Are The House Republicans Drowning In Healthcare Quicksand?

The third-ranking Republican in the House, Majority Whip Steve Scalise (R-LA) is responsible for running a team that counts votes for Ryan and McCarthy. When Ryan releases a trial balloon-- like, say, the Obamacare replacement plan he "leaked" last week-- it's up to Scalise to find out if there are enough votes inside the Republican conference for them to introduce it without having to go make deals with pesky New Dems and Blue Dogs. The largest group of right-wing Republicans in the conference-- 170 members-- is the Republican Study Committee and this week their chairman, Mark Walker (R-NC), gave the plan a big thumbs down, as did fellow Noth Carolina wing-nut, Mark Meadows, chairman of a smaller but more effective far right grouping, the Freedom Caucus. Opposition from the Republican Study Committee would instantly end Ryan's repeal and replace plan. Opposition from the Freedom Caucus could be countered by making a deal with Jim Himes' right-wing New Dems, the Republican wing of the Democratic Party, who are often easier for Ryan and McCarthy to deal with than the ideologues at the Freedom Caucus. The New Dems are all about corruption and are easily bought off, while the Freedom Caucus has very extreme positions that make it impossible for more mainstream conservatives to support their demands.

So... Scalise now says the leaked draft is old and no longer operative and everyone should just forget it until there's a new draft Ryan, Tom Price, Mike Pence and whomever are working on with Walker. Walker-- and many other Republicans-- hate the plan's dependence on the refundable tax credits Trump was extolling in his address to Congress Tuesday evening. They call it "an entitlement program" and worry it will make it too easy for too many non-white people to get health insurance. Ryan, and presumably Price, insist that the refundable tax credits are necessary for the "replace" part of "repeal and replace" to work in the real world.

Wednesday morning, Jennifer Haberkorn, writing for Politico, reported that the extremists in the conference don't give a damn about what Trump read from his teleprompter Tuesday night. There is no common ground among congressional Republicans on the most basic questions of how to do this-- "how much to spend to reshape the health system, how much financial help to give Americans to buy insurance and how to come up with the money to pay for it all."

Many Republicans agree that Americans should get some help with buying health insurance-- an alternative to Obamacare’s subsidies. But conservatives are somewhat skeptical, warning that they won’t support tax credits for recipients that could become a “new entitlement.” The leaders of two House conservative groups-- Republican Study Committee and House Freedom Caucus-- on Monday said they wouldn’t support the repeal legislation because of its refundable tax credits, which they liken to a new entitlement.

“It kicks the can down the road in the hope that a future Congress will have the political will and fiscal discipline to reduce spending that this Congress apparently lacks,” Republican Study Committee Chairman Rep. Mark Walker (R-N.C.) said. “Worse still the bill contains what increasingly appears to be a new health insurance entitlement with a Republican stamp on it.”

Republicans have to resolve several critical questions that will have a big effect on the price tag of a repeal-replace bill. One area where the GOP has to find consensus is how many Obamacare taxes to repeal. After initially saying all the taxes should go, some Republicans now think they should be retained, if only partially, to help cover the cost of the GOP replacement.

An even more controversial way to pay for the bill is the proposal from House leaders to cap the tax credit that employers get for providing health insurance to their employees. The policy is considered an alternative to Obamacare’s Cadillac tax on high-cost health insurance plans. Both are hated by employers and unions.

Those who want to cap the tax break say that the idea of tying health insurance to a job is a World War II-era relic that no longer makes sense in a mobile economy. But even they admit it is politically unpopular.

“The idea of changing, that makes sense,” said Rep. Mark Sanford (R-S.C.). “The question of having some cap at $30,000 and anything above that is in essence a de facto tax increase, is something that’s probably going to give a lot of Republicans pause.”

Republicans want to dramatically overhaul the Medicaid entitlement by giving states a fixed amount of money tied to the number of residents enrolled. But first, they have to prevent a food fight between the states that expanded Medicaid under Obamacare, a mix of Democratic- and Republican-led states, and those that held out, a group consisting of almost entirely red states.

The states that didn’t expand their Medicaid programs are poised to get significantly less money than the states that did opt in. Republicans are now figuring out how to make sure they’re not financially punished for rebuffing Obamacare.

“We’re going to have to find a solution that accommodates each of these two concerns,” House Speaker Paul Ryan said before the Presidents Day break.

The House is considering setting up special funds for the uninsured, which would provide a boost to the non-expansion states. But any governor that feels slighted is sure to make noise during the legislative debate over the bill.

And even if Ryan, McCarthy, Scalise and Team Trump manage to get whatever concoction they eventually come up with, through the House, the Senate has its own considerations, including a lack of gerrymandered all red districts. Senators can actually lose their seats for throwing too many people off their health care. Lisa Murkowski (R-AK) already told her state's legislature that she won't vote for a House bill that rolls back Medicaid expansion (which they voted for) or that defunds Planned Parenthood, where lots of Alaskan women get their healthcare.

If Susan Collins (ME) and Dean Heller (NV) feel the House bill is too extreme, especially now that Obamacare is polling higher than ever before, they could join Murkowski and that's the end of that-- unless Trump can "make a deal" with a Manchin or Heitkamp. And every day that Ryan and Pence and Price and the rest of them run around like chickens without heads trying to piece something together, is a day closer to the 2018 midterms, which is significant in two ways. First, it will frighten Republicans in more mainstream districts that if they do something extreme they could lose their reelection bids and, second, there's every chance in the world that after the midterms, the Democrats will be back in control of the House, working on serious legislation to actually make the Affordable Care Act work better for ordinary Americans.

Late Wednesday Bloomberg Politics reported that Ryan has a new bill but it's under lock and key-- top secret. Apparently the GOP leadership doesn't want any public input from their own peanut gallery-- let alone the general public. "The document is being treated a bit like a top-secret surveillance intercept. It is expected to be available to members and staffers on the House Energy and Commerce panel starting Thursday, but only in a dedicated reading room, one Republican lawmaker and a committee aide said. Nobody will be given copies to take with them." And when they say "members," they mean only Republican members. Frequent leakers on the committee include staff members who work for Ryan Costello (R-PA), Adam Kinzinger (R-IL), David McKinley (R-WV), Leonard Lance (R-NJ) and Tim Walberg (R-MI). Crackpot Trumpist and committee member Chris Collins (R-NY) challenged any of his colleagues to dare leak it when they see it today. "Unfortunately for you," he hissed at reporters, "we’re making sure it won’t be leaked." Gus Bilirakis, the Florida nutcase who has been boo-ed and jeered at almost every town in his Florida district, added smugly, "We’re not having a hearing or anything." Paul Ryan went on Today to mislead people, claiming "We’re not hatching some bill in a backroom and plopping it on the American people’s front door," which is exactly what they are doing.