GOP must sell health-care plan to a skep­ti­cal pub­lic

The Washington Post Sunday - - NEWS - Dan Balz dan.balz@wash­

It took a mon­u­men­tal ef­fort by Repub­li­cans to sell one an­other on the health-care bill that nar­rowly passed the House on Thurs­day. It could take an even big­ger ef­fort to sell it to the pub­lic.

When the bill fi­nally got through the House, President Trump and House Repub­li­cans staged a vic­tory party in the Rose Gar­den at the White House. Every­one knew it was pre­ma­ture, but House lead­ers and a president who lacked a sin­gu­lar leg­isla­tive vic­tory were look­ing for any ex­cuse to cel­e­brate.

The vic­tory party was a gi­ant sigh of re­lief rather than an ex­pres­sion of con­fi­dence in the sub­stance of the bill. What Repub­li­cans were cel­e­brat­ing was the sim­ple fact that after one spec­tac­u­lar fail­ure — hav­ing to pull the bill to avoid a loss on the House floor — and then weeks of tor­tu­ous in­tra­party ne­go­ti­a­tions, the votes fi­nally came to­gether to send the mea­sure to the Se­nate. House Repub­li­cans got the mon­key off their backs.

Many Repub­li­cans be­lieved that an­other fail­ure in the House would have been more dam­ag­ing to their cause than plung­ing ahead into the un­known. Per­haps. The re­ac­tion from Repub­li­cans in the Se­nate spoke to the lack of con­fi­dence in the sub­stance of the Amer­i­can Health Care Act as it emerged from the House — and prob­a­bly to the feared po­lit­i­cal fall­out if it was left un­touched.

The bill will un­dergo surgery when se­na­tors start to work on it, and there­fore the fu­ture of the leg­is­la­tion re­mains un­cer­tain. Should the Se­nate pro­duce some­thing sig­nif­i­cantly dif­fer­ent, the president and con­gres­sional lead­ers will face the choice of try­ing to rec­on­cile the House and Se­nate ver­sions or try­ing to jam the Se­nate bill through the House. The po­lit­i­cal cal­cu­lus could ar­gue for brute force. There’s still no guar­an­tee of fi­nal pas­sage of a health-care bill to re­vise the Af­ford­able Care Act.

All that is left to play out. No mat­ter the ul­ti­mate outcome, how­ever, House mem­bers have taken a fate­ful vote. There’s no cur­rent pub­lic polling about the bill that was ap­proved Thurs­day. What was known about the first ver­sion of the bill, the one that couldn’t muster the votes to pass, was not en­cour­ag­ing for any Repub­li­can look­ing at a re­elec­tion cam­paign. Fewer than 1 in 5 Amer­i­cans said they liked the ear­lier ver­sion. The more peo­ple knew, they more in­tensely they dis­liked it.

Few peo­ple out­side the House fully un­der­stand the fine print of the new bill, and it’s likely many in the House aren’t to­tally flu­ent on its con­tents ei­ther. The Con­gres­sional Bud­get Of­fice anal­y­sis of the ear­lier ver­sion high­lighted the fact that, a decade from now, it would re­sult in 24 mil­lion fewer peo­ple with health-care cov­er­age than un­der the cur­rent Af­ford­able Care Act. The House voted be­fore the CBO is­sued its anal­y­sis of the re­vised bill, but some House Repub­li­cans are al­ready at­tempt­ing to de­bunk those un­known find­ings, as they did with the ear­lier CBO anal­y­sis.

The president was an en­er­getic cheer­leader in the ef­fort to round up House votes and pro­mote the bill, but he was hardly at­tuned to the de­tails. He made state­ments on Thurs­day that he might re­gret. He said Oba­macare is now dead. He said the House bill would re­duce the cost of pre­mi­ums and lower de­ductibles. Some peo­ple would see their pre­mi­ums re­duced un­der the House bill, ac­cord­ing to the CBO — mostly younger peo­ple. Older Amer­i­cans face higher pre­mi­ums. They are part of the president’s con­stituency. That’s the im­pact a decade from now. Over the shorter term, the CBO has said the changes en­vi­sioned in the House bill would in­crease pre­mi­ums more than un­der Oba­macare.

Long be­fore the fi­nal act plays out in Congress, the po­lit­i­cal fight over health care is in full force. The 2018 midterms will mark one more elec­tion in which health care plays a cen­tral role, as it did in 2010, 2014 and 2016. Those elec­tions proved suc­cess­ful for Repub­li­cans, who made at­tacks on the Af­ford­able Care Act a cen­ter­piece of their cam­paigns. (President Barack Obama al­ways ar­gued that the loss of the House in 2010 had more to do with high un­em­ploy­ment than with the health-care bill.)

The House vote had an in­stant im­pact on po­lit­i­cal fore­casts. On Fri­day morn­ing, the Cook Po­lit­i­cal Re­port shifted rat­ings on 20 House races — all to the detri­ment of the Repub­li­cans. The changes now put two dozen Repub­li­can seats in the com­pet­i­tive cat­e­gory, in­clud­ing one marked as lean­ing to the Democrats.

The rat­ings shifts should be read with sev­eral caveats:

First, th­ese elec­tions are 18 months away, so pre­dict­ing the fu­ture is risky.

Sec­ond, Democrats haven’t ex­actly got­ten their own house in or­der: The an­tics of House Democrats mock­ing their Repub­li­can coun­ter­parts dur­ing Thurs­day’s vote was as pre­ma­ture a dec­la­ra­tion of vic­tory as what took place in the Rose Gar­den later that day.

Third, the state of the econ­omy will in­flu­ence vot­ers’ de­ci­sions.

Still, take the chang­ing fore­casts as an early warn­ing sig­nal for the Repub­li­cans. They are an im­me­di­ate in­di­ca­tor that what House Repub­li­cans did Thurs­day adds to the bur­dens of be­ing the party that holds the White House dur­ing a midterm elec­tion. It is also a view of the pol­i­tics of the House vote that is shared by any num­ber of Repub­li­cans.

The House vote prob­a­bly will con­trib­ute to an al­ready-ex­ist­ing en­thu­si­asm gap be­tween Democrats and Repub­li­cans, one that’s been on dis­play since In­au­gu­ra­tion Day. Trump’s base re­mains sup­port­ive of the president, but there’s lit­tle dis­pute that the Demo­cratic base is more en­er­gized than the Repub­li­can base.

Pas­sage of Oba­macare in 2010 en­er­gized Repub­li­can op­po­nents far more than it en­er­gized Demo­cratic sup­port­ers, but Democrats be­lieve Repub­li­cans will carry an added dis­ad­van­tage this time. Though Oba­macare sharply di­vided the pub­lic, spe­cific pro­vi­sions, such as al­low­ing chil­dren to stay on their par­ents’ plan un­til age 26 and the pro­hi­bi­tion on deny­ing cov­er­age for peo­ple with pre­ex­ist­ing con­di­tions, were rel­a­tively pop­u­lar. Key pro­vi­sions of the Repub­li­can bill have been judged neg­a­tively, in­clud­ing the new change that would let states ap­ply for waivers to loosen the re­quire­ments for cov­er­ing peo­ple with pre­ex­ist­ing con­di­tions.

For Repub­li­cans in swing dis­tricts, the House vote rep­re­sents a po­ten­tially big prob­lem if en­ergy is on the side of the Democrats. Of the 23 Repub­li­cans who sit in dis­tricts won by Hil­lary Clin­ton last Novem­ber, nine voted against the House bill and 14 voted in fa­vor of it. Of those nine, one Repub­li­can — Florida’s Ileana Ros-Le­hti­nen — al­ready has an­nounced her re­tire­ment, and Democrats see her seat as a prime pickup op­por­tu­nity. Whether those neg­a­tive votes will pro­vide some pro­tec­tion for the re­main­ing eight House mem­bers who run for re­elec­tion is an­other ques­tion.

That there are prob­lems with Oba­macare is no longer in dis­pute; the law needs fix­ing. In­sur­ance com­pa­nies con­tinue to with­draw from the ex­changes or are threat­en­ing to do so in coun­ties and in some states, in part be­cause of fi­nan­cial losses and in part be­cause of grow­ing un­cer­tainty about fu­ture rules and reg­u­la­tions.

The House has now spo­ken, con­tro­ver­sially, put­ting mem­bers at risk. It will be up to the Se­nate to find a safer path.


House Speaker Paul D. Ryan (R-Wis.) hugs Vice President Pence in the White House Rose Gar­den on Thurs­day after the House pushed through the Amer­i­can Health Care Act, send­ing it to the Se­nate.

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