If you listen to any Democrat in America, Senate Republicans' Obamacare replacement bill is (at best) "mean," and would result in "thousands" of Americans' deaths. According to CBO, the proposed legislation would result in 22 million fewer people obtaining insurance by the end of the budget window, primarily due to people choosing not to buy healthcare once Obamacare's mandate is repealed. The nonpartisan scorekeeper is once again placing an unjustifiable amount of faith in the power of the mandate, while using indefensible baselines for their analysis, given the real-life data available. Right on cue, many on the Left and in the media are running with the "22 million lose insurance" framing, which is a lie. CBO also projects that the Senate bill would save more money and reduce deficits more than the House version, and that after bumping premiums in the first year or two, it would reduce individual market healthcare premiums by 30 percent by 2020. Relatedly, a major insurer weighed in yesterday, averring that Republicans' Obamacare alternative would help "bolster" the Obamacare-destabilized individual market.

Still, as of this writing, Mitch McConnell does not have the votes for passage, or even to proceed to a final vote. Moderates like Dean Heller and Susan Collins are worried that the plan goes too far in reducing Medicaid (Collins is now sounding like she's moving toward an Obamacare attitude of 'fix, don't replace'), even though the bill increases Medicaid spending -- just not as much as Obamacare. In DC, this is known as a "draconian cut." Meanwhile, conservatives like Rand Paul, Mike Lee, Ted Cruz, and Ron Johnson say that the legislation doesn't even approach achieving full repeal, and that the core mandates that have driven up costs under Obamacare would stay intact under the proposal, thus failing to address the underlying problem. McConnell can only afford to lose two GOP votes in order to pass the bill, and right now, it looks like he's in danger of losing at least six. Senate Republican leadership has vowed to hold a vote later this week, but if they're shooting for a successful outcome, they may need to push negotiations into July:

New: @RonJohnsonWI just told me if senate gop leadership insists on moving to h care this week he will vote against motion to proceed. — Dana Bash (@DanaBashCNN) June 27, 2017

WASHINGTON (AP) — Utah Sen. Mike Lee becomes 5th GOP senator to oppose starting health care bill debate in latest blow to party leaders. — Kyle Griffin (@kylegriffin1) June 27, 2017

McConnell, meanwhile, is warning his members that if Republicans fail to advance their own Obamacare replacement bill, they will end up negotiating with Chuck Schumer , presumably on a package of "fixes" that will officially mark the permanency of the Democrats' failing law. And because it's failing , which nobody can honestly deny at this point, the GOP can either act to fulfill a clear campaign promise, or they'll need votes from this crew (and probably a lot of them) to stop the law's bleeding. Conservatives are divided on the bill: Philip Klein Peter Suderman , and National Review's editors are against it. Avik Roy is strongly for it . And others, like myself and Yuval Levin are conflicted. (I should note that my top concern about the Senate bill -- its lack of a mechanism to prevent free loading, and hasten Obamacare's adverse selection death spiral -- has been somewhat alleviated through a six-month waiting period to obtain health plans for new customers who have not previously been continuously insured. I'm not sure if it's a sufficiently potent provision, but it's obviously better than nothing). Here is a snippet of Levin's dead-on analysis

The most significant lesson Republicans have learned in this period is that what they—as a congressional conference guided by the sentiments of a majority of its members—want to do about Obamacare doesn’t begin with repeal. Whether they individually hold this view or not, congressional Republicans should not deny that this is the premise that they as a group have decided to start from, because the bill they passed in the House and the one they are now pursuing in the Senate wouldn’t make sense under any other premise. They are choosing to address discrete problems with Obamacare within the framework it created and to pursue some significant structural reforms to Medicaid beyond that, and they should want the merits of their proposal judged accordingly. Their premise is politically defensible—it is probably more so than my premise—and the proposal they have developed makes some sense in light of it.



On the substantive particulars, I would say the bill is mostly better than the House version passed last month. We will see what CBO and other modelers ultimately say (understanding the limits of such modeling), but it seems to me it will probably cover more people, reduce premiums more, and allow for a greater reassertion of state regulatory control over health insurance. Better than the House bill isn’t extravagant praise, of course, but it is certainly one bar such a bill ought to clear...I do think it is probably more good than bad on net—and could be readily improved and made more generous in years to come while retaining some important structural reforms and innovations.

Read the whole thing for a thoughtful and clear-eyed assessment of what the legislation actually does (this is another good piece on that front), as opposed to the salesmanship from GOP leaders, the boosterism from Roy, or the hysterical doomsaying from most of the Left. The Wall Street Journal's editors are calling the upcoming vote -- whether it is held this week or next month -- a 'do or die' moment for the Republican Party. They're right:

Senate Republicans are headed for a vote on their health-care bill as soon as this week, and Majority Leader Mitch McConnell is still scrambling for 50 votes. What the holdouts should understand is that this is a defining political moment. They may never have a better chance to improve U.S. health care and reform government, and the window is closing. Repairing the failing individual insurance market, putting Medicaid on budget for the first time in the entitlement’s history, and passing an enormous pro-growth tax cut are historic opportunities. If reluctant GOP Senators think they won’t be held accountable for a defeat, they should think again...[The bill delivers] enormous conservative policy victories, even if they aren’t everything we or other free-marketeers would like. Democrats built the entitlement state piecemeal over decades, and it will have to be reformed in pieces that are politically sustainable...Some Senators can’t be placated on substance and they may decide that defeating the bill is better for them politically. This is pure fantasy.



Democrats won’t ease their opposition to Nevada’s Dean Heller in 2018 if he votes no. They’ll double their investment against him as Mr. Heller’s political base sours on him. When you face a tough political choice, better to stick with your friends than bet on the kindness of political enemies. Another fantasy is that Republicans can vote no and blame Democrats for the collapsing ObamaCare status quo. The media will blame Republicans for every premium hike, and voters believe they elected a GOP Congress and President. If this bill fails Republicans will be forced to come hat in hand to Chuck Schumer’s Democrats for the votes to stop a downward spiral of surging premiums and declining choices. Conservative reform won’t be included. The larger and rarer opportunity is to show that conservative ideas can succeed in health care. More progress is possible as voters come to trust Republican solutions, but not if the GOP now panics into defeat. Senator Johnson entered politics to oppose ObamaCare. Is he really going to squander this chance to make his detour into politics worthwhile?

The editorial concludes, "every consequential legislative reform is difficult, but the GOP anxiety over repeal and replace is excessive. They should have more confidence in their convictions and how their solutions can improve American lives." If this thing gets punted into July, as seems quite possible, Democrats will have more time to turn the screws on wavering Republican members. But GOP leaders will also have some space and money with which to placate centrists:

Given that CBO says this reduces deficits by $321 billion, seems very likely they'll throw more money at centrists in coming days. — Philip Klein (@philipaklein) June 26, 2017

But if extra goodies are offered to entice moderates like Portman, Collins, Murkowski, Heller, Capito and Cassidy (those are a lot of cats to herd), wouldn't that necessarily alienate the conservative wing even further? If Lee, Cruz and Paul don't see more progress toward their priorities, their votes alone could sink the whole bill. Right now, it looks like even clearing a motion to proceed is going to be a heavy lift . Does McConnell have a few cards up his sleeve?