Evan Vucci / AP
They had the vote and the White House victory rally. Now they have to go out and make the case for their replacement for the Affordable Care Act — and not just to the faithful who wanted repeal all along. The bill was loaded up with politically dangerous changes all along, and judging from all the damaging headlines about what might count as a pre-existing condition, now it has even more.
Here's what could make them the most vulnerable, at town halls and in next year's mid-term elections.
- Pre-existing condition waivers. They're spending so much time explaining the waivers that states could get under Rep. Tom MacArthur's amendment, and the specific circumstances in which they might apply, that all of their work to limit the damage isn't doing them much good. It didn't help when Wisconsin Gov. Scott Walker immediately suggested he might apply for one.
- Essential health benefit waivers. They're going to spend a lot of time explaining which benefits might be cut and arguing about which ones aren't important. (Maternity coverage seems to be a big one.)
- Medicaid cuts. As Health and Human Services secretary Tom Price found this weekend, when the bill cuts $880 billion over 10 years, it's hard to convince people that no one will be hurt by that — especially when the Congressional Budget Office says 14 million people will lose coverage.
- Age rating. AARP is already firing away at the "age tax" — the provision that would let insurers charge older customers as much as five times more than young adults, compared to the 3:1 ratio under the ACA.
- Replacing the tax credits. The bill replaces the ACA's tax credits, which adjust for income and geography, with flat credits based on age. But by reinventing the ACA tax credit, they're finding all kinds of problems that have to be fixed — like CBO's warning that they'd leave the low-income elderly vulnerable to massive premium increases. (Sen. Susan Collins said on ABC's This Week that the GOP tax credits should adjust for — wait for it — income and geography.)
- Net investment tax repeal. The bill gets rid of the ACA's taxes, but by repealing the 3.8 percent tax on high-income people's net investment income, they're getting hammered with charges that the bill is a tax cut for the rich.
- Congressional exemption. The House scrambled to pass a separate bill to get rid of the exemption that shields members of Congress and their staffs from the effects of the state waivers. But judging from the way that exemption has taken off in social media, the damage is already done.