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Today in Obamacare: The rollout of the GOP plan is not going well

Paul Ryan
Bill Clark/CQ Roll Call/Getty
Bill Clark/CQ Roll Call/Getty

Three groups of Republicans to watch on the House health care bill

The American Health Care Act is only a day old, and it's already been met with a chorus of condemnations. It's certainly not dead yet, but it's not exactly thriving. Any one of three groups could scuttle it.

1. The far right of the Republican Party. Within the GOP, staunch conservative politicians and groups have objected most vocally to the bill so far, because they're upset that it doesn't do enough to roll back Obamacare. Heritage Action, the Club for Growth, Freedomworks, Americans for Prosperity, and Freedom Partners have already declared their opposition to the current draft. Sens. Rand Paul (R-KY) and Mike Lee (R-UT), and several members of the House Freedom Caucus, have joined them.

2. Mainstream members who listen to lobbyists. Many of the more moderate Republicans in the House and Senate are receptive to lobbying from important interest groups. So if associations representing doctors, hospitals, or insurers say the bill has problems, the House could well slam the brakes. (And lo and behold, on Tuesday afternoon, the American Hospital Association wrote that it "cannot support the American Health Care Act in its current form.")

3. Vulnerable members. Swing district representatives are already blanching at the prospect of a tough reelection fight. These are the members who really have their careers on the line, and several of them expressed misgivings about repeal and replace in leaked audio from a congressional retreat in January.

Overall, despite the early criticism, the vast majority of Republicans in Congress haven't weighed in just yet. That makes sense — those members want a chance to digest what's actually in the bill, to take the temperature of major interest groups, and to hear from their constituents.

The problem is that the extremely aggressive legislative calendar won't give them much more time to make up their minds.

What comes next

1. Markups begin tomorrow: The House Energy and Commerce Committee and Ways and Means Committee will begin marking up their respective portions of the AHCA at 10:30 am Eastern. The markups are expected to be quick — a few days at most, not weeks — before a final vote in each committee.

Four defections in either committee would prevent the bill from winning majority support. So if you're watching, keep an eye on the members in districts Hillary Clinton won last fall.

For Energy and Commerce, that's Reps. Mimi Walters (CA), Leonard Lance (NJ), and Ryan Costello (PA). For Ways and Means, it's Reps. Carlos Curbelo (FL), Erik Paulsen (MN), Peter Roskam (IL), Dave Reichert (WA), and Pat Meehan (PA).

2. The CBO score will come before the full House votes: Energy and Commerce Chair Greg Walden confirmed at a Tuesday morning press conference that "there will be a CBO score coming, and we look forward to that before [AHCA] comes to the House floor."

Walden didn't promise the score would come before his committee votes. That seems to put the members of the two committees in a tough spot, as they'll be forced to vote on the bill without knowing its estimated costs or how many people would lose coverage — something that could come back to haunt them in attack ads.

3. For the full House, 22 Republican defections would likely kill the bill: That's if Democrats remain united in opposition, as expected. The math is that there are 430 sitting members of Congress, so 216 yea votes are needed for a majority if everyone votes yea or nay.

237 members are Republicans, so they can afford to lose 21 of their own members' votes, but no more. Keeping in mind that there are 23 House Republicans in districts Clinton won, and at least 29 in the Freedom Caucus who could oppose the bill from the right, it's not all that hard to count to that number.

4. If something does pass the House, Senate leaders might bring it to the floor right away: I've been hearing rumors for a while that Senate Majority Leader Mitch McConnell might bypass his chamber's venerable committee process. Those rumors got some corroboration today from his deputy, John Cornyn, who told reporters that he expects a House-passed bill would be brought straight to the Senate floor.

Considering the timeline McConnell is laying out — he claims he wants a bill passed before the Senate's mid-April recess — he'd essentially have to skip the committee process. But senators used to weighing in extensively on proposed legislation likely won't be too thrilled about that.

This is a really aggressive timeline

I've said it before, but this is a remarkably rapid timetable for legislatively restructuring such an immense portion of the US economy.

The reason big legislation usually takes a long time is that the process involves getting major stakeholders on board. It involves rebutting criticisms, adapting to potential concerns, and building a strong case for why the bill is indeed a good idea.

Puzzlingly, McConnell and House Speaker Paul Ryan don't even seem to be trying to conduct this traditional process. Instead, they've adopted a "damn the torpedoes, full speed ahead" approach, simply daring their members to vote no.

Maybe they know where their members are and they're rightly confident that they can in fact muscle this through.

Maybe they're not at all confident they can get it through, but they've concluded that their only real chance of success, however small, is to move quickly.

And maybe they've also calculated that if their repeal bill blows up quickly, Republicans will be able to move on to other things on their agenda without having wasted months and months on a doomed health care plan.

Chart of the day

Kaiser Family Foundation

Today’s health policy and politics links

  • "Analysis: GOP plan to cost Obamacare enrollees $1,542 more a year": "We’re presenting an analysis here of the net financial impact of the Republican bill on premiums, after tax credits, plus cost-sharing. We estimate that the bill would increase costs for the average enrollee by $1,542, for the year, if the bill were in effect today. In 2020, the bill would increase costs for the average enrollee by $2,409." —David Cutler, John Bertko, Topher Spiro, and Emily Gee, Vox
  • "Analysts: Republican health care bill will cost 6 to 10 million people health insurance": "S&P’s analysis found about 6 million to 10 million people will lose health insurance if the bill passes, including 2 million to 4 million currently enrolled in the individual health insurance market, and 4 million to 6 million currently enrolled in Medicaid." —Dylan Matthews, Vox
  • "Republican Obamacare plan signals that liberalism has already won": "The argument is about whether the government should pay for it by forcing healthy people to purchase insurance under the threat of a penalty, as Obamacare does, or by threatening anybody who doesn't maintain continuous coverage with a 30 percent late fee, as the GOP prefers. Liberals, in other words, have won the central philosophical argument, and Republicans are reduced to fighting over the mechanics." —Philip Klein, Washington Examiner
  • "The Republican plan is even worse than Obamacare": "[The bill] will not, for example, make the looming possibility of a 'death spiral' in the individual market any less possible, and indeed may make it more likely. Passing this bill would certainly ensure that Republicans will 100 percent own any ensuing death spiral, and will have little luck whining that it was gonna death spiral anyway, because Obamacare. In other words, even if we leave aside any policy effects, this bill will be a disaster for the long-term political fortunes of the Republican Party." —Megan McArdle, Bloomberg View
  • "House GOP's Obamacare Replacement Will Make Coverage Unaffordable For Millions — Otherwise, It's Great": "The critical mistake of the AHCA is its insistence on flat, non-means-tested tax credits. The flat credit will price many poor and vulnerable people out of the health insurance market." —Avik Roy, Forbes
  • "The House Republican Obamacare Replacement Plan: Mind Boggling": "Obamacare is so poorly constructed it is literally an anti-selection machine. The Republican proposal is worse." Bob Laszewski, Health Care Policy and Marketplace
  • "The House GOP Leadership’s Health Care Bill Is ObamaCare-Lite — Or Worse": "The House leadership bill isn’t even a repeal bill. Not by a long shot. It would repeal far less of ObamaCare than the bill Republicans sent to President Obama one year ago. The ObamaCare regulations it retains are already causing insurance markets to collapse. It would allow that collapse to continue, and even accelerate the collapse." —Michael Cannon, Cato Institute
  • "Conservatives: Paul Ryan's healthcare plan replaces Obamacare with Obamacare-lite": "If Ryan put forward a healthcare bill that can’t even pass the House or the Senate–or either chamber of Congress–then got the Trump administration’s Health and Human Services Secretary to endorse it, he could be severely hurting the credibility of the Trump administration as part of a fool’s effort to advance his own political agenda." —Sean Moran, Breitbart News

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