Jun 12, 2017

On health care, look beyond 2018

Caitlin Owens, author of Vitals

(Rebecca Zisser / Axios)

The electoral consequences of passing a health care reform bill won't end with the 2018 midterms. Major provisions of the GOP's bill, including its Medicaid cuts and tax credit changes, would begin to take effect in 2020 — a year when the presidency will also be on the line and Senate Republicans will face a much tougher map than they are in 2018.

If the politics of the Affordable Care Act taught the GOP anything, it's that a major health care overhaul can significantly affect elections many cycles down the road. But on the other hand, after campaigning for years on repealing and replacing the ACA, there will be a price to pay if the party can't pass a bill.

And, even without a bill, allowing the ACA to collapse is probably politically tumultuous for the GOP as well. As one former GOP Senate staffer summed it up: "What was learned [from the ACA] is when people are angry because the system's not working for them, that's not good for anybody."

Big picture: Republicans campaigned aggressively against the Affordable Care Act for four cycles: 2010, 2012, 2014 and 2016. Looking at the same timeline for today's Senate Republicans ...

  • Only two sitting GOP senators are considered vulnerable next year, Sens. Jeff Flake and Dean Heller. The map is much rougher for Democrats, 10 of whom are running for reelection in states Trump won.
  • But the tables turn somewhat in 2020. Republicans will have to defend eight seats that only flipped from Democrat to Republican in 2014. There are fewer vulnerable Democrats in cycle that year, and you can expect the Democratic base to be pretty fired up for the 2020 presidential election.
  • 2022 is a long way away, but it's not looking like an easy year for Republicans, either. And there's plenty of recent precedent for keeping a health-care fight alive for three cycles.

Why this matters: The House bill began implementing some of its biggest changes in 2020, right before voters head to the polls. These changes include caps on Medicaid funding; a reduced tax credit for older, low-income people; optional state waivers for the ACA's essential health benefits; and a phaseout of the ACA's Medicaid expansion.

That's part of the reason we're seeing a push in the Senate to phase out the Medicaid expansion over a longer period of time, lobbyists and former aides say. "The American public has a short-term memory...[Republicans] recognize there's a perfect storm in 2020," Chris Condeluci, a former Republican Finance Committee aide, told me.

Key questions: Do senators — particularly those who will be up for re-election after the GOP law begins taking effect — believe the bill would help their constituents? And if they don't pass a bill now, how long will their base punish them?

  • "I think they are just hoping it's more meaningful to that group to have made good on their promise to repeal/replace than anything else," said one GOP lobbyist and former Hill staffer. "But I honestly don't think the base cares as much about whether members made good on the promise [if] their premiums go up or they lose coverage."

What we're watching for:

  • A further delay in the implementation of major reforms that could cause disruption. Paired with more generous federal assistance, this could be enough to get hesitant members to yes. "Nobody has battles over things eight years off," said Bob Blendon, a health policy professor at Harvard, who added that "the worst thing is to run in 2018, which relies on activist voters, and say, 'We didn't do anything.'"
  • Members up for re-election in 2020 or later — like Heller, Bill Cassidy or Shelley Moore Capito — coming out against the bill, saying it hurts their constituents and they can't vote for it.

Go deeper

Updated 2 hours ago - Politics & Policy

U.S. cities crack down on protesters

The scene near the 5th police precinct during a demonstration calling for justice for George Floyd in Minneapolis on Saturday. Photo: Kerem Yucel/AFP via Getty Images

Major U.S. cities have implemented curfews and called on National Guard to mobilize as thousands of demonstrators gather across the nation to continue protesting the death of George Floyd.

The state of play: Hundreds have already been arrested as tensions continue to rise between protesters and local governments. Protesters are setting police cars on fire as freeways remain blocked and windows are shattered, per the Washington Post. Law enforcement officials are using tear gas and rubber bullets to try to disperse crowds and send protesters home.

Updated 2 hours ago - Politics & Policy

George Floyd protests: What you need to know

Photo: David Dee Delgado/Getty Images

Clashes erupted between law enforcement and protesters in several major U.S. cities Saturday night as demonstrations over the death of George Floyd and other police-related killings of black men spread across the country.

The big picture: Floyd's death in Minneapolis police custody is the latest reminder of the disparities between black and white communities in the U.S. and comes as African Americans grapple with higher death rates from the coronavirus and higher unemployment from trying to stem its spread.

Updated 3 hours ago - Politics & Policy

In photos: Protesters and police clash nationwide over George Floyd

A firework explodes behind a line of police officers next to the Colorado State Capitol during a protest over the death of George Floyd in Denver on May 30. Photo : Michael Ciaglo/Getty Images

Police used tear gas, rubber bullets and pepper spray as the protests sparked by the killing of George Floyd continued nationwide into early Sunday.

The big picture: Police responded over the weekend with force, in cities ranging from Salt Lake City to Atlanta to Des Moines, Houston to Detroit, Milwaukee to Washington, D.C., Denver and Louisville. Large crowds gathered in Minneapolis on Saturday for the fifth day in a row.