Conservatives are using their considerable leverage on the measure ... to extract concessions on the Essential Health Benefits section of the bill, which mandates that insurers offer plans covering 10 services: outpatient care, emergency room visits, hospitalization, maternity and newborn care, mental health and addiction treatment, prescription drugs, rehabilitative services, lab services, preventive care and pediatric services.But apparently it's not punitive enough:
Though the move represented a win for conservatives, many Freedom Caucus members refused to commit their support for the bill. They want to cut even more Obamacare regulations, including its popular provision requiring insurers to offer coverage for people with pre-existing conditions.And every change that makes the bill more appealing to conservatives makes it less appealing to Republican moderates:
... a last-ditch bid by the White House to win conservative support late Wednesday appeared to repel moderates.How nasty is the bill now?
Moderate Republicans huddled with Speaker Paul Ryan and House leaders for nearly two hours Wednesday night but emerged without consensus. Immediately after exiting the meeting, Rep. Charlie Dent (R-Pa.), leader of the House’s moderate Tuesday Group, panned the bill, known as the American Health Care Act.
“After careful deliberation, I cannot support the bill and will oppose it,” Dent said in a statement upon leaving the meeting. “I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”
The worst provision in the manager’s amendment is a Medicaid work requirement that would allow states to revoke Medicaid coverage from new mothers who haven’t found a job within two months after giving birth.And if the bill is made mean-spirited enough to get through the House, it's likely to be far too harsh to win approval in the Senate, where Republicans can afford only two defections:
The Senate is different.... Four GOP senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, and Lisa Murkowski of Alaska — have written to McConnell to express concern about sharp rollbacks to Medicaid. Bill Cassidy of Louisiana and Susan Collins of Maine, meanwhile, have actually gone and written their own replacement bill, one that would likely lead to much smaller coverage losses....Now, can the entire Beltway please apologize to Barack Obama?
If you look at the Center for American Progress’ handy district-by-district breakdown of coverage loss under AHCA ... [and] you look up the most vulnerable House Republicans — generally suburban districts whose white population is very well-educated that swung away from the GOP in 2016 — they tend to be spared the worst of the bill’s sting.
Conversely, many House Republicans districts are so safe they wouldn’t lose to a Democrat even if the Trump administration unleashed a nuclear holocaust. To the extent that they worry about anything, they worry about losing their reputation for total ideological purism — and inviting a possible primary challenge from the right.
By contrast, Arkansas, Kentucky, and West Virginia are the three of the top five states that have been helped by the Affordable Care Act....
And the most vulnerable 2018 Senate Republican, Dean Heller of Nevada, represents a lower-income state with a lot to lose if AHCA passes. That’s why in addition to the six or so Republicans who’ve raised explicit objections to the House bill, you’ve heard all kinds of murmurs of discontent in the Senate — including from die-hard conservatives like Arkansas’s Tom Cotton.
Right-thinking people told us throughout Obama's presidency that he could have won a lot more legislative battles if he did more schmoozing. We were told that he should have had more convivial drinks with leaders of the opposition, the way, according to legend, Ronald Reagan and Tip O'Neill regularly did.
Many us countered that Obama was dealing with a GOP that had ruled out negotiations and compromise. Even when Obama won, as he did with the Affordable Care Act, he had to do so by winning over fellow Democrats -- and even they were hard to corral.
Well, now we see that Paul Ryan and Donald Trump (or whoever is negotiating for Trump) are struggling as much as Obama did -- in fact, more. They can't seem to put together a bill that will please enough members of their own party to form House and Senate majorities.
Remember, back in 2010, the notion that a law would increase health care coverage the way the Affordable Care Act has was seen as radically left-wing, at least by conservatives -- and many moderates. You simply couldn't do what needed to be done to cover a lot more people and expect to bring Republicans on board.
Well, now there are Republicans who fear for their political hides if they don't defend Obamacare's coverage levels. Those Republicans have now adopted the position of most Democrats in 2010. But what was then a partisan gap, and is now an intra-party gap, is still unbridgeable: Hardcore conservatives in the GOP refuse to back a law that leaves any of the decent, humane provisions of Obamacare in place.
So now we know that the problem wasn't Obama's failure to schmooze. Right now, with some Republicans talking like 2010 Democrats, even a GOP president who likes to glad-hand apparently can't get to yes.
So please apologize to Barack Obama. It wasn't him -- it was the implacable extremism of most Republicans.