deal.”

They sure are. Rand Paul and Ted Cruz, who helped derail the original “replace and delay” strategy that might have at least temporarily papered over GOP differences of opinion over health-care policy, are making discouraging noises about Zombie Trumpcare. Paul in particular seems determined to quash any happy-talk about consensus:

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

The more any eventual bill has to shift in the direction of Senate conservatives, of course, the less support there will be from moderates. And lest we forget, the GOP can only lose two senators to pass health-care legislation, barring any support from Democrats — and there are zero signs of any Democrats even considering a defection so long as the bill is being pushed on a party-line basis via budget-reconciliation rules that prohibit filibusters.

The rules governing the reconciliation procedure present another potentially big problem for Senate Republicans. The House bill, and particularly the new version with its authorization of state waivers of existing Obamacare regulations, is very likely to run afoul of the Senate parliamentarian’s enforcement of the Byrd Rule prohibiting non-budget-germane provisions in budget bills. If such provisions have to be struck, the compromises that have made it possible for the House to revive Trumpcare could quickly unravel.

And then there is the strong possibility that the Congressional Budget Office will “score” the House bill in a manner that makes its negative impact on health-care coverage vivid. The House itself may be able to avoid terrible publicity on the “score” by racing to a vote before CBO’s analysis comes down. But that evasion will not be possible for senators.


April 22: Zombie Trumpcare Refuses To Die, But Looks Doomed

What’s that gurgling, snarling sound in the distance? Must be Zombie Trumpcare, which as I explained at New York, refuses to die.

Despite near-universal predictions of doom — either now or later, on the House floor or in the Senate — the Trump administration is pushing House Republicans hard to schedule a vote next week on the latest version of Trumpcare, a.k.a. the American Health Care Act. The president’s claim that the the plan had “gotten really, really good … and a lot of people are liking it a lot,” appears to be pure happy talk. They don’t have the votes now to move the legislation forward, and may never have the votes to get this unfortunate legislation to Trump’s desk.

The much-bruited MacArthur Amendment to the earlier bill, with its provision for state waivers to sidestep comprehensive insurance-plan requirements and protections for people with preexisting conditions, may or may not attract some additional House Freedom Caucus votes. But it is very, very unlikely to sway those among MacArthur’s fellow moderates who refused to vote for the original bill. Yes, it would allow blue states to keep something like the original Obamacare individual-health-insurance markets in place, assuming insurers were willing to go along. But it keeps in place AHCA’s quick phaseout of the Affordable Care Act’s Medicaid expansion, hammering those same states.

Prospects in the Senate, where Republican moderates have much more leverage due to the GOP’s narrow two-vote majority, are much worse. On top of the substantive health care policy concerns House moderates have articulated (particularly over Medicaid), there are now three GOP senators who are not necessarily onboard for the defunding of Planned Parenthood that is part of the package. And there remain real problems with the Senate rules, since the state waiver provisions that are central to the MacArthur Amendment could easily be ruled non-germane to the budget process by the Senate parliamentarian, exposing the whole bill to a Senate filibuster.

So why the rush toward an apparent abyss? From the White House point of view, it’s apparently all about Trump’s panic over not having big accomplishments to boast of when the 100-day mark of his presidency arrives, on April 29. That factor is also reportedly driving a sudden hard line in the White House position in the appropriations negotiations aimed at avoiding a government shutdown on April 29. Since a renewed furor over health care could not possibly help the atmosphere surrounding the delicate appropriations talks, Trump is in danger of a dual disaster next week.

Perhaps the best thing about racing ahead is that it might not allow the Congressional Budget Office the time to score this new version of AHCA, a process that would undoubtedly produce a terrible number in terms of the impact on health-care coverage.

You might expect Paul Ryan to tell Trump the votes aren’t there for Zombie Trumpcare, and to ask him to call off the dogs. But Ryan is undoubtedly under pressure from some members who would prefer to get the monkey off their backs and blame the Senate or Democrats for the failure to enact health-care legislation, and others who figure a second failed vote in the House would convince everyone to give up and move on to the more congenial territory of tax legislation.

It’s a horror-show for Republicans, all right.


Zombie Trumpcare Refuses To Die, But Looks Doomed

What’s that gurgling, snarling sound in the distance? Must be Zombie Trumpcare, which as I explained at New York, refuses to die.

Despite near-universal predictions of doom — either now or later, on the House floor or in the Senate — the Trump administration is pushing House Republicans hard to schedule a vote next week on the latest version of Trumpcare, a.k.a. the American Health Care Act. The president’s claim that the the plan had “gotten really, really good … and a lot of people are liking it a lot,” appears to be pure happy talk. They don’t have the votes now to move the legislation forward, and may never have the votes to get this unfortunate legislation to Trump’s desk.

The much-bruited MacArthur Amendment to the earlier bill, with its provision for state waivers to sidestep comprehensive insurance-plan requirements and protections for people with preexisting conditions, may or may not attract some additional House Freedom Caucus votes. But it is very, very unlikely to sway those among MacArthur’s fellow moderates who refused to vote for the original bill. Yes, it would allow blue states to keep something like the original Obamacare individual-health-insurance markets in place, assuming insurers were willing to go along. But it keeps in place AHCA’s quick phaseout of the Affordable Care Act’s Medicaid expansion, hammering those same states.

Prospects in the Senate, where Republican moderates have much more leverage due to the GOP’s narrow two-vote majority, are much worse. On top of the substantive health care policy concerns House moderates have articulated (particularly over Medicaid), there are now three GOP senators who are not necessarily onboard for the defunding of Planned Parenthood that is part of the package. And there remain real problems with the Senate rules, since the state waiver provisions that are central to the MacArthur Amendment could easily be ruled non-germane to the budget process by the Senate parliamentarian, exposing the whole bill to a Senate filibuster.

So why the rush toward an apparent abyss? From the White House point of view, it’s apparently all about Trump’s panic over not having big accomplishments to boast of when the 100-day mark of his presidency arrives, on April 29. That factor is also reportedly driving a sudden hard line in the White House position in the appropriations negotiations aimed at avoiding a government shutdown on April 29. Since a renewed furor over health care could not possibly help the atmosphere surrounding the delicate appropriations talks, Trump is in danger of a dual disaster next week.

Perhaps the best thing about racing ahead is that it might not allow the Congressional Budget Office the time to score this new version of AHCA, a process that would undoubtedly produce a terrible number in terms of the impact on health-care coverage.

You might expect Paul Ryan to tell Trump the votes aren’t there for Zombie Trumpcare, and to ask him to call off the dogs. But Ryan is undoubtedly under pressure from some members who would prefer to get the monkey off their backs and blame the Senate or Democrats for the failure to enact health-care legislation, and others who figure a second failed vote in the House would convince everyone to give up and move on to the more congenial territory of tax legislation.

It’s a horror-show for Republicans, all right.