by Mish

House Speaker Paul Ryan on Sunday expressed confidence that the Republican health-care plan will pass the House later this week, saying his party’s lawmakers are working to make changes to the bill to address remaining concerns, including providing more assistance to older Americans.
“I feel very good about it. This is exactly where we want to be,” the Wisconsin Republican said in an interview with “Fox News Sunday.”
Changes that the House Republicans are considering include helping people in their 50s and 60s, who, according to a recent analysis by the Congressional Budget Office, will see sharp increases in premiums in 10 years, compared with what they would pay under the existing plan.
“We believe we should have more assistance, and that’s what we are looking at, for that person in their 50s and 60s because they experience higher health care costs,” Mr. Ryan said.
The bill continues to face tough prospects in the Senate, with a few key Republican senators renewing their opposition Sunday.
Sen. Susan Collins (R., Maine) said Sunday that three issues in the bill need to be addressed to get her support, including the huge loss of coverage estimated by the CBO for next year and for the next decade, the disproportionately heavy impact on older and rural Americans, and shifting of billions of dollars of the Medicaid cost to the states and hospitals.
“I believe that as a practical matter, people have a right to health care in that if they’re sick and they go to a hospital, they’re not going to be turned away,” she said on NBC’s “Meet the Press.”
Sen. Rand Paul, (R., Ky.), a leading opponent of the replacement bill, said he believed there was enough conservative opposition in the House to defeat the bill. He has been calling for complete repeal of the Affordable Care Act and argues that the replacement bill is “Obamacare lite,” a half measure.
“Now we are in a bidding war with Democrats,” he said on ABC’s “This Week.” “We’re going to offer half as much federal subsidies as the Democrats. We’re never going to win that bidding war.”

Assessing the Senate

It does not matter if it passes the House if it fails to pass the Senate. Rand Paul is obviously a no vote. Susan Collins is a likely no vote of now.

The Wall Street Journal reports GOP Senators Say House Health Bill Won’t Pass Without Changes.

While GOP leaders praised the [CBO] projection that their plan would bring down costs over time, some conservatives said that reduction was too little and too far in the future.
“That is unacceptable,” said Sen. Ted Cruz (R., Texas.) “As drafted, the House bill would not pass the Senate.”

And in another challenge to the bill, four GOP governors announced their opposition to the House bill, saying they believed it went too far in curbing Medicaid programs that they had chosen to expand.

Senator Tom Cotton

On March 12, Politico reported  Senator Tom Cotton Warns House GOP About Health Care Bill.


On March 14, The Huffington Post reported Tom Cotton Trashes GOP’s ‘Three-Step’ Strategy For Repealing Obamacare.

Just days after warning the plan could cost House Republicans their majority in the 2018 midterm elections, Cotton ripped into the GOP’s three-pronged approach to replacing the law with tax credits and health savings accounts.
“There is no three-step plan. That is just political talk. It’s just politicians engaging in spin,” Cotton said in a Tuesday morning interview with radio host Hugh Hewitt.
Last week, the speaker outlined the steps lawmakers and the administration will take to repeal and replace Obamacare. First, he said, Congress would pass the American Health Care Act with the help of a process called budget reconciliation. Second, Health and Human Services Secretary Tom Price would take administrative action to deregulate the Obamacare marketplace. And third, Congress would pass additional legislation to allow policies to be sold across state lines.
The three-step approach was a big part of the administration’s response to a brutal assessment of the bill by the nonpartisan Congressional Budget Office on Monday, which said the legislation would lead to 24 million people losing insurance by 2026. During a hastily arranged press conference at the White House, Price called the CBO estimate “unbelievable” because there are still more changes to come ― some regulatory, but some as legislation ― as Ryan outlined in his three-step strategy.
Cotton isn’t buying it, however.
“Step one is a bill that can pass with 51 votes in the Senate. That’s what we’re working on right now. Step two, as yet unwritten regulations by Tom Price, which is going to be subject to court challenge, and therefore, perhaps the whims of the most liberal judge in America,” he said in the interview, referring to the U.S. Court of Appeals for the D.C. Circuit, where most regulatory challenges are heard.

Senate Make-Up

The Senate makeup is 52-48 in favor of the Republicans. If there is a tie, vice president Michael Pence will cast the deciding vote.


  1. Rand Paul wants Obamacare repealed, and he appears to be firm.
  2. Ted Cruz wants funding cuts.
  3. Susan Collins wants an expansion of Medicaid.
  4. Tom Cotton wants a bill that does not involve three steps and will not hurt the mid-term elections.

Somewhere in that mess, Trump needs to find two votes or pick up a vote from Democrats.

Moreover, there can be no further Republican dissents, something I do not believe is guaranteed at this point.

Assuming there are no further dissents, is there a magic solution in the final House final bill that will get at least two of the Cruz, Collins, Cotton trio on board?

Mike “Mish” Shedlock

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