Health care fight poses risk

GOP could pay steep price in next election

Seven years ago, Democrats passed a sweeping health care bill that proved to be their undoing in the next election.

Is the GOP about to repeat history?

“It depends on whether this stuff works or not,” said House Republican Tom Cole of Oklahoma, after his party passed a plan last week to repeal and replace Obamacare, amid Democratic taunts the GOP was kissing its congressional majorities goodbye. “If it doesn’t make their life better, let alone if it makes their life worse, then we will pay a price. And we will lose the majority,” said Cole, who supported the bill.

“I think a lot of Republicans are going to end up paying a very big price for this vote,” said House Democrat Mark Pocan, whose home state of Wisconsin illustrates some of the competing factors that will determine the political fallout of the health care fight.

All five House Republicans from the state voted for the plan — Speaker Paul Ryan, Jim Sen-

senbrenner, Sean Duffy, Glenn Grothman and Mike Gallagher.

Recent polling in the state points to the political risks.

Six out of 10 voters said Congress should keep Obamacare in a March poll by the Marquette University Law School, though most of those said it should be improved.

Only 36% wanted to repeal it.

Most Wisconsin voters were skeptical a replacement plan would lower costs or increase coverage, and many thought it would do the opposite.

Most Wisconsinites on Obamacare (those buying policies through the law’s insurance exchanges) would pay considerably more under the GOP plan.

And many suffering the biggest financial hit live in House districts represented by Republicans.

Take a fairly typical Obamacare enrollee — a 60-year-old with an income of $30,000.

Under the GOP plan, effective premiums for those enrollees would rise by more than $10,000 a year in 23 Wisconsin counties, according to an analysis by the nonpartisan Kaiser Family Foundation. (To use one such county as an example — Polk — Kaiser estimates premiums for those buying their own insurance would rise by $4,660 and health insurance subsidies would decline by $7,090, for a net cost increase of $11,750).

The majority of those 23 counties are in the northern Wisconsin congressional district represented by Duffy — a district that gave President Donald Trump his biggest victory margin in the state.

Rural enrollees in Obamacare tend to be the biggest losers in the GOP bill, because their health care costs are higher. Highcost areas get extra subsidies under Obamacare — but not under the Republican plan.

“This is going to be devastating for rural Americans and rural Wisconsin,’’ said Democrat Ron Kind, whose rural western Wisconsin district would also see a big hit in aid for people buying their own insurance.

The net cost of premiums for these enrollees would rise almost as much — between $9,000 and $10,000 — in most of the counties in GOP freshman Gallagher’s northeastern Wisconsin district, according to the Kaiser study.

Those costs would go up just as steeply in the two biggest counties — Racine and Kenosha — in Ryan’s southern Wisconsin district.

Wisconsin is also a state where the explosive issue of pre-existing conditions could come into play.

The House bill allows individual states to seek waivers from certain Obamacare mandates, including the rule that insurers cannot charge more to people with pre-existing conditions. This sort of waiver would affect a limited population — people who buy insurance through the individual market and who have had a lapse in coverage.

Republicans argue those people would be protected because states that get a waiver would have to set up high-risk pools to insure people with pre-existing conditions.

But many analysts believe the law would still leave those people more vulnerable to cost increases that could make their plans unaffordable.

After the House bill passed, Wisconsin served up an instant example of how politically touchy this issue is and how it could spill over into state races for governor and the Legislature.

Gov. Scott Walker said Friday morning he would consider seeking a waiver from the Obamacare mandate — depending on what the final law looks like. But after his remark drew fire, Walker stepped back from those comments and told the Journal Sentinel he was “not looking to change” the rules for people with pre-existing conditions.

Wisconsin also illustrates how challenging it will be for Democrats to take back the House even if the health care debate plays out in their favor. The GOP tilt of the House map nationally means Democrats need to capture some Republicanleaning districts to win back a majority. In Wisconsin, none of the five House Republicans won their 2016 races by less than 19 points. Trump carried each of those districts by at least 10 points.

In the end, whatever health care “hit” the GOP takes in the 2018 elections will depend on some very large question marks. Will the Republicans in the House and Senate agree on a plan?

Will it look very different from the bill the House passed Thursday?

The fallout will be complicated by the fact there are both winners and losers in a conservative overhaul of health care. Many of the hits will be suffered by people on Medicaid (the bill contains major changes to that program) and those buying insurance on the individual market under Obamacare. (There were about 240,000 Obamacare enrollees in Wisconsin last year.)

But while many poorer and older Americans will lose, many younger, healthier and wealthier Americans could benefit financially.

Republicans are making the case that Obamacare is unsustainable, so preserving the system is not an option.

Asked last week if he was worried about a backlash against the GOP, Grothman said, “You always have to be worried, but we were left with a mess, and we’re making best we can with the mess. It’s a huge improvement over what would have happened if we had done nothing.”

That argument will be hotly debated in the months to come.

But now that they’re in power, Republicans know they’ll be held accountable for whatever system emerges from this debate, and that health care is a frighteningly potent political issue.

Most felt they couldn’t risk doing nothing, because of the repeated promises they’ve made to their GOP base to repeal Obamacare.

But now they face a different kind of peril.

“The Democrats got this done in 2010 … they believed, ‘OK, this is going to become popular.’ And it never became popular,” Cole, the Oklahoma Republican, said of the Affordable Care Act.

“So we can argue the policy, but politically, it was a bad decision. It cost them the majority (and) it has probably kept them in the minority ever since then,” he said.

“So we run the same risk.”