The word we get from Paul Ryan and Mitch McConnell is that the American Health Care Act (actually it's just a bill right now), is the bill. This is the ObamaCare replacement. Take it or leave it.
It doesn't sound like that's necessarily President Trump's position. He spent several days last week in intense discussions with conservative members of both the House and Senate - as well as libertarian Rand Paul, who sometimes pretends to be conservative - trying to reach an agreement that will push a good bill forward to passage. What the conservatives most seem to want is a quicker halt to the expansion of Medicaid, which Trump seems to be open to even if a lot of Republican governors in states that went ahead with the Medicaid expansion are nervous about it.
And in a further attempt to gin up support for the proposal, Trump invited skeptical Freedom Caucus members to a night of bowling at the White House next week.
The efforts are part of the White House's full-court press to get legislation that both repeals and replaces Obamacare, at least in large part, across the finish line.
And the Freedom Caucus is the key faction for the White House to sway.
The lawmakers oppose the timeline for phasing out Obamacare's expanded eligibility for Medicaid, which the leadership proposal rolls back in 2020, and also creation of advanceable, refundable tax credits based on age to help Americans buy health insurance.
"The first thing Republicans are bringing forward is a piece of legislation that we're going to put on a Republican president's desk that says repeal [Obamacare], but keeps Medicaid expansion and actually expands it, that keeps some of the tax increases," Rep. Jim Jordan, R-Ohio, told reporters Tuesday at a press conference.
"That is not what we promised the American people we were going to do," the former Freedom Caucus chairman said.
Instead, Jordan, along with Sens. Rand Paul, R-Ky., and Mike Lee, R-Utah, and other conservative lawmakers have stressed that the vehicle for Obamacare's repeal already exists: the 2015 bill to dismantle the health care law's key provisions that passed both chambers of Congress but was vetoed by President Barack Obama.
Though conservatives ideally would like to see GOP leaders bring up the 2015 bill once again--Jordan and Paul actually introduced that same legislation this week in their respective chambers--they're not opposed to negotiating.
"This is the beginning of the negotiation," Paul said at the press conference Tuesday. "The House Freedom Caucus' power and the power of several conservatives in the Senate is to withhold our support and to make it better. If they have 218 votes, we won't get any change."
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The problem with taking the bill in a more conservative direction, of course, is that GOP moderates like Susan Collins, Lisa Murkowski and Cory Gardner could band together and deny the bill 50 votes. Complain all you want about what happens when you bend to political reality instead of sticking to your philosophical principles, but your principles don't do anyone any good if they're never turned into policy.
Trump and congressional leaders have to thread a tricky needle here if they're going to can get the support of both the moderates and the conservatives in the Senate. As it stands right now, the bill could lose Murkowski, Collins and Gardner if it goes too far right. It could lose Ted Cruz, Mike Lee and not-really-conservative Paul if it goes too far left.
I applaud the willingness of both Trump and congressional conservatives to try to make this bill better, especially since anything that has to wait for Phase 3 (when the filibuster will be a factor) is much more difficult to get done than Phase 1. But I remain concerned that the GOP's tiny 52-48 Senate majority gives the likes of Collins and Murkowski outsized influence over this process. I don't like that a bit, and I suspect it's going to end up giving us an ObamaCare replacement that is in no way what many of us had hoped for.
But unless Trump is able to buy the moderates off by giving them something else they want even more - and I shudder to think what that might be - I'm having a hard time seeing the solution to the problem. It might be that the best reforms can't happen until 2019, when the GOP has hopefully expanded its Senate majority as a result of the very favorable map that beckons in the 2018 midterms. That will require the Republicans to do a very good job explaining how they did the best they could with the small majority they had, but that they can do far better if they have an even bigger majority to work with.
That's a hard case to make, especially when you know the media will do nothing to help you make it. Then again, Trump has demonstrated an unusual ability to make things happen in politics in spite of the media being at war with him. If he can push through an ObamaCare replacement that's truly worthy of this country in spite of the legislative numbers as they stand today, the guy is not just an unconventional politician. He's a freaking genius.
