Benjamin Studebaker

Today a new, more conservative version of Trumpcare passed in the House, by a vote of 217-213. All the Democrats voted against it, with 20 Republican members defecting to join them. This might be concerning for some, but the changes the Republicans made to get the bill through the House will make it even harder for them to get a bloc of moderate Republican senators to cooperate with them.

We’ve talked about what Trumpcare does before. The CBO projected that 24 million would lose their insurance and Medicaid funding would receive a 25% cut. But this did not go far enough for some conservative Republicans. They withheld their votes and forced the House leadership to attach an amendment. Here are a few of the key things that amendment adds:

• Individual states would be permitted to lower the minimum standard of insurance provision required by the law.
• Individual states would be permitted to force citizens with pre-existing conditions into a high-risk pool. They would be required to offer some level of subsidy to those citizens, but the size of the subsidy is not specified, and it may not be enough to avoid significant price increases for this cohort.
• Whenever individual states ask for waivers allowing them to get around provisions of the bill, the default policy will be to grant those waivers unless the request is denied within 60 days.

This amendment made the bill significantly more agreeable to the conservative House “Freedom Caucus”. Unfortunately for Republicans (and fortunately for the millions of Americans who stand to be harmed by the bill either directly or indirectly), there are a number of moderate Republican senators who opposed the bill because of what it does to Medicaid, and those provisions have not been changed–largely because changing those provisions would have once again cost the bill the support of the Freedom Caucus.

There are four Republican senators who signed a group letter against it over the Medicaid provisions:

• Rob Portman (R-OH)
• Shelley Moore Capito (R-WV)
• Cory Gardner (R-CO)
• Lisa Murkowski (R-AK)

The Republicans intend to pass the bill through a budget reconciliation process, circumventing a filibuster. But with 48 senate Democrats expected to oppose the bill, only three of these four have to stand their ground for the bill to fail. They say:

…we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.

This plan does not include stability for Medicaid expansion populations.

In addition to these four, there’s also Susan Collins (R-ME), who has said she won’t support a bill that cuts funding to Planned Parenthood, which this bill does. She said:

Obviously, I’m not happy that the speaker has decided to include the defunding of Planned Parenthood – an extremely controversial issue – in the package. There is a group of House Republicans led by Rep. Charlie Dent (R-Pa.) who are opposed to the defunding of Planned Parenthood in the (budget reconciliation) bill, and I hope they will be successful in separating the two issues or knocking it out altogether.

Dent was unsuccessful, and he ended up voting against the bill in the House. Collins has also expressed opposition over the coverage figures:

My goal is to expand access to health care and have more individuals covered than in the ACA, and prevent the collapse of the ACA marketplace.

There are others. Bill Cassidy (R-LA) has talked about voting against the bill because it takes healthcare away from so many people:

That’s not what President Trump promised. That’s not what Republicans ran on.

He’s worked with Collins in the past on legislative alternatives to both Obamacare and Trumpcare.

Dean Heller (R-NV) has said he doesn’t like the Medicaid cuts. He’s the only Republican senator from a blue state facing re-election in 2018.

Then there’s Ron Johnson (R-WI) arguing that the bill is a giveaway to the rich:

Lower-income people get less, he said, “but we’re helping (higher-income) people that Obamacare never helped. Politically, it doesn’t make any sense. Economically, it doesn’t make any sense.

We have at least eight Republican senators who are on the record indicating a significant level of opposition to the bill in its current form. These are just the ones we know about. If just three of them stay true to their apparent principles, the bill dies, even without any further Republican defections.

538’s model, which predicts how frequently individual members of congress will vote with Trump, ranks Gardner, Collins, and Heller as more likely to oppose him than many senate Democrats. All three represent states that went blue in 2016. They would be enough by themselves.

If you think of the federal political system like a car, the House is the gas and the Senate is the brakes. Senators have to represent entire states, and their support bases are more ideologically diverse. Their electorates are less likely to forgive them for passing legislation which causes them harm. And boy, does this bill cause harm.

So while it’s always bad news when we hear that 217 members of congress are prepared to take healthcare from 24 million people and leave them to bankrupt themselves or die trying, this collection of senate moderates will probably keep them safely insured.