Hill Republicans are in a jam on Obamacare

IF YOU TALK PRIVATELY to most Hill Republicans, they’ll tell you they’re in a jam on Obamacare and don’t know how — or if — they’ll get out of it. Forget tax reform by the end of the year for the moment and let’s resurface in reality: Republicans are having a hard time repealing and replacing Obamacare after a half-dozen years of promises.

MOVE THE BILL TO THE RIGHT, you lose moderates, move it to the left, conservatives dash and, either way, when they send it to the House, it faces an uncertain future. AND NOW, Sen. Ted Cruz is rising. His plan is under consideration and is expected to be scored for budgetary impact by the Congressional Budget Office, one of many signs it is in play in the healthcare debate, according to multiple sources involved. It basically allows insurers to sell non-Obamacare compliant plans, which would — if you listen to the provisions’ supporters — economically devastate the Affordable Care Act.

— HOT DOC: Check out how Cruz is explaining his amendment. http://politi.co/2sNfAX0

— WHAT CONSERVATIVES THINK: A top conservative on the Hill: “The first round of the health care fight revealed the votes to fully repeal Obamacare just do not exist in the House and Senate — despite six years of campaign promises. Now conservatives are uniting behind an amendment that they say could effectively undo Obamacare through the marketplace since the votes aren’t there to do it legislatively. Ted Cruz’s amendment would allow HHS to grant waivers to states that allows insurance companies to offer an unlimited number of non-ACA compliant health plans if they also offer at least one ‘qualified health plan’ (QHP) in both silver and gold coverage levels. Conservatives say this will result in substantially lower premiums and more choice for consumers. Opponents — and conservatives behind closed doors — say it will effectively kill what’s left of the ACA economically.”

— THE MATH: It’s hard to see how Mitch McConnell threads the needle here. He needs opponents like Sen. Dean Heller (R-Nev.) and skeptics like Sen. Susan Collins (R-Maine) to switch their votes. And even if Sen. Ted Cruz is in play, McConnell will have to find a way to get his home state Sen. Rand Paul (R-Ky.) on board. Paul, who is holding side talks with the president, was never truly thought to be in play for the GOP.

CASE IN POINT — WASHINGTON MEDIA DESCENDS ON PALCO, KANSAS, TO HEAR FROM JERRY MORAN — POLITICO’S SEUNG MIN KIM: “Moran gets an earful on Obamacare repeal at town hall” http://politi.co/2txdzLGWAPO’S DAVE WEIGEL: “A town hall in Kansas shows Republican struggles with health-care bill” http://wapo.st/2sNEiqnNYT’S TOM KAPLAN: “Unlikely Holdout Underscores Challenge for Senate Health Bill” http://nyti.ms/2swDSQT

AND LOCAL MEDIA TOO — KANSAS CITY STAR’S BRYAN LOWRY: “Packed town hall in Palco, Kan., urges Moran to stand firm against GOP health bill” http://bit.ly/2tYBxT9WICHITA EAGLE’S JONATHAN SHORMAN: “National health debate swirls around Moran at town hall” http://bit.ly/2to3sKB

— SEUNG MIN KIM: “[M]oran … rattled off a litany of concerns with the Senate GOP plan … stressing to an overflow crowd in this tiny rural town that he would not support the existing draft as written. During a town hall in this largely conservative area, Moran called it ‘troublesome’ that Kansas, which did not expand Medicaid under Obamacare, would under the GOP plan have to help shoulder the entitlement’s costs in states that did. Moran also raised concerns about ‘people with disabilities, the frail and elderly’ when it came to potential changes to Medicaid, a program that Moran said ‘has significant value.’

“Still, he made clear his opposition to Obamacare, telling the crowd of about 150 people that after visiting all 127 hospitals in the state, ‘there is not a hospital that I could find in Kansas that is financially better off as a result of the Affordable Care Act.’ But he also danced away from the ‘full repeal’ rhetoric that has dominated the Republican Party in the seven years since Obamacare was signed into law. ‘The Affordable Care Act creates significant difficulties that still need major attention,’ Moran told reporters after the town hall. ‘But I think at this point, it’s time to figure out how … to get rid of the bad things and improve on the things that need to be improved.’” http://politi.co/2txdzLG

— SMK’S TAKEAWAY: “[I]n this rural northwestern Kansas town, Moran stresses that coverage for preexisting conditions have to be protected. He rails against the decision by his own leadership to draft its Obamacare repeal measure almost entirely in private. The genial senator even steers away from derisively referring to the 2010 health care law as Obamacare, instead using its official term: The Affordable Care Act. …

“He also veered off the party message by saying that he would have preferred a process to ‘figure out where there are 60 votes to pass something that is so important to many Americans,’ implicitly rejecting the partisan fast-track approach GOP leaders deployed. It’s ‘almost impossible to try to solve’ the Republicans’ health care dilemma with just 50 votes, Moran added.” http://politi.co/2sNyk8S

— NOTE: If Jerry Moran is truly a holdout — and it sure sounds like he is, from SMK’s reporting — it’s real difficult to see how an Obamacare repeal passes the Senate. Moran won his last election with 70 percent of the vote, and his principal political hurdle — generally speaking — would be a primary challenge. The town hall was in Rooks County, Seung Min writes, which “gave Trump 84 percent of the vote.” Yet he sounds very skittish about repealing the law.

— “Rand and Donald’s wild health care ride: Rand Paul and Donald Trump have gone back and forth on an Obamacare repeal strategy, repeatedly undermining GOP leadership’s plans,” by Burgess Everett and Josh Dawsey. http://politi.co/2swqfBr

THE BACKUP PLAN — “McConnell says GOP must shore up ACA insurance markets if Senate bill dies,” by WaPo’s Juliet Eilperin and Amy Goldstein: “Senate Majority Leader Mitch McConnell (R-Ky.) said Thursday that if his party fails to muster 50 votes for its plan to rewrite the Affordable Care Act, it will have no choice but to draft a more modest bill with Democrats to support the law’s existing insurance markets. The remarks, made at a Rotary Club lunch in Glasgow, Ky., represent a significant shift for the veteran legislator. While he had raised the idea last week that Republicans may have to turn to Democrats if they cannot pass their own bill, his words mark the first time he has explicitly raised the prospect of shoring up the ACA.

“‘If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,’ McConnell said. ‘No action is not an alternative. We’ve got the insurance markets imploding all over the country, including in this state.’” http://wapo.st/2tPunjJ

TIM PHILLIPS INTERVIEW — “Koch brothers political chief: Health care effort a ‘disappointment’” http://cbsn.ws/2uxurlH … “We’re not ‘beholden’ to GOP lawmakers” http://cbsn.ws/2tOIZju

Source: http://www.politico.com/story/2017/07/07/playbook-obamacare-repeal-will-it-pass-240291

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