Is the Obamacare replacement bill the death of the Republican Congress? Piggybacking off what Leah wrote yesterday morning, Sen. Tom Cotton (R-AR) seems to be quite adamant that the House Republican majority could be put at risk if they vote for a bill that seems to be on the verge of political life support. Cotton issued this warning on ABC News’ This Week:
"I don't want to see the House majority put at risk on a bill that is not going to pass the Senate," he said. "That's why I think we should take a pause, try to solve as many of the problems on both Medicaid and the individual insurance market in this bill in the House and then allow the Senate to take its work up."If House Republicans rush to pass it, however, there will be consequences for their vote, he said.
Cotton cited the Democratic push for a British thermal unit (BTU) tax on sources of energy. That led to unified Republican opposition and divided Democratic support that helped kill the Democratic majority after the 1994 midterms. Over at Hot Air, Ed noted that this was a rather odd example since Hillarycare was one of the main reasons (assault weapons ban, House overdraft scandal were others) Democrats got killed in ’94:
The Health Security Act, better known at the time as HillaryCare, didn’t even manage to get a vote; it got tied up in internecine fighting among Democrats in the face of solid opposition by Republicans. After several attempts by the Clinton White House to get legislative action on the takeover of the heathcare system, Democrats booted it until after the midterms — and Republicans made 1994 a national referendum on socialized medicine much more than they did on BTUs or even taxes.After that, though, Democrats felt that they had lost because they had stalled too long. They applied that lesson in 2009-10, which is why Democrats got so desperate to pass ObamaCare that they ignored polling that showed majorities against the idea. That ended up backfiring as well, eventually reducing Democrats to their worst standing in all level of politics since the Hoover administration. That shows that the real lesson of 1994 was that Americans don’t like government control of economies.
That lesson might have some application here, too. If Republicans wind up doing nothing in this session of Congress to unwind ObamaCare, that may be the larger risk over doing something incremental. If the Senate refuses to move on an incremental package rather than doing some “carpentry” to get to a conference committee, then that might be the bigger problem.
Yet, given the composition of congressional districts, are we overreacting? Nate Silver at The New York Times wrote about how the GOP could have a majority for the next generation after the 2014 midterms. While he said that a Republican president might improve the chances of a Democratic takeover, it’s still dubious to suggest that a 2006 or 2010 wave would occur:
By picking up at least a dozen House seats in the elections last Tuesday, the Republicans cemented a nearly unassailable majority that could last for a generation, or as long as today’s political divides between North and South, urban and rural, young and old, and white and nonwhite endure.[…]
Even if the Democrats could retake the House in an anti-Republican wave, it probably won’t come with a Democratic president to take advantage of it. The party with the presidency rarely makes big gains in Congress. As my colleague Lynn Vavreck put it, the economy elects presidents; presidents elect Congress.
In other words, a Republican president is probably a prerequisite to a Democratic House. And even a Republican president might not assure another wave like 2006 or 2010, which itself would not even assure a Democratic House.
USA Today also wrote in November of 2015 that the generation-long grip the GOP has on the House is attributed to their strength at the state-level, where congressional districts are drawn and redrawn every ten years. At this level, the Republican Party is king, controlling 69/99 state legislatures, over 4,100 lawmakers elected into office (the most since the party’s founding), and two-thirds of the governorships. Yes, Democrats are trying to mount an effort to reclaim lost ground, but as long as white working class voters that dot rural America vote Republican—the House GOP majority will probably remain. And Democrats have given zero indication that they’re ready to reach out to these voters, even though they need them to retake Congress and eventually the White House.
Now, it goes without saying: if we do nothing, then, yes—Republicans will be on the chopping block. But I doubt that white working class voters will abandon Trump, who really hasn’t attached his name to this bill, a point aptly noted by Politico’s Hadas Gold, and vote Democratic in 2018. Yet, the fact that Trump is somewhat at arms length with this legislation could be another sign that this bill isn’t good. The Foundation of Government Accountability isn’t happy that the Medicaid expansion provision was kept in the bill:
Such a freeze is politically popular. A recent poll, released today by FGA, finds that 79% of Republicans and 81% of Trump voters support stopping ObamaCare expansion enrollment.
“Current conditions are unsustainable and place millions of truly needy Americans at risk,” FGA President and CEO Tarren Bragdon said. “We face a fiscal nightmare for states unable to handle exploding enrollment and budget-overruns into the billions of dollars. It is irresponsible to continue on this course.”
The conservative wing of the GOP is unhappy with this legislation as well, though the Association of Mature American Citizens (AMAC), the conservative version of AARP, praised the bill as a good first step:
On behalf of the 1.3 million members of AMAC, the Association of Mature American Citizens, I am writing in support of the American Health Care Act, or the reconciliation recommendations to repeal and replace the Patient Protection and Affordable Care Act (Obamacare). The provisions embodied in this Act are a vital, first step in the legislative process to completely repeal and replace Obamacare.Millions of seniors were promised time and again by the Obama Administration that they could keep their health plans and they could keep their doctors. The last six years have proved those promises false, and millions of seniors have been forced off their health plans and out of their doctors’ offices. For years, AMAC has repeatedly called on Congress to repeal the Obama Administration’s failed health care law, and to put the power of health care choices back into the hands of patients. As a starting point, this bill lays the necessary foundation for more robust and necessary changes to repeal Obamacare in its entirety.
Axios also listed what’s in and out of the bill, adding that it’s not "totally inaccurate" to call it Obamacare lite:
What pieces of Obamacare stay: A lot, including almost all of the consumer protections and market reforms. Here's some of what's staying in place:
- Protections for pre-existing conditions. Insurers still won't be able to deny sick people coverage, and they won't be able to charge them more than healthy people.
- Children will be able to stay on their parents' plan until age 26.
- No lifetime or annual limits on insurance coverage.
- Private plans must cover a set of "essential health benefits." (Though they don't have to cover as much of a patient's total health care costs as under Obamacare.)
- There's a limit on out-of-pocket costs passed along to private plan enrollees.
What pieces of Obamacare will either go away or be changed: How health coverage is subsidized and paid for within that regulatory structure.
- The individual and employer mandates are repealed. The individual mandate is replaced with a continuous coverage provision allowing insurers to charge extra to people who didn't keep themselves insured.
- Medicaid expansion is eventually phased out, and the way the federal government funds the program is massively reformed.
- Obamacare's premium subsidies, which are tied to income and the cost of premiums on exchanges, are replaced with an age-adjusted refundable tax credit.
- Nearly all of Obamacare's industry taxes are repealed, along with taxes on high earners. The exception is the Cadillac tax on expensive employer plan benefits, which is delayed until 2025.
- The use of health savings accounts is expanded.
Guy added that the Republican Study Committee proposed two amendments to the bill concerning Medicaid expansion, which capped new enrollment at the end of 2017 and added worked requirements for able-bodied enrollees in the government program. The Medicaid expansion is one of the most expensive provisions in the Affordable Care Act. This was necessary, and maybe proof that the GOP could make this bill into fresh start on health care we desperately need. The GOP has no room for error here.
Still, you get the vibes of disunity that killed Democrats over Hillarycare. Either way, the GOP is going to get slammed, but I doubt that it puts the House majority in the crosshairs. If anything, the Republicans facing political blowback will be from the conservative wing of the party from heavily Republican, or GOP-leaning, districts. In the end, the seat remains with the same party, just with a few more bomb throwers. At the same time, the bill, according to the CBO—doesn’t tackle rising premiums and it leaves at least an additional 20 million Americans won’t have health insurance by 2020.
It’s certainly possible that the House GOP is in trouble and things could take a turn for the worse, but for now-I’m skeptical. Conservatives have a tendency of overestimating the threat. In 2011, we all thought Scott Walker would be dead in the water for pushing collective bargaining reform. In the 2012 recall, he got more votes than he did during his initial 2010 gubernatorial run. We still have a long ways to go until 2018. For now, I’m looking at the structural aspects of this; the composition of the congressional seats and the GOP still has a tight grip. With the GOP as the dominant political force in the country, it will be harder for Democrats to find candidates to sacrifice what little influence they have at the state-level for a federal election that will end in their defeat. No state-level candidates rising to higher office means that some congressional races may be empty, which means there are no points of outreach made to rural voters from the Left, who can be persuaded to switch allegiances if the messaging is jobs-based—believe me. Democrats aren’t really interested in that. When Democrats start resonating in the Appalachia regions again, then I’ll be worried. At the same time, I'm fully aware that Democrats also made the same claims in 2009 about the state of the Republican Party, along with the perceived dominance of their party--which was steamrolled by the Tea Party wave.
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