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Pressure Mounts: Will Congressional GOP Unite, Or Will Infighting Allow Obamacare to Survive?

As Justin relayed earlier, multiple news reports indicate that Republicans will unveil their legislation to repeal and replace Obamacare sometime this week. The current law is collapsing under its own weight, is empirically failing on the metrics upon which it was sold, is unpopular, and is hurting more Americans than it's helping. Republicans up and down the ticket have run against Obamacare since its 2010 passage, winning three national elections in the process, and establishing a dominant political footing in the states. The party is now faced with the rare and historic opportunity of unified federal governance, which offers the promise of actually following through on an oft-repeated campaign pledge. Just as they did in their quest to pass their unwanted scheme in the first place, Senate Democrats are marching in lockstep to protect the rotting status quo. The GOP's success or failure in the essential task of ending this damaging law and supplanting it with a better alternative will rely upon unity of purpose and strategic messaging.  In advance of their proposal's formal roll-out, they're off to a mixed start, at best.

Conservatives like Sen. Rand Paul have preemptively criticized leadership for "hiding" the bill from the American people (in my view, leadership is understandably trying to get its ducks in a row before revealing a half-baked plan with insufficient buy-in), telling anyone who will listen that he has no interest in voting for "Obamacare-lite."  House Speaker Paul Ryan has dismissed the Kentuckian's antics as a publicity stunt and has committed to a transparent legislative process.  Sen. Paul has hinted that at least two upper chamber colleagues, Ted Cruz and Mike Lee, share his view. At the other end of the center-right spectrum, a handful of Republican Senators have expressed queasiness about supporting a bill that uproots Obamacare's Medicaid expansion. Additional pressure on this front has been applied by GOP governors who expanded the expensive and already-struggling program in their states. Particularly in the Senate, Republicans have very little margin for error in the whip-counting department, and party leaders can bet on mainstream media coverage that highlights internal divisions, and showcases repeal opponents' plights.  If individual members decide to prioritize their vision of perfection over a politically-attainable solution that vastly improves upon Obamacare, then the current law will remain intact, thanks to a splintered and dysfunctional opposition. Gut check: Does any Republican want the legacy of 'Obamacare protector' on his or her resume?  Perhaps we'll find out. Aside from what we may already know based upon a leaked draft we analyzed late last month, what might we expect from this week's announcement?

Hugh Hewitt interviewed HHS Secretary Tom Price this morning, resulting in a wide-ranging and illuminating discussion. Audio is available here. Price said that the president's goal is to sign Obamacare repeal legislation as soon as possible, emphasizing that a replacement bill should be passed nearly simultaneously, in order to ensure a smooth and stable transition for vulnerable and anxious consumers. Republicans will not "pull the rug out" from underneath people, he said, stressing that the goal is to provide all Americans with access to more choices and more affordable coverage, with fewer coercive federal mandates. Price also hinted that several of the popular provisions within the current law (protecting people with pre-existing conditions, barring lifetime caps, and the '26-year-old' rule) will likely be preserved through various mechanisms. Asked whether the Senate should apply the Reid Rule to the legislative filibuster to thwart Democratic obstructionism of a replacement framework, Price demurred, adding that "many, many things" can be accomplished through the budget "reconciliation" process.  Reconciliation requires only a simple majority in the US Senate; Democrats famously exploited the maneuver to put the finishing touches on their Obamacare jam-down during President Obama's first term.  The secretary also noted that the Obama administration implemented vast swaths of Obamacare through executive rule-making and guidance, every one of which can be reversed or modified in the same manner.

Price's comments on these matters are extremely relevant for two big reasons. First, Paul Ryan recently said that his party's forthcoming plan is modeled off of legislation Price introduced and championed as a member of Congress. Price, a medical doctor and budget wonk, is widely-respected on the Right.  He'll be a critical voice in the coming political fight, especially if Republicans have more or less embraced his vision for reform.  Second, Price is President Trump's hand-selected point man on healthcare. If the GOP replacement proposal is essentially the 'Price Plan,' that could signal that Trump may be especially willing to use his bully pulpit to galvanize support on its behalf. The president's approval rating is mediocre overall, but he's extremely popular among Republicans (as well as in a number of states represented by Senate Democrats who are up for re-election next year). If deployed strategically, Trump's megaphone could prove to be a decisive factor in whether or not Obamacare repeal and replacement becomes a reality. Will he bring reluctant Republican members to heel? Might he target pressure points to peel off certain Democrats, or at least puncture a few holes their wall of opposition?  I'll leave you with this New York Times report about outside conservative groups preparing to open their wallets and mobilize their supporters to make sure that GOP lawmakers feel the heat from their right flank, and not just from organized town hall protests and phone banking campaigns from Obamacare backers:

This battle is about to get real and specific. Conservatives should of course fight for the strongest viable alternative to Obamacare as possible, but a failure to make significant progress due to internal squabbling would be cause for "revolt" among the Republican base. The stakes are too high, and the vote counts too close, for widespread freelancing. Sometimes, rigid party discipline is required to accomplish difficult tasks.

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