Despite near-universal predictions of doom — either now or later, on the House floor or in the Senate — the Trump administration is pushing House Republicans hard to schedule a vote next week on the latest version of Trumpcare, a.k.a. the American Health Care Act. The president’s claim that the the plan had “gotten really, really good … and a lot of people are liking it a lot,” appears to be pure happy talk. They don’t have the votes now to move the legislation forward, and may never have the votes to get this unfortunate legislation to Trump’s desk.
The much-bruited MacArthur Amendment to the earlier bill, with its provision for state waivers to sidestep comprehensive insurance-plan requirements and protections for people with preexisting conditions, may or may not attract some additional House Freedom Caucus votes. But it is very, very unlikely to sway those among MacArthur’s fellow moderates who refused to vote for the original bill. Yes, it would allow blue states to keep something like the original Obamacare individual-health-insurance markets in place, assuming insurers were willing to go along. But it keeps in place AHCA’s quick phaseout of the Affordable Care Act’s Medicaid expansion, hammering those same states.
Prospects in the Senate, where Republican moderates have much more leverage due to the GOP’s narrow two-vote majority, are much worse. On top of the substantive health care policy concerns House moderates have articulated (particularly over Medicaid), there are now three GOP senators who are not necessarily onboard for the defunding of Planned Parenthood that is part of the package. And there remain real problems with the Senate rules, since the state waiver provisions that are central to the MacArthur Amendment could easily be ruled non-germane to the budget process by the Senate parliamentarian, exposing the whole bill to a Senate filibuster.
So why the rush toward an apparent abyss? From the White House point of view, it’s apparently all about Trump’s panic over not having big accomplishments to boast of when the 100-day mark of his presidency arrives, on April 29. That factor is also reportedly driving a sudden hard line in the White House position in the appropriations negotiations aimed at avoiding a government shutdown on April 29. Since a renewed furor over health care could not possibly help the atmosphere surrounding the delicate appropriations talks, Trump is in danger of a dual disaster next week.
Perhaps the best thing about racing ahead is that it might not allow the Congressional Budget Office the time to score this new version of AHCA, a process that would undoubtedly produce a terrible number in terms of the impact on health-care coverage.
You might expect Paul Ryan to tell Trump the votes aren’t there for Zombie Trumpcare, and to ask him to call off the dogs. But Ryan is undoubtedly under pressure from some members who would prefer to get the monkey off their backs and blame the Senate or Democrats for the failure to enact health-care legislation, and others who figure a second failed vote in the House would convince everyone to give up and move on to the more congenial territory of tax legislation.
It’s a fine mess, all right, but for now the undead Trumpcare bill continues to lurch unsteadily toward its fate.