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Does The GOP Health Care Bill Have A Chance?

In this week’s politics chat, we weigh the prospects of the Republican effort to repeal and replace the Affordable Care Act. The transcript below has been lightly edited.


micah (Micah Cohen, politics editor): Welcome!

harry (Harry Enten, senior political writer): Hey, everyone!

natesilver (Nate Silver, editor in chief): Hello from United flight No. 538.

harry: I remember United was also Continental. Remember that?

natesilver: Dating myself, but I remember Piedmont Airlines, which was a big carrier in Lansing, Michigan, when I was a kid and served good honey-roasted peanuts.

micah: For your consideration today: Will Republicans pass something resembling repeal/replace of the Affordable Care Act? Obviously, we don’t know the answer to that question, but we can dive into the factors pushing in either direction.

Let’s start here, though: How’s the rollout of the House Republicans’ bill (the American Health Care Act) going?

natesilver: Phase 1. Fuck up the rollout. Phase 2. Pretend the fuck-up was part of a three-phase plan. Phase 3. ???

micah: Ehhh. How bad has the rollout really been? There’s been a lot of “dead on arrival” talk — isn’t that overkill?

harry: Well, let’s see. Republican Rep. Jim Jordan says he’s going to file an alternative repeal plan. There are some Republican senators who are saying that the bill put forward by House Republicans doesn’t do enough to preserve the Medicaid expansion and others saying the opposite, that it’s too much like Obamacare. The AARP has come out against it. And we haven’t even gotten to the Democrats. That said, the bill isn’t doomed.

clare.malone (Clare Malone, senior political writer): Well, the latest I saw on Twitter was Trump adviser Kellyanne Conway trying to distance the White House from it, apparently. So I’m not sure what that says?

micah: That seems like the real wild card, Clare. How much does the White House push this?

perry (Perry Bacon Jr., senior writer): I keep reading that the rollout is going terribly. Can I just say that Paul Ryan got himself nominated vice president and then became House speaker. He is not clueless. He knew this bill would be bashed by lots of different groups. It is really hard to write a bill that pleases Heritage Action, Sen. Susan Collins, John Kasich and the House Freedom Caucus.

harry: Trump, to be clear, hasn’t endorsed the bill. He says it’s up for review and negotiation. It’s the beginning of negotiations. And, yes, I agree, Perry. It actually reminds me of the GOP presidential primary. There was a majority against Trump, but it was a majority made of different factions that couldn’t come together.

natesilver: But is it hard to write a bill that pleases at least one of Heritage, Susan Collins, John Kasich, Rand Paul, National Review, the AARP and the House Freedom Caucus? Absolutely nobody liked this thing.

perry: I think that was the point. A bill that was too right is not going to pass. One that is too left is not going to pass. I’m not saying this will pass either, but I can see how they got here.

micah: But don’t you think there’s a danger that if the politics of this get too messy (which seems inevitable) that Trump will just throw congressional Republicans under the bus?

clare.malone: I’m not sure Trump would do that much, Micah. It seems unwise, in part because then they would say, “OK, well what you got, then?” They would presumably have to offer some kind of idea of what they actually liked. And they don’t seem to be particularly policy-focused.

micah: Yeah, that seems like part of the problem here. What’s Trump’s endgame? What’s the Paul Ryan/Mitch McConnell endgame? Are those two things at all similar?

natesilver: Relatedly: What’s the constituency for this bill? Who is it a “win” for? And even if the answer is “nobody,” someone has to take one for the team and be willing to sing its praises.

harry: I don’t think it’s that crazy. Some people like oil, and some people like vinegar. To please both, you mix them together. The hope was that there would be just enough in this bill for each side that both would buy in. The risk is that there is just enough in the bill that both sides hate that they could end up hating the whole thing.

clare.malone: Salad dressing, huh?

micah: The Salad Dressing Theory Of Politics by Harry Enten

perry: To go back to Nate’s question, I think the audience for the bill is 216 House members (a majority because of vacancies). Is this something that they can vote for? I’ve seen lots of opposition to the bill from outside groups. But I am seeing the same five to seven Freedom Caucus members who oppose this quoted again and again. Are we sure 22 Republicans in the House will vote this down? I can concede the Senate is a different ballgame.

harry: There was a theory posited by our friend Sean Trende of Real Clear Politics that Senate Republicans just want to be able to say: “We presented a bill to kill the ACA. Republicans voted for it. The Democrats didn’t. We need more votes. Vote Republican in 2018.” Not sure I buy that. But it’s a thought.

micah: Blame red-state Democrats, basically.

natesilver: Before we move on, just one more bit of pushback on your contrarian claim that the rollout wasn’t so bad, Micah. There was some basic blocking-and-tackling stuff that they failed at. Like, not communicating this three-phase plan thing, unless they really did make that part up as they went along.

micah: What’s the three-phase plan again?

natesilver: Phase No. 1 is supposed to be the current plan — which they say can be passed through reconciliation. Phase No. 2 is executive order stuff. And Phase No. 3 is stuff that needs to be passed with 60 votes in the Senate.

perry: Specific parts of the rollout were bad. The hiding the bill last week. They have not explained well why they did not wait for a Congressional Budget Office score. They should have had some conservative validators lined up to sell the bill.

micah: I was amazed watching “Morning Joe” on Tuesday — they said they couldn’t get anyone from the administration on to talk about the bill. So that does speak to a botched rollout.

clare.malone: Well … who’s in charge of the rollout? Isn’t it really Ryan and company? Not necessarily the White House?

harry: Yeah, it wasn’t the administration’s bill.

natesilver: It’s like playing against the ’85 Bears and throwing a pick-6 on the opening possession because your receiver blew a route. Nobody said things were going to be easy, but you still have no excuse.

clare.malone: I DON’T GET THAT.

micah: So let’s dive into “whose bill is this?”

clare.malone: Paul Ryan

micah: Not Trump?

clare.malone: Naw.

perry: Ryan is the lead figure of this bill. Trump is involved now but can distance himself, since he can always say the Hill wrote the bill. So what Clare said.

harry: What are the signs that Trump had anything to do with this bill? House Republicans had this bill under lock and key for weeks. Hence, the Rand Paul stunt.

natesilver: I think it’s Ryan sort of trying to average out the desires of House Republicans and winding up with a solution that looks like it was crafted by committee.

perry: Also, if not Trump, Office of Management and Budget Director Mick Mulvaney, Health and Human Services Secretary Tom Price and Vice President Mike Pence will get blamed if this fails. They are closest to the House GOP.

micah: IDK, Trump is the head of the party. To what Perry just said, the administration was reportedly working with House Republicans the whole time. It seems a bit rich for the White House to turn around now and say, “This isn’t us.”

perry: Price was heavily involved in this bill. Pence did a rally with Ryan recently and said this was a huge administration priority.

clare.malone: Well … welcome to Trumpism (to Micah’s point).

harry: Yes, but as Perry wrote previously, there are so many players in Trump world. A bill could have the hand of Trump world in it, but that doesn’t mean Trump himself was part of it.

clare.malone: Trump and Steve Bannon, his chief strategist, are in the business of pure practicality politics vs. ideology politics, right now, right? If things are looking bad, looking like they’re unpopular with your people, they give themselves the latitude to say, “Hey, we’re new to this, and we agree with you that these Washington insider guys got some things wrong.”

micah: That’s my guess, yeah.

perry: So before we conclude that Trump is walking away from this bill or might, are we sure that is true? He tweeted his support for it. He had meetings this week with the GOP whip team. I am from Louisville, Kentucky, and read local papers there. Trump is going to Louisville on Saturday. I have to assume that he will be pushing on Rand Paul. Conway called into a Louisville radio station this week to say that Paul should get behind the effort. Trump tweeted the same thing. If Trump goes to a member’s home state and pushes them on a bill, that is pretty involved.

harry: I don’t think there’s any sign that Trump will give up on this bill. It’s just that this is a starting point. It’s essentially a blueprint. I don’t want to sound like a broken record, but that’s what the man said. Trump, in case you didn’t know, likes to think of himself as a negotiator.

natesilver: But is Trump attached to getting this bill passed, or is he attached to getting some bill passed? Or does he just want to pick a fight with Rand Paul, who’s an easy target in some ways?

micah: Good transition: Let’s talk endgames. What happens if they don’t pass anything? Clare, related to your big piece on Republican voters: Is there a revolt?

clare.malone: There are certainly some in the GOP’s base — those who were, say, Ted Cruz voters in the primary who flipped to Trump out of pragmatism — who voted for Trump for certain promised legislation and executive action. More specifically, that was “repeal and replace Obamacare!” and “Supreme Court nominees!” that you heard at every campaign event during the primary season.

So, if they weren’t to pass something, I’m not sure you’d see a revolt right away, per se, but that would give some cannon fire to primary challenges down the road, right?

perry: I feel like the optimal goal for Republicans, other than passing a bill, is to have the bill fail but be able to blame it on someone else. And the Democrats have no power and can’t be blamed. I don’t think the Freedom Caucus wants to get blamed. Or Rand. Or Ryan. Or McConnell. Usually, this kind of bill would die in committee, without a real floor vote. Don’t think Ryan or McConnell can afford that. Read Sarah Kliff on the Senate parliamentarian and how she could rule that parts of the bill do not meet Senate rules for reconciliation. She is the perfect fall person. If they can blame her, that would be perfect for the Republicans: “The bill failed, but it was some government bureaucrat!”

Is that too cynical?

natesilver: I don’t think it’s too cynical, necessarily. They’re in a real pickle. The other way they could try to get a similar result is to intentionally insert a provision in the bill that couldn’t pass through reconciliation instructions — e.g., allowing the sale of insurance across state lines — and then blame Democrats for killing things via the filibuster.

micah: I think we’ve learned that there’s no such thing as “too cynical.”

So you both think there won’t be a mass voter-led revolt if the GOP leaves Obamacare mostly as is? Even if they have a good fall person?

harry: Which voters, Micah? Primary voters, maybe. Because general election voters probably will be fine with it.

micah: Yeah, and to Clare’s point about Cruz voters: We learned there weren’t many of those.

clare.malone: Like, a tea party type deal?

micah: Tea party-lite?

clare.malone: I don’t think that would happen, given how much full-on power Republicans have right now. Psychologically, I’m not sure the GOP’s base is there.

They would be angry, yes, but not fire-ants-in-their-pants angry.

perry: I’ve always believed the conservative opposition to Obamacare would be less intense after Jan. 19, 2017. I wonder if there will be much of a backlash at all if this fails.

micah: The opposition was always more about the “Obama” than the “care,” in other words.

harry: Only 31 percent of Republicans want to repeal the law without a replacement package in place, so I’m going to agree with the panel here. Many want repeal, for sure, but even many Republicans don’t want to throw the baby out with bathwater.

micah: The lower-third on CNN right now is “Sources: Trump fully committed to selling health bill.”

clare.malone: If the chyron says it, it must be true.

micah: Words to live by.

natesilver: I’m going to change my name to Nate Sources.

micah: So, before we begin to wrap up, I just want to make sure that we’re not getting carried away with how much danger this effort is in. To recap, the consensus seems to be that Republicans botched the health care bill rollout, the bill pleases no one, Trump will push for it but may abandon the effort if the going gets tough, GOP voters wouldn’t freak out too much if something doesn’t pass and some Republican leaders may not even be trying to pass anything.

clare.malone: Well, the ultimate endgame is that none of us are making it out alive.

harry: The math for the Republicans is rather simple: To repeal, they need their caucuses to vote aye. They don’t need to get any Democratic votes. That in itself is a reason to be optimistic for Republicans that a bill could pass. Perhaps it’s not this bill, but a bill.

natesilver: Being alive is a pre-existing condition, which unfortunately isn’t covered.

micah: Being alive is an existing condition, Nate.

perry: I don’t agree with the consensus then. I think the bill has a good chance of passing the House, since I don’t see the 22 votes against. And I don’t right now see the third vote against in the Senate. If they can get this bill to votes, I think it can pass. I don’t think a long process of amending the bill will be that helpful to passing it.

micah: I may or may not have exaggerated the consensus.

clare.malone: i.e., partisanship is a hell of a drug? (to Perry’s point).

natesilver: I agree with the consensus, as laid out by Micah, and also think the bill has a chance of passing! They aren’t mutually exclusive.

perry: I’m not predicting passage.


natesilver: :champagne:

perry: Exactly! I think Nate is right: This all looks terrible right now, but the bill could still pass. Is that the consensus?

micah: I think so, yeah. (I don’t think we’ve ever reached consensus in a chat before.)

natesilver: Look, Republicans will get their act a little bit more together, partisanship will help at the margins, and maybe Trump can intimidate a few wanderers into supporting the bill. On the other hand, there are some big public relations blows yet to navigate, like the CBO score and whatever pushback they get from constituents at the spring recess.

I think the modal (most likely) scenario is that the House passes a more conservative bill than what’s on the table now and it gets stymied in the Senate.

perry: I think I agree with this, while not being sure what “stymied” in the Senate looks like.

natesilver: Yeah. It could die with a bang rather than a whimper, get filibustered, get ruled out of order by the parliamentarian, or lose on a floor vote. Lots of ways it could die. Or the Senate could gut the bill and do something token-ish that was actually fairly popular and dare the House to pass it in order to save face.

micah: OK — any final thoughts?

harry: This is just the beginning. Remember how long it took for the ACA to pass? It was long enough for Democrats to have 60 votes in the Senate when it started and then need reconciliation to pass the final parts because Scott Brown won the special election in Massachusetts.

natesilver: To me, it’s interesting that Obamacare sort of spontaneously became more popular the moment that Trump won the election. That’s suggestive to me that there isn’t much of a mandate for what the House bill might do and certainly not what the House Freedom Caucus’s version of a bill might do.

If the House bill is polling at, I dunno, 35 percent favorable and 51 percent unfavorable, then how long is its lifespan going to be?

harry: I saw a fascinating poll on this — about what made opinion flip. It seemed, to the authors of the poll, that it wasn’t the underlying parts of the ACA. Opinions on those stayed the same. Rather, they argued the popularity of the bill spiked because people were becoming more knowledgeable of what was in the law.

natesilver: I don’t buy that interpretation, since the popularity spike came immediately after the election.

harry: What interpretation would you buy? That people started thinking about it differently?

natesilver: I think it was the public telling the GOP that it was on a leash. And that it didn’t have license to start messing with entitlement programs, even theretofore fairly unpopular entitlement programs.

clare.malone: But Republicans did leave enough of the original elements of Obamacare in their plan to have it be called “Obamacare Lite” by some on the right.

So there could still be something to the idea that people are more aware of aspects of it.

perry: Micah has been predicting this process would go like 1993 and 2009 for weeks. I wasn’t so sure. It looks like he was right.

harry: To Clare’s point — yes, there could something. Perhaps it’s both that and what Nate suggested. To Perry’s point, health care is really hard. It probably cost Democrats a bunch of House seats in 2010.

Nate Silver is the founder and editor in chief of FiveThirtyEight.

Harry Enten is a senior political writer and analyst for FiveThirtyEight.

Clare Malone is a senior political writer for FiveThirtyEight.

Perry Bacon Jr. is a senior writer for FiveThirtyEight.

Micah Cohen is the politics editor.