Tax cuts in the Republican health care plan are the 'central' issue

Jesse Lee, a former official in the Obama White House, wrote on Twitter yesterday, "I say this in all honesty: you could easily write a bill with ideas from both parties that would fix issues in ACA & make Trump look great." This happens to be entirely true.

Indeed, it's the secret hiding in plain sight. If Republicans were serious about identifying and addressing the Affordable Care Act's real shortcomings, they could work out a deal with Democrats, stabilize the marketplaces, offer incentives to insurers, and make meaningful improvements to the system. This would be an incredibly popular move, and more importantly, it would help a lot of people.

But it wouldn't satisfy any of the Republicans' ideological goals, starting with the GOP's raison d'etre. The Washington Post's Matt O'Brien had a good piece yesterday on the central pillar of the party's health care plan.

The Senate health-care plan isn't a health-care plan. It's a tax cut.

That's clear enough from how little thought it puts into actually stabilizing insurance markets versus how much it does into showering the rich with as much money as possible. Indeed, it would go so far as to retroactively cut the capital gains tax -- something, remember, that's supposed to be about incentivizing future investment -- in an apparent bid to get people to create jobs six months ago.

That may sound like a joke, but it's quite real. The Senate health plan actually includes a provision that cuts taxes with an effective date of Dec. 31, 2016.

It's part of the broader plan to cut taxes, primarily on the wealthy, by hundreds of billions of dollars according to yesterday's report from the Congressional Budget Office.

I mention this in large part because it appears to be one of the parts of the legislation that the bill's architects prefer not to talk about. White House Budget Director Mick Mulvaney has insisted the tax cuts in the GOP plan are "not central" to the policy debate. Why not? Because he says so.

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Republican rhetoric on the uninsured descends into incoherence

Republicans have plenty of criticisms for the Affordable Care Act, and some of their points are more credible than others, but of all the arguments GOP officials are pushing aggressively, I think we've identified the worst.

Yesterday afternoon, for example, Donald Trump's White House published a curious tweet:

FACT: when #Obamacare was signed, CBO estimated that 23M would be covered in 2017. They were off by 100%. Only 10.3M people are covered.

I realize the White House's communications office is struggling right now -- the communications director recently quit after a few months on the job, and no one wants to replace him -- but someone over there probably should've read this before publishing it. If the Congressional Budget Office projected that the ACA would cover 23 million Americans, and the CBO was "off by 100%," that means it would've been off by 23 million -- because 100% of 23 million is 23 million. According to the White House's own message, that's not what happened.

Worse, by claiming that "only" 10.3 million Americans have gained coverage through the ACA, Trump World has cut the actual number roughly in half (though it is a nice change of pace for Republicans to acknowledge that the ACA has brought coverage to millions, even if the White House's numbers are all wrong). The figure only includes consumers who've bought insurance through exchange marketplaces, and ignores others who've gained coverage through the law.

But the underlying point of the tweet is that coverage levels matter. If you want to evaluate a health care blueprint, the argument goes, then take seriously how many Americans are insured under that system.

Senate Majority Whip John Cornyn (R-Texas), in a message apparently intended to serve as criticism of the ACA, added yesterday, "28 million uninsured under Obamacare." The White House has been pushing this data point, too.

It's baffling to see Republicans push this argument because it makes their own side look so much worse.

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With support for the ACA growing, Republicans go after single payer

For the last several years, Republicans have defined themselves by their hatred for the Affordable Care Act. That, however, is quickly becoming a greater challenge: "Obamacare" is not only a successful policy, it's also the most popular it's ever been. Public support for the ACA is quite a bit stronger than public support for Donald Trump, congressional Republicans, or their regressive health care alternative.

And that's led some Republicans to shift their posture a bit. Unable to win a debate over the Affordable Care Act, GOP officials have turned their attention toward a single-payer system.

Last week, for example, Sen. John Thune (R-S.D.) said, "If we don't get this done and we end up with Democratic majorities in '18, we'll have single payer. That's what we'll be dealing with." Sen. Pat Roberts (R-Kan.) added that Congress has to pass an unpopular far-right bill, no matter what, because the alternative is single payer, "and that's socialized medicine."

At yesterday's untelevised White House briefing, Press Secretary Sean Spicer seemed quite animated on the subject.

"But make no mistake about it that Obamacare is dying. And the reality, as I mentioned last week, is that, when you look at the majority of House Democrats, they support a single-payer, $32 trillion bill backed by Bernie Sanders. That's what the alternative is.

"It's not a question of Obamacare versus the American Health Care Act. It's a question between we need to accept that Obamacare is dead, we need to understand that the reality is that what the choice is is between putting in a system that is affordable and accessible, or a single-payer $32 trillion healthcare plan that the majority of House Democrats support."

It's a shame that White House officials struggle this badly to keep up with the basics of the debate. We know, for example, that the Affordable Care Act is neither "dying" nor "dead." It may make Trump World feel better to believe this, but for those who still take reality seriously, the claim just isn't true.

It's also a shame that Republicans no longer see the fight against the ACA as one they can win, so they find it necessary to change the subject.

But perhaps most important is the fact that Republicans, whether they realize it or not, may be inviting the one policy they hate the most.

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As their health plan falters, Republican leaders reach a crossroads

The Congressional Budget Office's report on the Senate Republicans' health care plan was simply brutal. The GOP blueprint, Congress' non-partisan scorekeepers found, would take coverage from 22 million Americans, increase consumer costs, and make insurance worse.

Sen. John McCain (R-Ariz.), asked about the CBO's findings, told reporters on Capitol Hill late yesterday, "Well, obviously that's not good news."

The question now becomes what Senate Republicans intend to do about it. Sen. Dean Heller (R-Nev.) announced his opposition to the GOP legislation on Friday, and as of last night, as others joined him, GOP opposition appeared to reach a critical mass.

Sen. Susan Collins, R-Maine, announced via Twitter that the CBO report reaffirmed her fears about deep cuts to Medicaid in the Better Care Reconciliation Act and said she would vote against the "motion to proceed," a procedural vote that allows the Senate to bring up a piece of legislation to be debated and eventually voted on. [...]

Sen. Rand Paul, R-Ky., also said he wouldn't vote for the motion to proceed, a vote expected to take place either Tuesday or Wednesday of this week.... Sen. Ron Johnson, R-Wis., is a third senator who said that he could vote against the procedural motion this week, saying he "would highly doubt" that he would support it.

Asked whether she would vote for her party's plan, Sen. Lisa Murkowski (R-Alaska) added last night that she's not in a position where she could "vote in the affirmative"

To pass the regressive bill, Senate Republican leaders can lose no more than two of their own members. At least for now, the tally appears to be well above two -- and the number of GOP opponents is growing, not shrinking.

And that leaves Senate Majority Leader Mitch McConnell (R-Ky.) with a limited number of options.

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