GOP Lawmakers in Clinton Territory Weigh Health Bill Vote
As the most conservative members of Congress try to flex their political muscle on the new health care legislation, GOP leaders face the tough job of balancing hard-liners' demands against those of moderate colleagues who worry various provisions in the bill won’t pass muster with constituents.
Opposition from Republican Sens. Ted Cruz, Rand Paul and members of the House Freedom Caucus has garnered attention from GOP leaders and President Trump, who is traveling to Kentucky next week to promote the replacement effort -- and perhaps put pressure on Paul, the state's junior senator. But a quieter group of lawmakers from districts that Trump either lost, or barely won, are assessing the plan, too, and some are already leaning against it. Tipping to conservatives’ wishes would risk alienating those concerned about phasing out Medicaid subsidies too quickly or about fallout from the Congressional Budget Office projections of higher premiums and an increase in the number of uninsured.
The process, which could drag on through the next recess, could leave some of the already vulnerable members susceptible to attacks from constituents wary of health care changes. On this legislation and other measures, this group of lawmakers will be interesting to watch, particularly the 23 Republicans who hail from districts Hillary Clinton won in 2016.
Florida Rep. Ileana Ros-Lehtinen, whose district Trump lost by 20 points, said she intends to vote against the bill, known as the American Health Care Act, arguing that finding the proper replacement for Obamacare requires bipartisan work.
New York Rep. John Katko, who represents a district that has gone Democratic in presidential years, said this week that the CBO report gives him "significant concern."
Democrats are targeting these 23 Republicans—eight of whom are from California—in their long-shot efforts to take back the House. Clinton carried half of these districts by at least five points. And while most of these Republicans significantly outperformed Trump, some, like San Diego-area Rep. Darrell Issa, won by razor-thin margins.
Issa told RCP he is still undecided about the legislation, which is still being tweaked, and said the impact on mental illness coverage under Medicaid was a concern for his constituents. The California congressman said he also wanted to make certain the projected rise in the number of uninsured Americans—24 million over a decade, according to CBO report—would be largely attributable to people choosing not to purchase insurance, and not because they were getting kicked off a plan.
Clinton won Issa's district by 7.5 points, and the congressman was re-elected by about half a percentage point. "I campaigned for Marco Rubio, then I supported Trump, and I won my district," he said. "So my view is, my district trusts me. But they trust me to listen thoroughly and ask for answers.
"Is Obamacare collapsing if we do nothing? Yes," he said. But, "I've got to be comfortable that the fix accomplishes many of the things it says."
As the former chairman of the powerful Oversight Committee, Issa was a fierce critic of then-President Obama. Indeed, Mitt Romney beat Obama in this district by about six points—and won 14 other districts that flipped in favor of Clinton in 2016, according to a Daily Kos analysis of the election results, which helps explain support for Republicans there. Democrats argue that Trump will weigh heavily in these mostly suburban or majority Hispanic districts in the 2018 midterms, and believe that incumbents' votes on health care legislation will carry political consequences.
House conservatives said Thursday that midterm losses are the cost of doing business. "Historically, in an off-year presidential election, there are times you do lose Republican seats," said Republican Study Committee Chairman Mark Walker. "There is no guarantee for these moderate members."
"We are going to lose seats if we don't keep our promises," said Freedom Caucus member Rep. Raul Labrador. "We're going to lose more seats with Obamacare lite."
Members of the centrist Tuesday Group gathered this week to discuss their concerns, mainly about the legislation's plan to end Obamacare's Medicaid expansion by 2020. Others have voiced concern about the bill's impact on seniors and those with low income. But it's unclear whether centrists will hold the line through to the end.
GOP leaders anticipate centrist Republicans will ultimately hold to their pledge of replacing Obamacare, if given a binary choice. And several of these members already supported the legislation in their requisite committees, though some of those votes were cast before the CBO report was published. GOP defections in the Budget Committee vote on Thursday came from conservative lawmakers.
Rep. Carlos Curbelo, whose district Trump lost by 16 points, approved the legislation during the House Ways and Means Committee markup, arguing that the fact that "the far left and the far right have come together to viciously attack this proposal is likely a good indicator that it is sound, sensible policy." The Florida congressman is now evaluating the CBO numbers as well as any other additional changes before making his final decision, his office said.
Curbelo won his district by nearly 12 points, and has made news for eschewing party politics by introducing legislation to protect DREAMers and for urging the Trump White House to uphold the Obama administration's climate change accord.
Washington Rep. Dave Reichert, who represents a district both Clinton and Obama won, voted for the legislation in the Ways and Means Committee. Reichert told RCP that his constituents have concerns about the CBO score, and that he would talk with them about it during a town-hall gathering later this week. Ultimately, though, he intends to support the bill.
Kansas Rep. Kevin Yoder, whose district Trump lost by just one point, said he is still working through the legislation, but believes the bill is on the right track. He said his constituents like that it keeps the Obamacare provision for pre-existing conditions and argued that he can explain to them that the projected increase in the uninsured rate would be a result of people no longer being required to purchase insurance coverage. "We don't believe the federal government has the responsibility or the authority to force people to buy products," he told RCP. "If we don't get this right then the Democrats will move to a single-payer system. This is the last off-ramp on the socialism highway here."
Illinois Rep. Peter Roskam (in photo above, left), another Ways and Means member who supported the bill in committee, signaled reservations about the Medicaid component in an interview with Crain's Chicago Business this week. Trump lost his district by about seven points, and Roskam, who usually aligns with leadership, is often a target of Democrats.
The American Action Network, an outside spending group aligned with House GOP leadership, is providing some air cover for vulnerable Republicans on the health care reform issue. The group launched a $1.5 million ad campaign this week in 15 districts. "Republicans are keeping their promise with a new plan for better health care," the narrator says in the ads, which never mention the word "Obamacare."
The spot is airing in Curbelo's and Issa's districts, as well as in the San Antonio area represented by Republican Will Hurd. Hurd drove to Washington this week—a 1,600-mile road trip—with Democratic Rep. Beto O'Rourke. The two documented their car travel—forced by snowstorms that had canceled flights—on social media as a model of bipartisanship.