Will TrumpCare Turn Arizona Purple in 2018?

On crucial votes, Arizona conservaDem Kyrsten Sinema votes with the GOP far more than with the Democrats. The worst political coward in the entire House her repulsive political career has been one of switching parties and positions the way a normal person changes socks. She started as an independent socialist, became a Green, then a Democrat, a New Dem and finally the bottom of the barrel: Blue Dog. She loves telling people she didn't vote for Nancy Pelosi as speaker. Although her crucial vote score for the 115th Congress is a ZERO-- the only Democrat in Congress with a ZERO at this point-- her lifetime crucial vote score, 35.75, is the lowest of any Democrat in the House except fellow Arizona Blue Dog, Tom O'Halleran, a former Republican state legislator who switched parties for the sake of his own career path-- and he's only been in Congress for 3 months. Taking her very blue district into account, she has the lowest "F" of any Democrat in the House. When Ryan or McCarthy wants to be able to tell the press some especially hideous piece of legislation pummeling working families is "bipartisan"... well, that's why they have Sinema on speed-dial.

So if there was going to be even one Democrat to get on board with TrumpCare, everyone assumed it would be Sinema. So far, though, she's not embracing it-- even worse news for Ryan than conservatives like Rob Wittman, Ted Yoho and Justin Amash announcing that they're NO votes. Sunday, the Arizona Republican did an exhaustive look at the state's whole congressional delegation and didn't find much Ryan could be optimistic about-- and that was before the devastating CBO report showing 24 million people losing health insurance over the course of the next decade, 14 million in just the first dreadful year (2018, the year of the midterm elections). Before we go any further though, let me offer a district by district look of how many people are projected to lose coverage if TrumpCare is ever enacted. Statewide that would be 6,828,065, 7.6% of Arizona's total population. Here's the district breakdown, which is far more devastating for rural districts than it is for metropolitan districts:

• AZ-01 (Tom O'Halleran-Blue Dog)- 110,494- 14.5%
• AZ-02 (Martha McSally-R)- 41,011- 5.7%
• AZ-03 (Raul Grijalva-D)- 80,271- 10.5%
• AZ-04 (Paul Gosar-R)- 71,468- 9.7%
• AZ-05 (Andy Biggs-R)- 42,614- 5.4%
• AZ-06 (David Schweikert- R)- 42,614- 5.7%
• AZ-07 (Ruben Gallego-D)- 42,614- 5.5%
• AZ-08 (Trent Franks-R)- 42,614- 5.5%
• AZ-09 (Sinema-Blue Dog)- 42,614- 5.5%

Ron Hansen and Dan Nowicki at the Republican noted that "After years of calling for the dismantling of 'Obamacare,' many Republicans have come to a stark realization. It might be all but impossible, politically, to do so while ignoring how it extended coverage to millions of uninsured Americans." Conservative are in a real quandary. Four of the state's five Republicans in the House and both Arizona senators publicly withheld support, while three of the four House Democrats-- the worthless Sinema is staying mum to make sure which way the wind is blowing before she says anything-- made clear they absolutely oppose Ryan’s TrumpCare plan.

"If Republicans have accepted that everybody with pre-existing conditions are covered, that kind of dictates a lot of what you can and can't do," Sen. Jeff Flake, R-Ariz., said, citing one of the key tenets of President Barack Obama's signature 2010 health law.

"The debate has moved, certainly, from where it was seven years ago."

Sen. John McCain, R-Ariz., who attacked Affordable Care Act problems during his 2016 re-election campaign, said demands to just repeal the law are not feasible without a responsible replacement.

"We cannot abandon any group of Americans who have become accustomed to receiving health care," McCain told the Arizona Republic. "The question is how do you maintain it as affordable."

Not all in their party agree, which became evident when House Republicans unveiled their Affordable Care Act repeal bill last week to mixed reviews. Conservative GOP lawmakers were among the harshest critics, noting the plan is similar in structure to the ACA and dismissing it as "Obamacare Lite" or “RINOcare,” using the acronym for "Republican In Name Only."

Arizona's congressional delegation highlights how the situation has lawmakers off balance as President Donald Trump's first high-stakes legislative battle takes shape. Not only must they consider that opposing the plan would put them at odds with the president-- and his Twitter account-- but also with significant interest groups and donors who fund their campaigns, as well as their leaders in Congress, who can yield significant influence over their career path on Capitol Hill.

...With four members, Arizona has an outsized presence in the Freedom Caucus, a group of 40 or more Republicans whose hard line on spending in the past has pushed the federal government to the brink of a shutdown. Only one of them, Rep. David Schweikert, offered support for the GOP plan.

He followed leadership and voted Thursday to move the bill out of the powerful Ways and Means Committee, of which he is a member.

But members of the Freedom Caucus made it clear the proposal falls well short of their desire to scrap the ACA and create a market-driven system.

In a written statement, Biggs said, "The health care package ... is an amendment-- and not a clean repeal-- to Obamacare. ... I campaigned on a clean repeal to Obamacare and a free-market, patient-centered alternative to truly lower the costs of insurance premiums, and I intend to work with my colleagues in the House to ensure that Americans have affordable and accessible health care options."

Gosar rode the anti-Obamacare wave of 2010 to Washington. He has frequently cited his experience with the health-care system as a dentist to savage the ACA.

After being pressed by Majority Whip Steve Scalise, R-La., to side with Trump or Minority Leader Nancy, D-Calif., Gosar bristled.

“My folks out in rural Arizona, they don’t have much choices. It’s too expensive for them to afford,” Gosar told The Hill. “So all of a sudden you’re going to see a very captive audience being driven from that competitive marketplace. And that’s why to me everything is all about recreating that competitive market.”

A Gosar spokesman on Friday clarified that Gosar feels House Republican leaders and Trump are making an effort to listen to their concerns.

Rep. Trent Franks, also a Freedom Caucus member, was silent on the GOP plan last week. His spokeswoman did not respond to requests for comment on the issue.

Whatever Franks doesn't like about the plan, he is likely pleased it would defund Planned Parenthood, the health-services organization reviled by many conservatives because it provides abortions. Franks has made his opposition to abortion a central pillar of his tenure in Congress.

These days, Flake is feeling the most political heat. He faces his first re-election test as a senator next year.

Flake memorably got crosswise with Trump during last year's campaign, earning the ire of the president's supporters. Other Republicans are sizing up their chances for a possible challenge.

As a member of the House, Flake, whom the Club for Growth also supported in past campaigns, voted against the Affordable Care Act in 2010.

Flake said he sees pros and cons with the House repeal bill.

"Finally dealing with Medicaid as one of the three entitlement programs that are simply unsustainable" is one of the good parts, Flake told the Republic. "This puts at least some parameters around it."

On the other side, Flake views the bill's refundable tax credits as more taxpayer subsidies.

"We'll see when CBO comes back how that scores, but it's still pretty expensive," Flake said, referring to the pending cost and coverage estimates by the Congressional Budget Office.

McSally, a Republican, and Sinema, a Democrat, both were guarded on the GOP plan last week. They are not fans of the ACA and both preside over districts that are considered competitive, though each was comfortably re-elected last year. Both are also routinely mentioned as contenders for statewide office someday.

A spokesman for McSally said she is "encouraged" the GOP plan includes the provisions of the ACA she likes and noted she is "carefully reading the 123-page bill, listening to local stakeholders and in the days ahead will work with House leadership for a viable solution" to the nation's health care challenges.

In an interview last month, she tried to frame the issue as one of structure, not ideology.

"Can we agree that we’re on the same page and trying to get to the same outcome and we disagree on how to get there? It’s not like we don’t have the same goals, which is people can get access to health care," she said.

McSally has called for a system where "people can have choice and options, and people with pre-existing conditions are not one diagnosis away from going bankrupt."

For her part, Sinema rejected the race to pass the GOP bill without knowing its cost and how many people would be covered.

"I've been very, very critical of the ACA, but I do believe that if you are going to repeal it, you have to have a thoughtful replacement that ensures affordability and accessibility," she said in an interview before the Republican plan was released. "I'm very practical and I have no ideology connected to the solution here. ... I don’t have any predetermined have-to's on a list."

While McSally and Sinema held back their views, Rep. Tom O’Halleran, D-Ariz., who won the state’s closest congressional race last November, did not.

"This plan is neither affordable nor does it provide quality care for the vast majority of Arizona families," O'Halleran said.

The ACA has outsized importance in his district because it permanently authorized Indian Health Services.

Reps. Ruben Gallego and Raul Grijalva, who represent safe Democratic districts, have acknowledged changes are needed to the ACA. But they have drawn the line against any changes that would cut coverage.

"I don't think it's enough to say no to Trump," Grijalva said. "You have to be able to tell your constituents there was a better alternative."

Having just won a new six-year term, McCain isn't feeling political pressure, either. But he does want to uphold his word to Arizona voters by fixing the problems created by the Affordable Care Act.

"The reality we're facing is that Obamacare is unraveling," McCain said. "In Arizona, we only have one provider and well over 100 percent inflation in premiums. Obamacare, as it is, is not sustainable, so we have to work to fix it."

McCain hasn't come to a conclusion about the House GOP repeal bill, but said it will face unlimited amendments when it comes to the Senate.

He said he won't go along with conservative efforts to force an outright repeal without a replacement program.

"That's not what I campaigned on. I said I would repeal and replace," McCain said. "If I went along with that, I would be contradicting what I told the people of Arizona when I was running for re-election. So when these individuals say just repeal it, that's not what we told the American people we would do."

The DCCC will likely follow their same failed strategy and target just one district: AZ-02 (Martha McSally), a swing district that Romney won narrowly in 2012 (49.9% to 48.4%) but that Trump lost more substantially last year-- 49.6% for Clinton and 44.7% for Señor Trumpanzee. The DCCC didn't lift a finger for moderate candidate Matt Heinz who went up against McSally's $7,826,194 warchest with just $1,576,119 and lost by 37,000 votes, 56.7% to 43.3%. Ryan's Congressional Leadership Fund PAC spent another $662,677 attacking Heinz and the DCCC and Pelosi's House Majority PAC just looked in the other direction, whistling Dixie. This year, the DCCC says they are targeting AZ-02 but there is, as yet. not announced candidate.

In fact, the only Arizona Republican with a Democratic opponent so far is Andy Biggs (AZ-05-- Mesa, Chandler, Gilbert and the suburbs east of Phoenix as far as Apache Junction and Queen Creek). The district is one of the reddest in the state (R+17) but Talia Fuentes, a progressive and a biologist, wants to take Biggs on again anyway. Although last November Trump didn't do nearly as well as Romney did in 2012, he still managed to beat Clinton 57.6% to 36.5%. Fuentes was crushed by Biggs (63.1% to 36.9%) who spent $946,069 to her $18,650. The Club for Growth spent an additional $572,149 bolstering Biggs while the DCCC, as usual, sat the race out. The Southwest Regional Council of Carpenters spent $29 to help Fuentes.