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Health care politics now favors the Democrats

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(Bloomberg View) — Not everyone hates Paul Ryan’s new health care bill. Sure, conservative policy wonks, pretty much across the board, hate it. Right-wing agitators like Heritage Action hate it. Donor tax-cut advocates like the Club for Growth hate it. Conservative purists — that courageous breed that eschews tainted compromise with dull reality — hate it.

Naturally, liberals hate it, as do people with serious health problems who depend on reliable health insurance.

Related: GOP ACA change bill may favor commercial health

Yet a Democratic leadership aide was far less unkind. Asked purely about the bill’s political merits, he said Democrats, policy consequences aside, would be delighted to see Republican House members casting votes in favor of it, which he likened to walking a plank.

Former Democratic strategist Robert Shrum similarly envisions Republicans dropping into the abyss. “If you were cynical, and all you cared about was the political calculus, you’d want this misshapen monstrosity to pass,” he said in a telephone interview. Democratic pollster Paul Maslin emailed: “Probably better for us if it passes. Unfortunately the right wing knows that too and they may kill it for that reason.”

“Obamacare repeal” was originally supposed to be the first of two tax cuts for the wealthy. Phase I would knock out the tax revenue that funds Affordable Care Act programs. In Phase II, Republicans would not only deliver another round of tax cuts to the wealthy, they would have that legislation scored against the revised, more favorable, baseline produced by Phase I. Depletions to the treasury caused by Phase I would make the revenue lost to high-end tax cuts in Phase II appear less onerous.

That may yet come to pass. But the one-two punch depends on Republican leaders rallying support for a bill for which they can’t relate the most basic details: How many people will lose health insurance? How much will their misfortune cost the U.S. Treasury? GOP leaders want to begin moving the legislation before the Congressional Budget Office can finish analyzing it.

If Republicans can’t pass an Obamacare budget bill after dozens of symbolic votes against Obamacare, and after years of raging against the law, it not only casts a pall over the joyous act of cutting taxes in Phase II, it raises an existential question about the GOP itself: Beyond tax cuts, what’s it good for?

If the new legislation “goes down in flames,” emailed another Democrat, pollster Anna Greenberg, “it could depress GOP turnout in the midterms.” Either the final bill will please the right-wing purists in the House Freedom Caucus, Greenberg said, in which case some Republicans who support the bill will face primaries from their right, or many Trump voters will lose their health insurance. “Either way,” she said, “nothing good comes from this effort.”

Democratic schadenfreude is not quite the same as Democratic power. The party has been hapless in off-year elections; both 2010 and 2014 were devastating, transferring hundreds of seats in the House, Senate, state legislatures and governor’s offices from Democratic to Republican control. But the election of Trump has galvanized the liberal grassroots. They have been screaming, Tea-Party-like, at their representatives in town halls across the country. Democrats aren’t just the out party now, which typically gains in midterm elections. Like Republicans circa 2010, they’re the outraged party.

“Democrats are going to crawl across broken glass on their knees to go vote in 2018, if the conditions exist as they do today,” said Democratic Gov. Jay Inslee of Washington in an interview Feb. 27 with the Washington Post.

Democratic fury is not an immediate concern of Speaker Ryan. More pressing is the state of his majority, which is prone to fray at both the extreme and moderate ends. The Senate majority leader, Mitch McConnell, has a similar problem and, presuming no Democratic support, has only two wayward votes to spare.

The prospect of betraying white working-class voters, many of whom, whether they know it or not, benefit from Obamacare doesn’t seem to weigh on the GOP congressional leadership. But it might bother the White House. Trump promised to replace Obamacare with something “terrific.”

“I’m proud to support the replacement plan released by the House of Representatives,” Trump said Tuesday after meeting with House Republicans at the White House.

But the legislation will hurt millions and transform their health care subsidies into tax benefits for the richest. Trump may be fine with that in theory but the buck in this administration never stops anywhere near the Oval Office. If the repeal bill ends up looking like a loser — and it’s got a hangdog look already — who thinks Brave Sir Robin of the Round Office will buckle down, take the heat and work to pass it?

Republicans will face hell from their base if they fail to repeal Obamacare. But parts of that base will suffer if the effort succeeds. Perhaps the most fitting coda of this shameless period of American history would be Trump and other Republicans saving lives by killing their own cynical, misbegotten deed.

Francis Wilkinson writes editorials on politics and U.S. domestic policy for Bloomberg View. He was executive editor of the Week. He was previously a national affairs writer for Rolling Stone, a communications consultant and a political media strategist.


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