Today, House Republicans are waking up to a big set of brutal ratings changes from the Cook Political Report. In the wake of the vote, Cook has shifted 20 GOP-held seats toward Democrats. Yes, 20.

AD

The House passage of the bill “guarantees Democrats will have at least one major on-the-record vote to exploit in the next elections,” Cook analyst David Wasserman writes, adding that the GOP passage of a bill this unpopular “is consistent with past scenarios that have generated a midterm wave.”

AD

The changes shift three House GOP districts from “Lean Republican” to “Toss up”; another 11 from “Likely Republican” to “Lean Republican”; and another six from “Solid Republican” to “Likely Republican.” Virtually all the Republicans in those districts voted for the health-care bill. The result is that overall, Cook’s ratings now put approximately two dozen GOP-held seats in the “Toss Up” or “Lean Republican” categories, meaning that they seem vulnerable as of now — and Democrats must flip 24 House seats to win the lower chamber.

Many more somewhat less vulnerable Republicans voted for the bill, too, potentially putting even more seats within reach. “Not only did dozens of Republicans in marginal districts just hitch their names to an unpopular piece of legislation, Democrats just received another valuable candidate recruitment tool,” Wasserman added. (Another 20 or so are in the “Likely Republican” category, which are harder to reach, but it’s not impossible that the political environment could deteriorate further for House Republicans in coming months.)

AD

Other analysts have reached similar conclusions. Daily Kos’ Stephen Wolf posted this chart, showing that 24 of the House Republicans who voted for the health-care bill come from districts where Trump carried less than 50 percent of the vote, 14 of them won by Hillary Clinton:

Meanwhile, Nate Silver takes stock of the abysmal unpopularity of the bill and concludes that the vote for it could prove “a job-killer for GOP incumbents.” And Nate Cohn draws a comparison between yesterday’s vote and the 2010 vote for the Affordable Care Act that helped cost Democrats dozens of House seats and their majority. As Cohn notes, if that history is any guide, it’s possible that those Republicans who voted for the GOP bill could lose substantial support in the next election.

To be sure, there are plenty of caveats. Republican districts tend to be safer than the 2010 Democratic districts were. The GOP bill probably won’t pass in anything like its current form. A milder version might end up emerging once the Senate weighs in. The Republican bill, whatever it ends up looking like, might get more popular. Or nothing may pass, and all this could fade from memory. But as Cohn concludes, it’s not impossible that things could get worse from here, if a Republican plan does pass in some form, because the changes it imposes could be felt before the 2018 elections:

AD

AD

Many effects of the new health plan could hit before the midterms. If those changes are wrenching to too many people, it is certainly possible that the Republican grip on the House will be in serious jeopardy — and that a lot of members have just cast votes that could define their career.

There are several layers of irony worth appreciating. Note, for instance, that the vote for the plan may end up putting a lot of Republicans at risk even if nothing like the current plan ends up passing. By contrast, many Democrats sacrificed their careers with a vote for a bill that did become law.

What’s more, as Paul Kane reports, many Republicans voted for this dangerous bill even though they didn’t like it all that much. They did this for a variety of reasons — caucus politics; pressure from Trump; a perceived need to show that House Republicans can govern; to increase the odds for other priorities. By contrast, the Democrats who voted for the ACA did so because they believed in it — and helped contribute to a historic coverage expansion as a result, though that may be in danger now.

The House GOP bill now faces very long odds in the Senate, precisely because it’s a moral and political disaster. One of the big moral questions at the core of the health-care debate is whether to vastly roll back the ACA’s spending and regulations that are currently enabling so many poor and sick people to gain coverage, and to again put that coverage at risk. The GOP bill puts this coverage in danger for millions. Thus, many GOP senators and governors — for political and principled reasons alike — are not going to accept the House GOP bill’s deep cuts to Medicaid and weakening of protections for people with preexisting conditions. The result will be a long, intense debate that serves to focus more attention — possibly for months — on the albatross that many vulnerable House Republicans just hung around their own necks.

AD

AD

**********************************************************************

* GOP SENATORS FACE TOUGH ROAD ON HEALTH BILL: The New York Times sums up the difficulties ahead for the repeal-and-replace bill in the Senate:

Senate Republicans will face some of the same dynamics that stymied the House for weeks. Moderate senators will demand significant concessions, which in turn could alienate three hard-liners: Senators Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah. Republican senators are certain to face pressure from governors worried about constituents on Medicaid losing their coverage.

The House bill’s phase-out of the Medicaid expansion is likely to be opposed by GOP senators and governors from states that opted into it. But conservatives won’t accept anything that doesn’t phase it out.

* KEEP AN EYE ON THE GOP GOVERNORS: The Associated Press adds this about the House GOP bill’s phase-out of the Medicaid expansion:

Many of the 31 states that accepted Obama’s expansion of that program are led by GOP governors, and senators have no interest in cutting their states’ funds and taking coverage away from voters. Republican senators also represent states ravaged by deaths caused by opioid abuse. The House measure would let states escape Obama’s requirement that insurers cover anti-drug services.

Yeah, this bill is going to get slaughtered by many Republicans in the days and weeks ahead.

* BIG PROCEDURAL CHALLENGE LOOMS IN SENATE: The new GOP bill added provisions allowing states to seek waivers on essential benefits and preexisting conditions, to win over conservatives. The Post points out this will create a new set of problems in the Senate:

AD

AD

The original proposal initially left many of the ACA’s insurance regulations alone — with the goal of ensuring it would pass muster with the Senate parliamentarian — but not all of them. The House’s version of the bill would undercut the ACA’s insurance regulations even more. That might make it difficult for Republican senators to pass the measure under a procedural maneuver known as “reconciliation,” which is usually reserved for budget legislation.

This is a problem. It means Republicans probably can pass measures impacting the Medicaid expansion, subsidies and individual mandate with a simple majority — but probably can’t pass these sorts of deregulatory features conservatives want.

* STATE OFFICIALS NOT CRAZY ABOUT HOUSE GOP BILL: Politico asks GOP governors and state legislators whether they would seek waivers from the ban on insurers jacking up premiums on preexisting conditions, if the GOP bill ever becomes law:

Not a single governor has stepped up to say they want to take advantage of that leeway. Officials in a dozen states surveyed by POLITICO weren’t eager to embrace opt-outs that would let states skirt key insurance provisions, including safeguards for people with pre-existing conditions and a set of basic, required health benefits … for now, state officials are holding back. Governors run the risk of being blamed for abandoning patients with pre-existing conditions if they grab any of these exemptions.

What a shocker. If somehow this does become law, this would put them in a terrible spot, because they’d come under tremendous pressure from the right to seek these waivers.

* HOUSE MODERATE PREDICTS BILL WILL BE ‘GUTTED’: Rep. Charlie Dent (R-Pa.). who opposed the bill, had this to say about what’s next for GOP moderates who voted for it:

AD

AD

“Members have been asked to vote for a bill that is particularly treacherous, that is going nowhere in the Senate. This legislation will be gutted and we will have voted for a bill that will never become law. Will it cause headaches for people? Absolutely.”

Yeah, pretty much. But at least those moderates don’t have to fear being punished by Trump’s terrifying Twitter feed!

* THE TRUMPISM OF THE DAY: After the health-care bill passed yesterday, Trump murmured a few things about how Trumpcare is going to make America awesome again, then said this to the prime minister of Australia:

“It’s going to be fantastic health care,” Trump said, referring to his new health care plan. “I shouldn’t say this to our great gentleman and my friend from Australia because you have better health care than we do.”

Australia has universal health care. On Chris Hayes’s show last night, Sen. Bernie Sanders (I-Vt.) burst into laughter after being played a video of Trump’s remarks. It’s worth a watch.

* AND TRUMP JUST WANTED A ‘WIN’: Politico reports on a call between Trump and Rep. Fred Upton (R-Mich.), who had opposed the health-care bill, angering Trump, before delivering the amendment that salvaged it:

Trump did not want to talk about the merits of the legislation — he didn’t care much about those specifics, senior officials said. What mattered to him was how a failed vote would hobble his presidency and the ability to get other legislation through Congress. He wanted a win.