5 reasons health care bill would fail, 3 reasons it may not

Monday, July 24, 2017
Senate Majority Leader Mitch McConnell of Kentucky speaks at a news conference last week on Capitol Hill in Washington. There are many reasons the Senate will probably reject Republicans' crowning bill razing much of "Obamacare." There are fewer why McConnell might revive it and avert a GOP humiliation.
Andrew Harnik ~ Associated Press

WASHINGTON -- There are many reasons the Senate probably will reject Republicans' crowning bill razing much of former president Barack Obama's health-care law. There are fewer reasons Senate Majority Leader Mitch McConnell might revive it and avert a GOP humiliation.

Leaders said the Senate will vote Tuesday on their health-care legislation. They've postponed votes twice because too many Republicans were poised to vote no. That could happen again.

The latest bill by McConnell, R-Ky. -- and it could change anew -- would end penalties Democrat Obama's health-care law slapped on people without insurance and on larger companies not offering coverage to workers.

It would erase requirements insurers cover specified medical services, cut the Medicaid health-insurance program for the poor and shrink subsidies for many consumers.

IF IT FAILS Awful poll numbers

In an Associated Press-NORC Center for Public Affairs Research poll this month, 51 percent supported Obama's statute, while just 22 percent backed GOP legislation.

Perhaps more ominously for Republicans, the AP-NORC poll found by a 25-percentage-point margin, most think it's the federal government's responsibility to ensure all Americans have coverage.

That's a growing view -- there was just a 5-percentage-point gap in March. It underscores a harsh reality for the GOP: It's hard to strip benefits from voters.

Awful CBO numbers

The nonpartisan Congressional Budget Office said under McConnell's plan, 22 million more people would be uninsured by 2026, mostly Medicaid recipients and people buying private policies.

For single people, the typical deductible -- out-of-pocket expenses before insurance defrays costs -- would balloon that year to $13,000, up from $5,000 under Obama's law.

Note to the entire House and one-third of the Senate, which face re-election in 2018: 15 million would become uninsured next year. And though CBO said average premiums should fall in 2020, they'll rise in 2018 and 2019.

The bill would let insurers charge people approaching retirement age higher prices than they can now, boosting premiums "for most older people," CBO said.

Older people like to vote.

Awful Senate numbers

With a 52-48 GOP majority, the bill would survive if no more than two Republicans oppose it. With the indefinite absence of the cancer-stricken Sen. John McCain, R-Ariz., McConnell's margin of error shrinks to one.

At least a dozen senators have expressed opposition to the legislation or were noncommittal. Lawmakers and aides said others haven't surfaced publicly.

Moderate senators from states with vast Medicaid populations want to protect those voters. Conservatives consider it their mission to eliminate the law they've campaigned on abolishing for years. These aren't easily resolved disputes.

Presidential drag

President Donald Trump wants "Obamacare" repealed.

He also has public approval ratings below 40 percent -- Bad! -- and a propensity for turning on people. Just ask House Speaker Paul Ryan, R-Wis., and Attorney General Jeff Sessions.

After Ryan labored for months before the House approved its health-care bill and earned a Rose Garden celebration, Trump called the measure "mean." Trump said he wouldn't have picked Sessions for his job had he known he'd recuse himself from investigations into Russian meddling in last year's campaign.

Some lawmakers might not be blamed for declining to carry Trump's water.

Lemons to lemonade

The bill's rejection still would let lawmakers cast votes showing their positions. Supporters could say they honored their repeal "Obamacare" pledges; foes could say they protected their states or adhered to conservative principles.

Defeat would let the Senate refocus on tax cuts or other initiatives, though it's unclear what major issues don't divide Republicans.

A loss means there won't be a GOP law voters might blame for health-care problems they encounter, though Republicans may own the issue in the public's eye because they run the government.

IF IT PASSES The unthinkable

This isn't happening, right? Republicans have run on repealing "Obamacare" for years.

The administration won't let the effort fail without a fight.

Trump lunched with senators at the White House last week and tweeted Republicans "MUST keep their promise to America!"

On Friday, Vice President Mike Pence urged leaders of conservative, anti-abortion and business groups to pressure senators. Medicaid administrator Seema Verma has tried luring senators unhappy with Medicaid cuts, including Ohio's Rob Portman and West Virginia's Shelley Moore Capito, with more flexibility for governors to use Medicaid funds to help pay expenses for beneficiaries shifting to private insurance.


The health bill's floundering has tarnished McConnell's reputation as a legislative mastermind. Many Republicans privately said if the votes were gettable, he'd have gotten them already.

But the 33-year Senate veteran is wily and doesn't want his record stained with this failure. He understands what GOP senators need and has time. If anyone can rescue the legislation, he can.

Trump factor

GOP senators cross Trump at their own peril. Eight in 10 Republicans still rate him favorably. In the 2018 midterm elections, when turnout traditionally is down, those loyal voters could make a difference.

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