A lot of House Republicans probably heaved a sigh of relief when they learned that a Friday defection by Sen. John McCain (R-AZ) may have saved them from another round of Obamacare votes.
“If you’re in a congressional swing district, this was not a vote you were looking forward to taking,” said Ken Spain, a GOP strategist and former top staffer at the National Republican Congressional Committee. “McCain did Republicans a favor — this was going to be a very difficult vote that was going to have significant political consequences in 2018.”
That’s especially true for the House Republicans in states that expanded Medicaid, since the Senate bill to repeal the Affordable Care Act would be particularly devastating to those states, and since a number of those lawmakers are already facing brutal reelection fights.
Seventeen states face drastic cuts of 30 percent or more of their federal funding for premium subsidies and Medicaid, according to the Trump administration’s own numbers, with some of the hardest-hit states represented by vulnerable GOP incumbents who are already staring down tough reelection fights in 2018.
If McCain and other Senate Republicans had kicked the bill back to the House, that would have left members with a dire choice: Break with their party over a seven-year promise and be labeled — in President Trump’s words — “the Republican who saved Obamacare,” or vote for a bill that would be particularly harmful to their own constituents and their own electoral hopes. Due to that, a number of House Republicans are likely hoping the bill dies in the Senate before they have to take another career-damaging vote.
Instead, McCain gets that dubious title — and Republicans can hope to move onto safer ground.
“If this stops it to a point where we can move onto tax reform, an issue with a more direct economic tie to individuals, then I think he’s done us a favor,” one Republican pollster told TPM Friday afternoon, shortly after McCain’s announcement.
Those seventeen at-risk states are home to 15 of the 32 Republicans the nonpartisan Cook Political Report ranks as being in toss-up or lean Republican races. That includes six members from California, a pair each from New York, New Jersey and Minnesota, and three from Pennsylvania.
The hastily-drafted Graham-Cassidy bill would repeal much of the Affordable Care Act, including the individual and employer mandates, convert Medicaid into a capped block grant that loses values over time, and allow states to waive some protections for people with pre-existing conditions.
Under the bill’s complex formula, the states that expanded Medicaid under Obamacare are by far the hardest hit. California faces a dramatic 45 percent cut in its state funding by 2026 — a whopping $21 billion, according to numbers put out by the Centers for Medicaid and Medicaid Services on Friday. New York isn’t far behind, with a 44 percent projected loss of federal support totaling a $9 billion cut.
Recent reports from non-partisan independent groups like the Kaiser Family Foundation, Brookings, and Avalere find deep, painful funding cuts to these states as well—and estimate that tens of millions of people would lose insurance by 2026.
“People drastically underestimate how hard it’s going to be for some House Republicans to vote for this repeal bill,” Jesse Ferguson, a Democratic campaign veteran working with the pro-Obamacare group Save My Care, told TPM before McCain announced his decision.
Democrats scrambling to defeat the latest Obamacare repeal bill are putting a particular emphasis on the California and New York GOP House delegations. Save My Care is out with digital ads pushing five Republicans who backed the earlier bill to vote against this one, highlighting the particular damage the bill would do to the Empire State. SoCal Health Care Coalition is going after five vulnerable California Republicans with digital ads as well.
Republican members from those states sounded increasingly alarmed about the cuts over the last few days — a sign that they were less than thrilled to have the bill land back in their laps.
The New York delegation’s Republicans had been especially vocal in their concerns.
“If you look at how much of a loss it would be to New York state, it’s $18 billion,” Rep. Elise Stefanik (R-NY), who’s from a marginally competitive district, warned on Thursday.
Rep. Tom Reed (R-NY), another potentially vulnerable member, said that he was worried about the people who’d gotten health coverage under his state’s Medicaid expansion.
“They’re the ones who are going to suffer by this policy that we’re enacting,” he said on CNN Friday morning.
And Rep. Peter King (R-NY) said early last week that the Medicaid cuts particularly concerned him.
“Right now, I don’t see how I could vote for it,” he told the Washington Post. “It’s extremely damaging to New York.”
California’s GOP members have so far been mostly silent on the bill, and in the past have shown more of a willingness to follow leadership’s marching orders.
The last time the House voted to repeal Obamacare back in May, every single California Republican fell in line and supported the bill in spite of its deep cuts to Medicaid, weakening of protections for people with pre-existing conditions, and ban on tax credits for any insurance plan that covers abortions, which every plan in California does by law.
McCain’s decision likely means they won’t have to vote on an even more damaging bill.
Dave Wasserman, who runs The Cook Political Report’s House race coverage, predicted before McCain’s announcement that if the Senate can muster the votes on the bill, wavering House Republicans will end up caving, and badly damage their reelection prospects as a result.
“The Senate is the choke point here. The House, if forced between nothing and whatever the Senate does, will go with whatever the Senate does,” he said. “Republicans for the most part ran on this pledge, they won their seats, and they intend to follow through, even though it will cost many of them their jobs.”
“There will be plenty of plank-walkers if this bill comes to a vote on the floor of the House,” he predicted.
Now, they likely won’t have to face that prospect.