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GOP Health Care Repeal Looks Poised to Go Down With a Thud

The Republican Obamacare repeal plan appears to be dead — for now. What happens next?
Protesters hold signs and shout at lawmakers walking out of the U.S. Capitol on May 4 after the House of Representatives narrowly passed a Republican effort to repeal and replace Obamacare.NICHOLAS KAMM / AFP - Getty Images

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 health care repeal likely to go down with a thud

For Senate Republicans, the health care developments over the last 12 hours must seem like the legislative equivalent to a standoff in a Quentin Tarantino flick. First, Sens. Mike Lee, R-Utah and Jerry Moran, R-Kansas, said Monday night that they wouldn't vote for the Senate health care legislation, which is now enough opposition to kill the bill. Then Majority Leader Mitch McConnell appeared to force Lee and Moran (and other GOP senators) to walk the plank by stating the Senate would vote on — as an amendment — a full repeal of Obamacare “in the coming days,” and would work on a replacement later. And in response to that, you're likely to see other Senate Republicans, especially the moderates, gang up on McConnell, given that a straight repeal would increase the number of uninsured by 32 million (!!!). And so like in the Tarantino movie, there are two options: 1) everyone disarms, or 2) it all ends very badly.

NBC’s Leigh Ann Caldwell has more. “While straight repeal passed the Senate in 2015, there was no possibility that it would go into effect because then-President Barack Obama vetoed the legislation. Just last week, Sen. Roy Blunt, R-Mo., told reporters that straight repeal wouldn't get the support of 50 Republicans.”

We’ve seen legislation, including this health care effort, come back from the dead before. But right now, repealing and replacing Obamacare looks more like Mr. White and Mr. Orange than — take your pick — Jon Snow or Halloween’s Michael Myers.

What the GOP could have learned from Obamacare, revisited

Back in March, when House Republicans first began their effort to repeal and replace the Affordable Care Act, we observed that the GOP had ignored some key lessons from how Democrats passed their legislation into law. And it’s worth revisiting these lessons in light of last night’s developments.

  • Get industry and major stakeholders to support the legislation: That's what Democrats and the Obama White House achieved in 2009-2010. Yet by comparison, House and Senate Republicans had groups like the AARP, the American Hospital Association, and the American Medical Association all opposing their efforts. What's more, the powerful group representing the country's health insurers (AHIP) ripped into the Ted Cruz amendment in the Senate legislation.
  • Go slow: Ultimately, the year-long process to pass Obamacare backfired politically, especially after Democrats lost Ted Kennedy's Senate seat. But as a way to pass legislation, the slow process was successful -- committee hearings, courting the opposition (even if that ultimately didn’t), Congressional Budget Office scores way in advance of votes. But this time around, Republicans didn’t try any of these things. As Sen. John McCain, R-Ariz., said in a statement last night: “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”
  • At least reach out to the political opposition: Yes, Obamacare didn't get a single vote from a Republican lawmaker. But it wasn't for a lack of trying. The Obama White House actively courted Sens. Susan Collins and Olympia Snowe, R-Maine, as well as Sen. Chuck Grassley, R-Iowa,. Indeed, Snowe voted for the Senate Obamacare proposal in committee in October 2009 — although she backed away in the votes for final passage. This time around? Republicans didn’t even try to reach out to Democrats.
  • Unite the party around the central tenets of the legislation: In 2009-2010, Democrats/independents from Ben Nelson and Joe Lieberman to Nancy Pelosi and Bernie Sanders agreed on the major provisions of the Affordable Care Act — exchanges working with private insurers, subsidies to help disadvantaged Americans to pay for insurance, major health-insurance regulations, and Medicaid expansion. Yes, they argued over a public option, but they agreed on almost everything else. Yet in 2017, Republicans were divided over basic things like whether to keep Medicaid expansion, whether to rollback insurance regulations, and whether the government should have any role when it comes to health care.
  • Have supermajority support — or close to it: Finally, and perhaps most importantly, Democrats held a supermajority in the U.S. Senate (60 votes), or close to it in 2009-2010. But this time, Republicans tried to repeal and replace Obamacare with just 52 senators, who range from Rand Paul, R-Ky., and Ted Cruz, R-Texas, to Susan Collins. And while Republicans attempted to pursue some of their goals via reconciliation (which requires just a simple majority), other key components to drive down costs and reform the health-insurance industry require 60 votes.

It’s so hard to take away a benefit

There’s another lesson Republicans learned: It’s VERY hard to take away a benefit. “An American entitlement, once established, can almost never be retracted,” the New York Times writes. “Since the day the Affordable Care Act passed Congress, Republicans have vowed to overturn it. In the beginning, many voters were with them, handing the Republican Party some of the tools: a sweeping rejection of House Democrats in 2010 — a rejection of government reach — followed by the Senate in 2014. But in the intervening years, as millions of Americans have become insured under the law that was derisively tagged with President Barack Obama’s name, the health care program has become more and more popular, even with Republican governors.”

Health care going down to defeat is a huge blow to Trump: Make no mistake.

If this marks the end of the GOP effort to repeal and replace Obamacare, it’s a huge defeat for President Trump. As our colleague Steve Kornacki smartly observed over the weekend, Trump has defied the experts and the numbers time and time again. Many political observers in 2015 said he couldn’t win the GOP nomination, but he did. And many thought he’d probably lose to Hillary Clinton, but he didn’t. But if health care goes down, then it looks like the laws of political gravity are still functioning: You need a popular president to pass legislation; you need that president to use his bully pulpit (at least with his own party); and you need that president to AT LEAST look like he’s reaching out to the opposition. As Trump tweeted this morning, “We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” And he added, “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”

NBC|SurveyMonkey poll: Fear of war grows

"An overwhelming majority of Americans — 76 percent — are worried that the United States will become engaged in a major war in the next four years, according to a new NBC News|SurveyMonkey National Security Poll out Tuesday. The number has jumped 10 points since February, when 66 percent of Americans said they were worried about military conflict. Although Americans are concerned about a number of national security threats, a strong plurality (41 percent) believe that North Korea currently poses the greatest immediate danger to the United States, emerging as a more urgent concern than ISIS (28 percent) or Russia (18 percent), according to the poll, which was conducted online from July 10 through July 14.”