Republicans Weigh Their RyanCare Votes

House members in swing districts may get a primary challenge if they vote in favor. But a “no” vote would be a death sentence from the base.

AP Photo/J. Scott Applewhite
Charlie Cook
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Charlie Cook
March 20, 2017, 8 p.m.

More than a few House Re­pub­lic­ans are likely to be tak­ing deep breaths as they board the sub­way from the Long­worth or Ray­burn House Of­fice Build­ings to the Cap­it­ol on Thursday to vote on the Amer­ic­an Health Care Act. They know that they will be cast­ing a fate­ful vote on a bill that no one really likes and, giv­en the lack of af­fec­tion for it in the Sen­ate, one that is ex­tremely un­likely to be signed in­to law in its present form.

Staunch con­ser­vat­ives don’t like it, some dis­miss­ing it as “Obama­care Lite,” while oth­er law­makers, mostly mod­er­ates or those rep­res­ent­ing swing dis­tricts, fear a back­lash if they de­cap­it­ate Obama­care. For Demo­crats, the vote is a no-brain­er. All are ex­pec­ted to vote against it. The irony, of course, is that the Amer­ic­an Health Care Act, aka Ry­an­Care, is, like the Af­ford­able Care Act of 2010, aka Obama­care, a mon­grel of a piece of le­gis­la­tion, with ex­traneous bits ad­ded to at­tract votes and oth­er pieces tossed in to avoid los­ing votes.

What’s in­ter­est­ing is that Amer­ic­ans have a de­cidedly mixed view of Obama­care. The March 12-14 Fox News Poll showed its fa­vor­able rat­ings only barely high­er than its un­fa­vor­able ones, 50 to 47 per­cent, and strongly un­fa­vor­able views ex­ceeded strongly fa­vor­able ones by 36 to 26 per­cent. When Fox asked people wheth­er they “fa­vor or op­pose the Re­pub­lic­an health care plan that would re­place Obama­care,” just 34 per­cent were in fa­vor and 54 per­cent were op­posed, with strongly un­fa­vor­able views out­strip­ping strongly un­fa­vor­able ones, 40-17 per­cent. Of the 54 per­cent op­posed to the GOP plan, 67 per­cent said it was be­cause it made too many changes to Obama­care, while 21 per­cent said it didn’t make enough changes.

The Fox News poll showed that 92 per­cent of re­gistered voters cur­rently have some kind of health in­sur­ance: 51 per­cent re­ceive it from their em­ploy­er, 15 per­cent pay for them­selves, and 27 per­cent re­ceive it through a gov­ern­ment pro­gram like Medi­care or Medi­caid. Thirty-five per­cent rated the qual­ity of their cur­rent health in­sur­ance “ex­cel­lent,” 42 per­cent “good,” 16 per­cent “only fair,” and 6 per­cent “poor.” That means 77 per­cent think their health in­sur­ance is good or ex­cel­lent and 22 per­cent rate it fair to poor.

Ry­an­Care faces the same pub­lic per­cep­tion prob­lem that af­flic­ted Obama­care sev­en years ago: People are deeply mis­trust­ful of politi­cians and gov­ern­ment fid­dling with their health care. Many didn’t much like it when Demo­crats made whole­sale changes, and they took out their frus­tra­tions in the 2010 and 2014 midterm elec­tions. Now they’re un­happy that Pres­id­ent Trump, House Speak­er Paul Ry­an, and oth­er Re­pub­lic­ans are mess­ing with their health care. Demo­crat­ic Sen. Joe Manchin of West Vir­gin­ia told MS­N­BC last month that “a lot of people didn’t really know, and still don’t know, how they got health care … but I as­sure you they’ll know how they got rid of it.”

I can­vassed four of the smartest Re­pub­lic­an con­sult­ants last week on this ques­tion: “What would you guess that un­named Re­pub­lic­an strategists are telling their cli­ents about health care votes next week, ac­know­ledging that every­one is in a dif­fer­ent situ­ation?”

One said he thought Re­pub­lic­ans were be­ing ad­vised to vote in fa­vor. “You will get no cred­it with I’s and D’s for op­pos­ing it; they will still vote against you in ‘18 re­gard­less of how you vote. At the same time, a ‘no’ vote guar­an­tees a GOP primary op­pon­ent. You are go­ing to be tied to Trump and his policies no mat­ter how of­ten you try to stay in­de­pend­ent. Bet­ter to suck it up and pre­pare for war with the Demo­crats in ‘18.”

An­oth­er took a sim­il­ar tack: “We have to re­peal Obama­care and re­place it. Not re­peal­ing will kill us with the base in 2018, and not re­pla­cing it will kill us with swing voters and low-propensity turnout Trump voters.”

Said a third: “I know strategists who worry about the Re­pub­lic­an Party’s repu­ta­tion as a whole are telling their cli­ents that we will look ut­terly im­pot­ent if we can’t come up with a re­place­ment for Obama­care after prom­ising to do so for the past six years.”

The fourth offered a more nu­anced an­swer: “Not many Re­pub­lic­ans are go­ing to worry about a primary op­pon­ent who hits them for hav­ing cut be­ne­fits from de­serving re­cip­i­ents. They’re go­ing to be more wor­ried about not do­ing enough to un­der­cut Obama­care—they need to worry about the ‘not con­ser­vat­ive enough’ angle on whatever it is they do.”

He con­tin­ued, “But if you’re in a swing dis­trict or state, you’ve got that prob­lem plus the prob­lem of a chal­lenge that you hurt mid- to low-in­come people and your vote cost them their health in­sur­ance. Then a ‘no’ vote would be easi­er than a ‘yes’ vote be­cause you can shift the reas­ons why you voted against it, say­ing in a primary that it was im­per­fect be­cause it did not do enough and in the gen­er­al be­cause it did too much.”

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