Bad
polling, Medicaid's popularity among reasons GOP just can’t get over the hump
on Obamacare repeal.
By ADAM CANCRYN and RACHANA PRADHAN
07/18/2017 12:32 AM
EDT
Senate Republicans'
bid to dismantle and rewrite Obamacare is officially dead. Any effort to pick
up the pieces and move ahead requires staring down monumental challenges,
starting with healing deep divisions among Republicans deflated by failure to
deliver on a defining promise.
But with Obamacare’s
popularity rising and repeal's popularity diminishing, they’ve got little room
to maneuver to get 50 out of 52 Republican senators on board. Conservatives
want to repeal more; Moderates don't want to see huge coverage losses. Senate Majority
Leader Mitch McConnell has now proposed a straight up repeal vote — without an
immediate replacement — but that too is a hurdle. Here are five reasons why
Republicans just can’t get over the hump on Obamacare repeal after seven years
of trying:
Town Hall pressure
works
Just weeks before
Sen. Jerry Moran (R-Kan.) made his opposition official and helped kill the
bill, H.R. 1628 (115), he faced down hordes of
constituents at a town hall pleading with him not to repeal Obamacare — in
conservative Kansas. The raucous event put Moran on the defensive, and prompted
him to pledge to defend protections for people with pre-existing conditions.
Heated protests — because many senators stopped having the town halls —
occurred in Arizona, Colorado, Ohio and other states with undecided or hesitant
senators.
Outspoken voters
hardened moderate Sen. Susan Collins' resistance to the repeal effort too, and
have made life difficult for Republicans throughout their six-month attempt to
dismantle Obamacare. The Senate failure is only likely to further inspire the
law's most ardent defenders, and make GOP senators think twice about heading
home again to defend another repeal bill.
Medicaid's newfound
popularity and its moderate champions
The Senate’s overhaul
of Medicaid went far beyond what Obamacare itself had done to expand the health
care program for the poor; it made the biggest changes since the program’s
creation in the 1960s. Several Republican moderates found it increasingly
difficult to support the move to cap federal spending and take $800 billion out
of the program. Collins and Lisa Murkowski (R-Alaska), for instance, argued
that the repeal bill shouldn’t include such sweeping entitlement reform.
Medicaid now covers
74 million people, roughly one in five Americans. About half of those covered
are children; in some states, Medicaid covers more than half of all births. It
is also the largest source of funding for long-term care in the U.S. And the
millions of people added to the rolls through Obamacare expansion only added to
its popularity.
Governors from both
parties — including key Republicans like Ohio’s John Kasich, Nevada’s Brian
Sandoval, Arizona’s Doug Ducey and Arkansas’ Asa Hutchinson — had also
criticized the GOP’s efforts on Medicaid, which would have blown big holes in
state budgets. The Senate bill would have led to 22 million more uninsured
people, roughly 15 million of them from Medicaid.
The full repeal
brigade — shunning
partial repeal and replacement
In 2015, virtually
every Senate Republican voted for a straight repeal of Obamacare — secure in
the knowledge that then-President Barack Obama would veto it. Two years later,
almost all of them were willing, even eager, to settle for much less. They
tried to split the difference between eliminating unpopular parts of the law,
like the individual mandate, while preserving popular benefits, like
protections for people in poor health and some subsidies to make insurance more
affordable.
Except Sen. Rand
Paul. The Kentucky Republican was steadfast in his refusal to vote for a bill
that preserved Obamacare's framework, further complicating the GOP's
already-tight path toward 50 votes. Other conservatives sympathized, including
Mike Lee (R-Utah) who announced Monday night that he’d block it. Paul and a few
fellow conservatives are likely to jump on the bill's failure as a fresh
opportunity to push for a straight repeal — and McConnell late Monday night
indicated they may have a chance to cast that vote.
The polls for the
Senate bill were terrible
The Obamacare repeal
effort has seen abysmal ratings in polls and been buffeted by protests from
liberal groups and raucous town hall meetings around the country. It’s hard for
Republicans to vote for a bill with dismal approval ratings — that keep getting
worse.
Just three weeks ago,
the Quinnipiac poll found that voters more than three to one oppose the GOP’s
health care plan. In the meantime, Obamacare’s popularity has only risen.
According to the Kaiser Family Foundation monthly tracking poll, over the past
year the 2010 health law has seen a modest increase in support among the
general public, with 51 percent expressing favorable views and 41 percent
expressing negative opinions. Roughly half of the public viewed Obamacare more
favorably than the GOP’s replacement.
Infighting on the
right
When Senate
Republican leaders added a conservative provision to the bill that let insurers
sell cheap, deregulated plans, it was supposed to secure the crucial support of
Sens. Ted Cruz (R-Texas) and Lee. But it failed to lock in Lee, who said it
didn’t do what it was intended to do. Instead, it ended up motivating him to be
a deciding vote to doom the bill.
The problem: The
amendment he crafted with Cruz was modified when it was inserted into the
legislation, it preserved Obamacare's ban on splitting the individual insurance
market between healthy and sick people. That may sound like a technicality — it
has to do with whether healthy people subsidize sicker ones — but it proved a
dealbreaker for Lee, and serves as a fresh warning to Senate leaders who think
they can negotiate a last-minute compromise between their moderate and
conservative wings — or even among independent minded conservatives.
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