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Republicans Face No-Win Situation on Healthcare Vote

After it became clear on Thursday that House Republicans did not have the necessary votes to pass the American Health Care Act (AHCA), the Trump administration gave them an ultimatum: pass the bill on Friday, or the administration will move onto other legislative priorities, such as tax reform and border security. The ultimatum came  from Budget Director Mark Mulvaney, and was a late Thursday evening response to the announcement from GOP leaders that they were delaying the vote on the AHCA, the Republican healthcare bill which would “repeal and replace” the Affordable Care Act, otherwise known as Obamacare.

Repealing Obamacare has been a rallying cry for Republicans ever since its passage in 2010. While Republicans voted to repeal Obamacare dozens of times during the Obama administration, those votes were always merely a form of protest, as they faced near-certain defeat in the Senate or through Obama’s veto. Friday’s potential vote will be much tougher; no matter what happens the consequences will be very real.

The bill faces opposition from both moderate members – known informally as the “Tuesday Group” – and the ultra-conservative House Freedom Caucus. The former group is worried about the political consequences of directly voting to strip their constituents of healthcare, as the CBO estimates that 24 million Americans would lose coverage if the AHCA passes. The latter group contends that the repeal effort is not conservative enough, with many dubbing it “Obamacare-lite.” Despite having the House majority, Republicans can only afford to lose twenty-one votes in order for the bill to get through the chamber. By Thursday morning, however, thirty Republicans had indicated that they were planning to vote “no” or were leaning that way.

President Trump has threatened wavering lawmakers with political retribution should they fail to support the AHCA. Trump reportedly told Mark Meadows, the chairman of the Freedom Caucus, “I’m going to come after you,” during a private meeting with House Republicans earlier on Thursday. This puts Meadows and other Freedom Caucus in a bind; while Trump has an approval rating of 87 percent among Republicans, notable conservative groups such as the Club for Growth and Heritage Action for America have come out against the bill and urged lawmakers to vote against it. This means that many Republicans are likely to face primary challenges from the right regardless of their actions. In light of this dissatisfaction of the bill from both flanks of the GOP, as well as near-universal distaste for it amongst Democrats, the AHCA already faces a negative 17 percent approval rating from the American public.

Though Trump repeatedly pledged during the campaign that he would repeal and replace Obamacare, he has also shown to be ideologically flexible on the issue of healthcare. While he veered right in breaking his campaign promises that no one would lose coverage upon Obamacare’s repeal and that he would not cut Medicaid, he has also in the past expressed support for left-wing ideas such as universal healthcare.

The ultimatum, along with the expressed desire to move onto other legislative priorities, may perhaps be a ploy from the Trump administration to get healthcare reform off their backs altogether. Americans who helped carry Trump to victory last November – lower-income, older, rural voters – would be hit the hardest under the AHCA. In nearly 1500 counties around the country, a 60-year-old man with an income around $30,000 would stand to lose more than $6000 in federal insurance subsidies, and 68 of the 70 counties with the largest losses supported Trump in November. Meanwhile, the AHCA would provide a massive tax cut the nation’s wealthy citizens, particularly those making over $200,000 dollars per year.

With this information almost certainly in mind, Republicans have moved to pass the AHCA with astonishingly unprecedented speed for such major legislation – less than one month after it was introduced, and with virtually no public hearings or input from healthcare experts. By contrast, despite Republicans making similar criticisms of Democrats during the passage of Obamacare, the process of passing Obamacare took over a year from start to finish. It included multiple public hearings with testimony ranging from healthcare economists to stakeholders throughout the healthcare industry. 

All these dynamics will come to a head on Friday, with Republicans facing an assortment of subpar options. If Trump is serious about his ultimatum, seven years of Republican promises will either be fulfilled to the satisfaction of virtually no one – only then to face a very uncertain future in the Senate – or not be fulfilled at all in the foreseeable future. If Trump is lying about his ultimatum, he will suffer yet another political setback following the continuing controversies about his campaign and administration’s ties to Russia, as well as the double failure of his travel ban.

Trump said last month “Nobody knew health care could be so complicated.” Those words now appear inadvertently prescient.