:format(webp)/cdn.vox-cdn.com/uploads/chorus_image/image/53841767/656561084.0.jpg)
Welcome to VoxCare, Vox’s daily round-up and analysis of the health care news that matters most. To subscribe by email, use this widget. Otherwise, read on!
Will House Republicans muster the votes to pass the American Health Care Act tomorrow? I don’t know. But if they don’t, a major reason will be that President Trump’s closing argument was weak.
As my colleague Andrew Prokop noted, Trump’s final pitch “doesn’t include anything even remotely resembling an affirmative case for the actual bill House Republicans have to vote on.” This may be because Trump doesn’t actually understand the bill they’re voting on. But lacking a persuasive case to make on the merits, Trump has defaulted to an unpersuasive case on the politics.
In statements both public and private, Trump has been telling Republicans that they’ll have “a political problem” if they don’t pass the AHCA. “Many of you will lose in 2018” if the bill fails, he said. At times, he’s resorted to explicit threats — “I’m gonna come after you,” he told Rep. Mark Meadows. He’s also played good cop to his own bad cop, predicting Republicans would win 10 Senate seats if they cleared the legislation.
The problem Trump faces in making this case is it is clearly, obviously wrong — and members of Congress know it.
Many of the House Republicans Trump is trying to persuade won their seats in the aftermath of Obamacare, and so the political dynamics that follow in the wake of a party passing an unpopular health care bill are familiar to them. Democrats were, of course, crushed in the 2010 midterm elections, but that doesn’t prove too much — perhaps it was the economy, or disappointment with Barack Obama, that led to their defeat.
But political scientists Brendan Nyhan, Eric McGhee, John Sides, Seth Masket, and Steven Greene dug into how Democratic backers of the Affordable Care Act performed in the next election. They found that “the vote share of Democrats who supported health care reform was 5.8 points lower than that of the most comparable Democrats who opposed the bill.” The implied seat loss from that support was huge: 25 seats, which would have been enough for Democrats to hold the House majority.
The American Health Care Act isn’t Obamacare, of course — but the particular ways in which it is not Obamacare look worse, not better, for Republicans.
First, Trump, at 40 percent in the latest Gallup poll, is significantly less popular than Obama was when the Affordable Care Act passed. So his protective effect looks weaker.
Second, though Obamacare passed in 2010, its main provisions didn’t take effect until 2014. The American Health Care Act, however, starts up in 2018 — and according to the Congressional Budget Office, 14 million people will become uninsured that year because of its provisions. You don’t need to be a political genius to intuit the chaos that will create in the health care system, or the damage that will do to Republicans running for reelection.
This is why it’s so damaging that Trump and the GOP leadership haven’t made a stronger substantive case for the American Health Care Act. By the time Obamacare passed, it was clearly unpopular, and it was clearly going to endanger vulnerable Democrats who voted for it. But it was also a bill Democrats believed in substantively, and many voted for it because they thought its passage would be worth the sacrifice of their seats.
But GOP leadership is rushing legislation that has little enthusiastic support from stakeholders, policy experts, key Republican voices, or really anyone outside of Paul Ryan and Donald Trump. Doing big things is hard, and it often requires persuading legislators to overcome cynical political calculations and tie themselves and their careers to a larger, grander project. When Trump instead appears before them and tells them that cynical political calculations are why they should pass an unpopular bill backed by an unpopular president that will cause a nightmarish amount of upheaval in an election year, it’s not the world’s most convincing case.
Which isn’t to say the AHCA won’t pass tomorrow. Stranger things have happened. But its prospects would be a lot brighter if the underlying legislation were stronger and its backers could make better, more substantive arguments on its behalf.
Chart of the day: If you're wealthy, the AHCA gives you about $6,000. If you're poor, it costs you $1,420.
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/8203729/urban_graph.png)
Daily reads
With research help from Caitlin Davis
When you’ve lost the Wall Street Journal editorial board... “All of this continues the pattern from the campaign that Mr. Trump is his own worst political enemy. He survived his many false claims as a candidate because his core supporters treated it as mere hyperbole and his opponent was untrustworthy Hillary Clinton. But now he’s President, and he needs support beyond the Breitbart cheering section that will excuse anything. As he is learning with the health-care bill, Mr. Trump needs partners in his own party to pass his agenda.” —Wall Street Journal
“If Health Bill Is Killed in the House, Ideology Will Be the Main Reason.” “So far, the House Republicans who oppose the plan aren’t from the places most dependent on Medicaid or the Obamacare tax credits. They’re not even among the most vulnerable Republicans when considering the 2018 elections. Instead, the health care debate is splitting House Republicans along ideological lines, with few signs that members are being pulled off familiar terrain by the effect of the law on their states or districts. This could change before the Republicans bring their plan to a vote on Thursday. A disproportionate share of undecided Republicans are from Medicaid expansion states or relatively moderate districts.” —Nate Cohn, New York Times
“9 health reform lies Congress members are telling their constituents.” “More Republicans fudged than Democrats, though both had their moments. The legislators cited wrong statistics, conflated health care terms, and made statements that don’t stand up to verification. It’s not clear if the inaccuracies were intentional, or if the lawmakers and their staff don’t understand the current law or the proposals to alter it. But either way, the issue has become increasingly heated as the House gets ready for a vote on the GOP’s replacement bill this Thursday. Here are some whoppers from members of both parties, and the truth and context behind what they told voters.” —Charles Orstein and Julia Belluz, Vox
