Here's where things stand: The Left hates the new plan, of course. The Trump/Ryan legislation could cure pediatric cancer, and liberals would be complaining that it's mean-spirited and "extreme." But key players on the Right are also deeply skeptical of the bill, if not outright opposed -- including a bevy of influential groups. The public isn't fond of Obamacare, which they view as sufficiently flawed as to require total repeal or a massive overhaul. They're also supportive of major tenets of the GOP plan, although they're against spending cuts (but also don't favor generous benefits for others that make their own coverage more expensive). Trade-offs aren't popular; in other words, voters want to have their cake and eat it, too. Congressional Republicans are caught in the middle of this political crossfire. They're eager to fulfill the "repeal and replace" promise on which they've successfully campaigned for years, but they're split on how best to accomplish that. Some conservatives believe the bill preserves too much of Obamacare and fails to uproot the entire system in favor of a more free-market approach. Some purple-ish state Republicans, by contrast, worry that the legislation isn't generous enough, fearing headlines about millions losing coverage.
So what leadership and the White House are attempting to do with the AHCA is thread the needle within a framework that (a) satisfies enough members to secure passage, and (b) adheres to the rules of reconciliation for "phase one" of the three-phase approach. It's a challenge. Several of the New York Times' in-house, right-leaning opinion writers have panned the bill is as politically toxic because it doesn't provide enough benefits, and doesn't attract the support of any major constituency group. Conservative healthcare wonk Avik Roy has made similar points in a piece bearing the unironic headline "GOP's Obamacare Replacement Will Make Coverage Unaffordable For Millions -- Otherwise, It's Great." Read it. Conservative groups, meanwhile, charge that the plan is 'Obamacare lite' and should be scaled back considerably. Add into the mix the Wall Street Journal's editors giving the legislation two thumbs-up, with National Review weighing in with one thumb sideways. With that as the backdrop, here's House Speaker Paul Ryan responding to criticisms in some depth on Hugh Hewitt's radio program this morning. If you want to understand where the legislation is coming from, and what it seeks to achieve, this clip is absolutely worth 16 minutes of your time:
For an array of nuanced analyses of the proposal, I'd direct you to health policy experts Yuval Levin (constructively skeptical) and James Capretta (open, but urging some changes), as well as former Congressional Budget Office director Douglas Holtz-Eakin (modestly supportive). In my mixed view of the bill, a big missing piece for me is a convincing explanation that its various mechanisms will actually solve Obamacare's adverse selection/death spiral problem. If that doesn't happen, the fundamental dynamics of the failing current law won't change, and this time it'll be Republicans with their fingerprints all over the mess -- even if other positive policy and fiscal outcomes eventually flow from the reforms. Meanwhile, the CBO score is expected to drop early next week, perhaps on Monday. Brace for impact. It will likely show that GOPCare saves a lot of money, and may reduce costs for many consumers. But it will absolutely show that millions of people will lose their current coverage plans because of it. Republicans better eat their Wheaties and be prepared for the messaging battle that awaits. Lots and lots of coherent and persuasive communication is necessary. That's tougher, obviously, when divided conservatives are still 'shooting inside the tent.'