Last week, the nation's hospital and physician groups joined patient, consumer and senior advocates in condemning the newly introduced American Health Care Act, which guts Medicaid and provides inadequate subsidies for buying individual health insurance plans.
Their concerns didn't faze President Donald Trump. Less than eight hours after those lobbyists hit “send” on their protest letters, he met with leaders of the radical right—the anti-tax Club for Growth, the Heritage Foundation (which in an earlier incarnation invented Obamacare) and the Koch brothers-backed Americans for Prosperity.
To win the votes of the three dozen or so members in the tea party-backed Freedom Caucus, who are calling the AHCA “Obamacare-lite,” the president needs to assure them that the final bill will be—from a provider, patient and consumer perspective—even worse. Without some Freedom Caucus votes, House Speaker Paul Ryan is unlikely to muster the 218 votes he needs to tack the AHCA onto a budget reconciliation bill.
Don't be fooled by predictions of some political analysts and pundits that the AHCA is “dead on arrival.” If Ryan needs to lurch further right to get it passed, he will.
Ryan has been around long enough to know that the final legislation will be hashed out in a conference committee since there's no way the Senate will pass the House version. Already, four Republican senators have come out against sunsetting Medicaid expansion payments in 2020 and shifting the program to capped per capita payments.
Can Senate Majority Leader Mitch McConnell, whose home state of Kentucky has been one of the biggest beneficiaries of the Affordable Care Act's insurance expansion, win over those waverers? He's going to have to come up with something a bit more generous than what's in the House bill.