If Ryan Pushes Through His Plans To Wreck The Health Care System, The GOP Will Lose Over Two Dozen House Seats In 2018

The closest Blue America ever came to actually endorsing a Republican was in 2012 when thoughtful Libertarian Justin Amash was the GOP candidate against rot-gut conservative hack, Steve Pestka, an anti-Choice crackpot and vicious homophobe. Michigan's local anti-Choice organization endorsed Pestka over Amash. We didn't exactly endorse Amash, but we told our Michigan members to consider him.

If I had to guess which of them voted for Trump last month in the secrecy of the voting booth, it wouldn't be Amash. Friday Amash told a reporter from The Hill that he doesn't think Trump has an understanding of the Constitution-- if he's even ever bothered to read it. "He seems to believe that government works like a business and he is the CEO of the business, and that is not how it works. We have separate branches, checks and balances, federalism. I don’t think it’s out of any bad intention. I think he just views the job in a sort of  'extra-constitutional' way, outside of the Constitution. I don’t think our framework in this country really comes into play when he’s thinking about how the job should operate." Smash has attacked Trump for appointing Jeff Sessions Attorney General and for strip U.S. citizenship from anyone who burns a flag, and has been one of his harshest Republicans critics about Trump's obvious and glaring conflicts of interest and about Trump's crony capitalism approach to Carrier. "It’s cronyism. We have a Constitution. The president doesn’t just get to do anything he wants. He has to work within the constitutional framework, regardless of why people elected him. And deals like that hurt the people of Indiana; they don’t help the people of Indiana. They redistribute resources and offer benefits to one company when another company down the road doesn’t get those same benefits. Sometimes competitors don’t get those same benefits. That’s just central planning. That was tried in the Soviet Union. It didn’t work very well... My job [on the House Oversight Committee] is to uphold the Constitution, follow the rule of law and represent all my constituents. I think we should treat [Trump] the same way we treat any president. That means we need to make sure there are no conflicts of interest, just like we would do if Hillary Clinton had won.If we were going to look at the issues for Hillary Clinton, then we should also look at them for Donald Trump. I just think the same standard should apply."

Amash founded the House Freedom Caucus and progressives disagree with him on almost everything. But not everything. When it comes to health care, though, Amash is plain old GOP bad news. There are a few Republicans who understand that destroying Obamacare-- let alone Medicare-- is extremely harmful to America... and to the GOP. Sarah Ferris and Scott Wong reported Friday about a handful of mainstream conservative Republicans who are getting nervous with Ryan's, Pence's and Price's stated intention of dismantling the social safety net. The ones who are nervous aren't the extremists in the South whose constituents are too stupid to understand what's about to happen to them but Republicans in swing districts primarily in the suburbs.

The repeal and not-replace plan that Ryan and his team are hellbent on passing is freaking out Charlie Dent (R-PA), Ryan Costello (R-PA) and John Katko (R-NY), who will be the first to go in a 2018 wave election in the GOP actually dismantles Medicare.

One lawmaker said the moderates were “getting skittish” about leadership’s plan to replace the sprawling healthcare law within about a year of Trump’s inauguration, which they said would run too close to the 2018 midterms.

“It’s going to be technical, all the insurance stuff. It’s hard work, putting that in play. But that’s the beginning of the next election cycle,” the lawmaker said.

GOP leaders in the House and Senate are aiming to pass legislation dismantling most parts of ObamaCare using a budget tactic called reconciliation in Trump’s first 100 days. The tactic would allow legislation to be approved in the Senate to avoid procedural vote filibusters.

Top lawmakers have acknowledged it would not go into effect immediately because Congress needs a transition period to pass a replacement. But that plan has spurred an intra-party battle among some conservative lawmakers and groups that argue it should be repealed immediately.

Speaker Paul Ryan (R-WI) spent much of Friday morning’s meeting outlining the broad logistics for the legislatively difficult move to repeal the law, which would require close coordination with the Senate.

Ryan confirmed that using reconciliation to repeal ObamaCare would be one of the chamber’s first acts in the new Congress, according to a readout of the meeting.

Another lawmaker in the room, Rep. Tim Murphy (R-PA), said he believed there was an appetite for spending more time on working to replace the law.

“This whole process will be done thoughtfully. We do not want to move in haste,” said Murphy, who is vying to lead the health subpanel of the Energy and Commerce Committee next year. “Just as a surgeon does not jump to surgery without doing a proper diagnosis with x-rays, the same thing here.”

The repeal-and-delay strategy-- which has gained traction since Trump’s election-- will also require a separate strategy to replace the law. It will likely involve cooperation from Senate Democrats, which could drag out the replacement process.

“We know we can do a lot of repeal through reconciliation but you can’t do replace through reconciliation,” said Rep. Tom Cole (R-Okla.), a member of the House Budget Committee.

He said working with Democrats on a replacement would be one of GOP’s toughest issues: “There will be a lot of drama with this over the next year.”

The NY Times explained it this way on Friday: "Republicans in Congress plan to move almost immediately next month to repeal the Affordable Care Act, as President-elect Donald J. Trump promised. But they also are likely to delay the effective date so that they have several years to phase out President Obama’s signature achievement... [There's] a growing recognition that replacing the health care law will be technically complicated and could be politically explosive."

There are 20 million people who have coverage now and many of them are Trump voters-- and Trump has said there are parts of Obamacare that he doesn't want to see fall by the wayside, expensive benefits that Republicans have no idea how to pay for. The Republicans want to make sure nothing substantive happens to cause anyone to lose any benefits before the 2018 midterms.

“We are not going to rip health care away from Americans,” said Representative Kevin Brady, Republican of Texas and chairman of the Ways and Means Committee, which shares jurisdiction over health care. “We will have a transition period so Congress can develop the right policies and the American people can have time to look for better health care options.”

Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate health committee, said: “I imagine this will take several years to completely make that sort of transition-- to make sure we do no harm, create a good health care system that everyone has access to, and that we repeal the parts of Obamacare that need to be repealed.”

But health policy experts suggest “repeal and delay” would be extremely damaging to a health care system already on edge.

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

Details of the strategy are in flux, and there are disagreements among Republicans about how to proceed. In the House, the emerging plan, tightly coordinated between Mr. Ryan and Mr. Pence, is meant to give Mr. Trump’s supporters the repeal of the health law that he repeatedly promised at rallies. It would also give Republicans time to try to assure consumers and the health industry that they will not instantly upend the health insurance market, and to pressure some Democrats to support a Republican alternative.

“I don’t think you have to wait,” Representative Kevin McCarthy of California, the majority leader, told reporters this week. “I would move through and repeal and then go to work on replacing. I think once it’s repealed, you will have hopefully fewer people playing politics, and everybody coming to the table to find the best policy.”

Under the plan discussed this week, Republicans said, repeal will be on a fast track. They hope to move forward in January or February with a budget blueprint using so-called reconciliation instructions, which would allow parts of the health care law to be dismembered with a simple majority vote, denying Senate Democrats the chance to filibuster. They would follow up with legislation similar to a bill vetoed in January, which would have repealed the tax penalties for people who go without insurance and the penalties for larger employers who fail to offer coverage.

That bill would also have eliminated federal insurance subsidies, ended federal spending for the expansion of Medicaid, and barred federal payments to Planned Parenthood clinics.

But in the Senate, Republicans would need support from some Democrats if they are to replace the Affordable Care Act.

The budget reconciliation rules that would allow Republicans to dismantle the Affordable Care Act have strict limits. The rules are primarily intended to protect legislation that affects spending or revenues. The health law includes insurance market standards and other policies that do not directly affect the budget, and Senate Republicans would, in many cases, need 60 votes to change such provisions.

Repealing the funding mechanisms but leaving in place the regulations risks a meltdown of the individual insurance market. Insurers could not deny coverage, but they would not get as many healthy new customers as they were expecting. Hospitals would again face many uninsured patients in their emergency rooms, without the extra Medicaid money they have been expecting.

Even a delay of two to three years could be damaging. Health policy experts said the uncertainty could destabilize markets, unnerving insurers that have already lost hundreds of millions of dollars on policies sold in insurance exchanges under the Affordable Care Act.

“Insurers would like clarity on the shape of the replacement plan to continue participating on exchanges if Obamacare is repealed,” Ana Gupte, an analyst at Leerink Partners who follows the insurance industry, said Friday.

Republicans are hoping that Mr. Trump will be able to use his bully pulpit to lean on vulnerable Democrats up for re-election in states Mr. Trump won, such as Senators Joe Manchin III of West Virginia and Jon Tester of Montana.

...“If they are looking at fixing what’s there, I’ve been wanting to work with Republicans for years now,” said Mr. Tester, whose state cast just 36 percent of its vote for Hillary Clinton. “But if they are going to take away provisions like pre-existing conditions, lifetime caps, 26-year-olds, I think they are barking up the wrong tree.”

And some moderate Republicans see peril in repealing first and replacing later, favoring instead a simultaneous replacement to ensure a smooth transition.

“We are firing live rounds this time,” Representative Charlie Dent, Republican of Pennsylvania, said. “If we repeal under reconciliation, we have to replace it under normal processes, and does anyone believe that the Senate Democrats, with their gentle tender mercies will help us?”

Republicans said they would work with the Trump administration on replacement legislation that would draw on comprehensive plans drafted by Mr. Ryan and Representative Tom Price, the Georgia Republican picked by Mr. Trump to be his secretary of health and human services.

Any legislation is likely to include elements on which Republicans generally agree: tax credits for health insurance; new incentives for health savings accounts; subsidies for state high-risk pools, to help people who could not otherwise obtain insurance; authority for sales of insurance across state lines; and some protection for people with pre-existing conditions who have maintained continuous coverage.

Republicans said they hoped that the certainty of repeal would increase pressure on Democrats to sign on to some of these ideas.

Democratic leaders, for now, feel no such pressure. Republicans “are going to have an awfully hard time” if they try to repeal the health law without proposing a replacement, said Senator Chuck Schumer of New York, the next Democratic leader. “There would be consequences for so many millions of people.”

And consequences for plenty of Republican legislators. Leaving out the likelihood that the DCCC will continue recruiting unelectable conservative candidates, there are at least two dozen districts that plausible progressive Democrats could flip in 2018 if Ryan decides to push what he's threatening and the Senate goes along. If the DCCC miraculously ceased to exist, these are all seats that could fall to the Democrats immediately-- and win back the majority:

• CA-49- Darrell Issa- 50.3%
• NY-24- John Katko- 61.0%
• CA-25- Steve Knight- 54.2%
• CA-10- Jeff Denham- 52.4%
• NY-19- John Faso- 54.7%
• CO-06- Mike Coffman- 51.3%
• IL-12- Mike Bost- 54.3%
• NY-22- Claudia Tenney- 47.0%
• TX-23- Will Hurd- 48.5%
• ME-02- Bruce Poliquin- 54.9%
• IA-01- Rod Blum- 53.9%
• VA-10- Barbara Comstock- 52.9%
• PA-07- Pat Meehan- 59.7%
• CA-21- David Valadao- 58.0%
• MN-02- Jason Lewis- 47.0%
• IA-03- David Young- 53.5%
• NJ-03- Tom MacArthur- 59.5%
• PA-08- Brian Fitzpatrick- 54.5%
• NY-01- Lee Zeldin- 52.5%
• NJ-02- Frank LoBiondo- 59.4%
• PA-06- Ryan Costello- 57.3%
• FL-26- Carlos Curbelo- 53.0%
• MI-11- Dave Trott- 52.9%
• FL-27- Ileana Ros-Lehtinen- 54.9%
• WA-08- Dave Reichert- 60.0%
• IL-13- Rodney Davis- 59.7%
• NE-02- Don Bacon- 49.4%
• PA-15- Charlie Dent- 58.4%
• MN-03- Erik Paulson- 56.9%
• NY-02- Peter King- 62.4%
• NC-02- George Holding- 56.7%
• AZ-02- Martha McSally- 56.7%
• WI-07- Sean Duffy- 61.8%
• WI-08- Mike Gallagher- 62.7%
• TX-21- Lamar Smith- 57.0%
• WI-01- Paul Ryan- 65.0%

Blue America is just getting started-- recruiting candidates and working on strategies to help win back the House. We have several candidates who are planning to run and one-- Doug Applegate-- who came within just a fraction of a percent of beating the odious Darrell Issa last month-- already running. Please consider contributing to Doug's campaign here on our 2018 Blue America page. Remember any of this? Keep this video for when Ryan and Price get going: