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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