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GOP Faces Three Challenges as Health Care Heads to the Senate

As the health care bill goes to the Senate, Republicans there will have to grapple with their vote margin, midterm election concerns and their mood.
Paul Ryan, Mitch McConnell
Senate Majority Leader Mitch McConnell of Ky., accompanied by House Speaker Paul Ryan of Wis., speaks to reporters outside the White House in Washington, Monday, Feb. 27, 2017.Pablo Martinez Monsivais / AP

First Read is your briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter

GOP faces three challenges as health fight turns to the Senate

Republicans passing health care out of the House was always the easiest part of repealing and replacing Obamacare. Now comes a much harder part — the Senate — where the GOP faces three challenges. Call them the three M's:

Margin: In the House, Republicans currently enjoy a 238-193 majority, so they could lose 20 Republican votes and still pass the legislation like they did yesterday. But in the Senate, it’s a slim 52-48 majority, and thus they can afford just two defections — a daunting task when their members range from Ted Cruz/Rand Paul/Mike Lee on the right to Susan Collins/Lisa Murkowski in the middle.

Midterms: In 2018, Senate Republicans are blessed by the fact that only nine of their members are up for re-election, and most of them hail from ruby-red states. But there are two exceptions — Jeff Flake (AZ) and Dean Heller (NV). How they navigate the Senate’s right-center divide, especially given the GOP’s slim majority, could be crucial.

Mood: As NBC’s Benjy Sarlin writes, Senate Republicans are in no rush to pass legislation, and they’re not big fans about the bill House Republicans just cleared. "We're not under any deadline, so we're going to take our time," Sen. John Cornyn (R-TX) said yesterday. Added Sen. Lindsey Graham (R-SC) on Twitter: “A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.” And then there’s President Trump’s job-approval rating, which remains stuck in the low 40s.

Here’s how Republicans can turn it all into law

Despite those challenges in the Senate, there’s still a chance that this entire effort can become law. Here’s how Republicans do it, as we described in March:

  • Step 1: Make the House bill more conservative to shore up the right flank. (DONE)
  • Step 2: Mitch McConnell and GOP Senate appease the moderates: Senate Majority Leader Mitch McConnell offers revisions to placate the moderate voices (like Collins, Murkowski, Shelley Moore Capito, and maybe Heller and Flake) by making Medicaid fixes and restoring funding for Planned Parenthood. To get 51 votes, Republicans can afford to lose two GOP votes (say Paul and Cruz — but not more than that (Collins, Murkowski, Capito, Heller, Flake).
  • Step 3: Senate Republicans dare the House to oppose their more moderate bill: And if that passes, the Senate side dares House conservatives to oppose the bill — which they would say is the last best chance to repeal and replace Obamacare. Of course, that approach is perilous: Will House Republicans really accept more/expanded Medicaid funding? Can they swallow not defunding Planned Parenthood? Can the Freedom Caucus accept that the Senate legislation probably won’t touch Essential Benefits?

As we put it back in March: Can it still pass into law? Absolutely. Will it be easy? No way. And keep in mind: The real Democratic attacks haven't even begun.

Yesterday’s health-care vote is going to play out in races well before the 2018 midterms

Speaking of Democrats, they’re beginning their health-care attacks on Republicans well before the 2018 midterms — starting with the upcoming special congressional elections, as well as in this year’s marquee gubernatorial race. Here’s Democrat Jon Ossoff in that GA-6 special: “I strongly oppose this bill, which allows discrimination against Georgians with pre-existing conditions and would make health insurance unaffordable for millions of families. This bill puts Georgians’ lives at risk,” he said in a statement.

Republican opponent Karen Handel has previously called the GOP legislation “a work in progress, but it is on the right track.” In Montana’s special congressional election, which takes place on May 25, Democrat Rob Quist also pounced on the legislation. “The House of Representatives … passed a bill that would kick thousands of hardworking Montanans off of their health insurance and raise premiums by hundreds of dollars a month,” he said. And in Virginia’s gubernatorial race, Democrat Tom Perriello cut a TV ad within minutes of passage that seized on the GOP bill.

A lot of vulnerable House Republicans took difficult 'yes' votes

As for the 2018 midterms, it’s striking how many potentially vulnerable Republicans had to cast YES votes to pass the legislation. Of the 23 House Republicans who represent districts that Hillary Clinton carried in 2016, 14 of them voted YES. And of the 35 House GOPers who are running in competitive races, per the Cook Political Report, 25 of them voted YES.

Of the 23 Republicans representing districts Clinton won in 2016 (14 yes, 9 no)

  1. Coffman (R-CO) NO
  2. Comstock (R-VA) NO
  3. Costello (R-PA) NO
  4. Culberson (R-TX) YES
  5. Curbelo (R-FL) YES
  6. Denham (R-CA) YES
  7. Hurd (R-TX) NO
  8. Issa (R-CA) YES
  9. Katko (R-NY) NO
  10. Knight (R-CA) YES
  11. Lance (R-NJ) NO
  12. McSally (R-AZ) YES
  13. Meehan(R-PA) NO
  14. Paulsen (R-MN) YES
  15. Reichert (R-WA) NO
  16. Rohrabacher (R-CA) YES
  17. *Ros-Lehtinen (R-FL -- retiring) NO
  18. Roskam (R-IL) YES
  19. Royce (R-CA) YES
  20. Sessions (R-TX) YES
  21. Valadao (R-CA) YES
  22. Walters (R-CA) YES
  23. Yoder (R-KS) YES

Thirty-five Republicans in competitive races, per Cook Report (25 yes, 10 no)

  1. Bacon (R-NE) YES
  2. Blum (R-IA) YES
  3. Bost (R-IL) YES
  4. Coffman (R-CO) NO
  5. Comstock (R-VA) NO
  6. Costello (R-PA) NO
  7. Culberson (R-TX) YES
  8. Curbelo (R-FL) YES
  9. Denham (R-CA) YES
  10. Faso (R-NY) YES
  11. Fitzpatrick (R-PA) NO
  12. Frelinghuysen (R-NJ) YES
  13. Hurd (R-TX) NO
  14. Issa (R-CA) YES
  15. Katko (R-NY) NO
  16. Knight (R-CA) YES
  17. Lance (R-NJ) NO
  18. Lewis (R-MN) YES
  19. McSally (R-AZ) YES
  20. Meehan (R-PA) NO
  21. Paulsen (R-MN) YES
  22. Poliquin (R-ME) YES
  23. Reichert (R-WA) NO
  24. Rohrabacher (R-CA) YES
  25. *Ros-Lehtinen (R-FL -- retiring) NO
  26. Roskam (R-IL) YES
  27. Royce (R-CA) YES
  28. Sessions (R-TX) YES
  29. Smucker (R-PA) YES
  30. Tenney (R-NY) YES
  31. Trott (R-MI) YES
  32. Valadao (R-CA) YES
  33. Walters (R-CA) YES
  34. Yoder (R-KS) YES
  35. Young (R-IA) YES

Per MSNBC’s Ed Demaria, there are seven potentially vulnerable California Republicans on this list, and ALL SEVEN voted for the House GOP bill. California will be an interesting state to watch next year…