GOP inches toward passing regressive, unpopular health care plan

Most of the coverage of the health care debate this morning focused on the apparent demise of the House Republicans’ American Health Care Act. Those reports were understandable: GOP officials realized last night that, once again, they simply didn’t have the votes.But quite a bit has changed over the course of today. The Huffington Post‘s Matt Fuller, who’s done exceptional work on the political twists and turns of the process on Capitol Hill, reported a short while ago that the Republicans’ bill “could actually pass,” possibly as early as today.

Let’s unpack where we are at this point.How many House Republicans oppose the bill? Different news organizations have different head-counts, but the total number of “no” votes among House Republicans, as of this minute, is between 18 and 21.Is that enough? No. The number to keep an eye on is 23: if 23 GOP lawmakers oppose the bill, it’ll die. If the total is 22 or fewer, it’ll pass.So they’re very close to having enough? In theory, the total of “no” votes should offer health care supporters some optimism. With a few dozen Republicans considering themselves “undecided,” it means GOP leaders would need practically all of them to support the party’s regressive plan in order to pass it.Then why all the chatter about the bill passing? A couple of things have changed. First, the count of “no” votes is looking quite fragile. Yesterday, for example, Reps. Fred Upton (R-Mich.) and Billy Long (R-Mo.) seemed to effectively kill the bill by announcing their opposition. Today, however, they switched back to “yes” votes.Second, the pressure on individual GOP members is intensifying. While much of the American mainstream and health care advocates urge Republicans to be responsible, House Republican leaders and the White House are pushing very aggressively, urging GOP lawmakers to do the right thing for the party. As a result, some of those “no” votes are already wavering, and there’s no reason to assume that contingent won’t shrink.Why did Upton and Long switch? House Speaker Paul Ryan (R-Wis.) and GOP leaders offered to add $8 billion over five years to high-risk pools. Inexplicably, that was enough to earn their support.Huh? Yeah, I know. Under the Republican plan, Americans with pre-existing conditions risk being thrown into high-risk pools, and the $8 billion over five years is intended to help defray those folks’ increased costs.Does that make sense? Not even a little. Most estimates suggest that in order to make high-risk pools work, Congress would need to spend tens of billions, if not hundreds of billions, over the next decade. Throwing $8 billion over five years is pathetic — something Upton conceded yesterday before changing his mind today.Is the rest of the bill consistent with what we know? Pretty much, yes. The core elements — deep Medicaid cuts, tax breaks for the wealthy, tens of millions of Americans losing their coverage — remain the same. What’s different from the bill that nearly came to the floor in March is that this iteration guts protections for those with pre-existing conditions.What about the Congressional Budget Office? This version of the Republican bill does not yet have a score, and Republicans have decided they do not care what the independent assessment says about the bill’s impact. To wait for a CBO report is to allow members (and the public) to realize just how ridiculous this legislation is, so GOP leaders won’t risk it.What about that rule that says legislation has to be publicly available for at least three days before it receives a vote? Republicans used to care about that. Then they decided not to care.If there’s a vote, when will it be? Probably tomorrow, but if GOP leaders believe they’ve reached 216 votes, they could rush it onto the floor tonight. There have been rumors to that effect.For Democrats, maybe that’d be a good thing? I’ve been hearing this argument all day, with Dems saying there’s a benefit to having Republicans vote in support of a wildly regressive and unpopular piece of legislation. The attack ads in next year’s midterms would write themselves, and GOP lawmakers who vote for this monstrosity would have a tough time defending the indefensible.That said, I think it’s a short-sighted perspective. If the bill dies, the Affordable Care Act and its beneficiaries are fairly secure. If the bill passes the House, the future is uncertain, and risks abound. (It reminds me a bit too much of Democrats who were relieved Donald Trump won the Republican nomination, because there was simply no way he could win a general election.)Watch this space.