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GOP's Obamacare Replacement Plan Faces Four Big Obstacles

First Read is a morning briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter
A patient gets his blood pressure measured with a sphygmomanometer and a stethoscope in Iserlohn, Germany on Sept. 17, 2005.
A patient gets his blood pressure measured with a sphygmomanometer and a stethoscope in Iserlohn, Germany on Sept. 17, 2005.Klaus Rose / picture-alliance/dpa/AP file

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

GOP’s Obamacare replacement plan faces four obstacles

House Republicans have produced real legislation to replace Barack Obama’s 2010 health-care law. That’s the good news for them — and it eliminates a long-standing Democratic talking point that the GOP hasn’t offered a real alternative to the law. The bad news for them is that their bill faces four obstacles, the biggest of which divide conservative and more moderate Republicans:

1. It essentially keeps Obamacare’s architecture: The House GOP plan replaces the individual mandate with a 30% surcharge if customers go weeks without insurance, and it swaps Obamacare’s subsidies for tax credits, per NBC’s Maggie Fox. And that has received criticism from conservative Republicans. “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!” Sen. Rand Paul (R-KY) tweeted. Added Rep. Justin Amash (R-MI): “Obamacare 2.0,” he said.

2. It phases out Medicaid expansion by 2020: While this likely will please many conservatives, it’s bound to anger more moderate Republicans in states that have expanded Medicaid coverage. “While we support efforts to repeal and replace the Affordable Care Act and make structural reforms to the Medicaid program, we are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states,” Sens. Rob Portman (R-OH), Shelley Moore Capito (R-WV), Cory Gardner (R-CO), and Lisa Murkowski (R-AK) said of an earlier GOP draft bill.

3. It contradicts Trump’s central economic message: One of President Trump’s most powerful messages -- especially in places in Michigan, Pennsylvania, and Wisconsin -- is that the little guy is getting screwed over by the big guy. But here is exactly how Democrats are going to attack the House GOP plan: It gives a big tax break to the wealthy (by eliminating taxes that Obamacare imposed to pay for the 2010 law), and it will cover fewer Americans (by as many as 15 million, per one estimate).

4. It lacks real transparency: In 2010, Republicans complained that Democrats jammed through Obamacare without real transparency. Yet while House Republicans have unveiled their legislation, the committee markup begins TOMORROW -- so no hearings and subcommittee work. More importantly, the Congressional Budget Office has yet to weigh in on the legislation’s costs and coverage. A House GOP aide tells First Read, “Committees regularly go through the markup process without a formal CBO score.” But just imagine the howls from Republicans in 2009-2010 if Democrats didn’t hold hearings and have a CBO score before marking up the legislation…

To sum it all up: Conservatives don’t like the legislation because it keeps Obamacare’s architecture; moderates don’t like the phasing out of Medicaid; Trump might not like the blowback from supporting legislation that cuts taxes for the wealthy while taking away health care from ordinary Americans; and those who complained about transparency seven years ago are getting less transparency now.

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But here’s how Republicans can still pass it

This is their last best chance to eliminate Obamacare: Despite those four obstacles, however, there is one big reason why Republicans might still be able to pass legislation: This is their last best shot to eliminate Obamacare. If Republicans can’t do it now -- in control of the White House and Congress, and after seven years of promising to overhaul -- then they’ll never do it. And that could be a powerfully motivating force. As Trump tweeted this morning, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!” But to pass something, Republicans are going to have to reconcile conservatives who want to eliminate Obamacare’s architecture (because when Democrats return to power, they can make their own changes) and moderates who want to keep it (Medicaid expansion). That’s quite a conundrum.

Here’s what’s in the House GOP bill

The breakdown, per NBC’s Leigh Ann Caldwell and Alex Moe:

  • Tax credits: The bill would provide tax credits that could be obtained in advance for people to buy insurance based on age. Under Obamacare, people get subsidies to buy health insurance based on income. Under the GOP plan, 20-year-olds could get tax credits worth $2,000, and the credits would grow the older a consumer gets. A 60-year-old could get a $4,000 tax credit. The tax credits would start to be reduced for a person making more than $75,000 and for a couple making more than $150,000 to ensure that high-income patients' insurance wasn't being federally subsidized.
  • Health savings accounts: The bill would expand the incentive to use so-called health savings accounts by doubling the allowed contribution to more than $6,000 per person and $13,000 for a family.
  • Medicaid: In 2020, Medicaid expansion would be frozen and new people would be barred from enrolling under the income-based system. The new way to provide coverage would allow states to implement eligibility based on population, essentially putting capping the number of people who could enroll in the government program for low-income people.
  • Planned Parenthood: The measure would strip funding for Planned Parenthood for one year.
  • What would stay: The measure wouldn't fully repeal Obamacare. It would keep some of the most popular components of the Affordable Care Act, including an assurance that people with pre-existing conditions could keep their insurance. It would als allows people under age 26 to stay on their parents' insurance.

McCain: Trump needs to show evidence for his wiretapping allegation

Roll Call: “Senate Armed Services Chairman John McCain said Monday that President Donald Trump needs to show evidence he was wiretapped at the behest of former President Barack Obama. ‘The president said it, and based on something. What was the basis of his conclusion that his predecessor had broken the law by wiretapping Trump Tower?’ McCain said. ‘The American people need to know.’” More: “When the Arizona Republican was told that White House officials said they would not take further questions about Trump’s Saturday morning tweet, McCain said Trump had an obligation given the gravity of the accusations. ‘They should answer questions. The American people have a right to know. They can say whatever they want to say. I’m saying the American people have a right to know on what basis the president of the United States said that his predecessor had broken the law by wiretapping Trump Tower,’ McCain said.”

All eyes on Rod Rosenstein

At 10:00 am ET, the Senate Judiciary Committee holds its confirmation hearing for Trump’s pick to be deputy attorney general — Rod Rosenstein. And given the news that happened last week, this won’t be your ordinary confirmation hearing. “Mr. Rosenstein faces the Senate Judiciary Committee on Tuesday as the president’s nominee for deputy attorney general. In that post, he would oversee investigations into Mr. Trump’s campaign and Russia, because Attorney General Jeff Sessions removed himself from any such cases after the disclosure last week that he had misled Congress about meeting twice with the Russian ambassador,” the New York Times writes.

What were other presidents doing on March 7?