Trump's Obamacare repeal attempt fails in US Senate

Tuesday, Aug 1, 2017, 07:56 AM | Source: The Conversation

By Adrian Beaumont

Trump's Obamacare repeal attempt fails in US Senate

Adrian Beaumont, University of Melbourne

In the US Senate, there are 52 Republicans and 48 Democrats. With Vice President Mike Pence able to cast a tie-breaking vote, 50 votes were needed to repeal the 2010 Affordable Care Act, otherwise known as Obamacare.

On 25 July, a motion to proceed to a floor debate passed 51-50 on Pence's vote. Later that day, a comprehensive plan to repeal and replace Obamacare failed 57-43 with defections from both more moderate and right-wing Republicans. On 26 July, a "clean" Obamacare repeal, with no replacement, was defeated 55-45.

In a last-ditch attempt to pass a bill, Republicans proposed a "skinny" repeal, in which the least popular parts of Obamacare would be axed, but the law would otherwise be largely unchanged. The requirement that all adults buy health insurance is unpopular, although the individual mandate allows the health insurance markets to function.

A Senate vote was scheduled on skinny repeal just after midnight Washington time on 28 July. Republican leaders thought they had 50 votes, but Arizona Senator John McCain surprisingly voted No to sink the skinny repeal 51-49.

For the time being, this vote ends the Republican efforts to repeal and replace Obamacare, without any input from Democrats. There may be some plan that will get 50 Republican Senators, but not at this stage.

In all four health care Senate votes, all 48 Democrats, plus the more moderate Republican Senators Lisa Murkowski (Alaska) and Susan Collins (Maine) had voted the same way. 49 Republicans, including McCain, had voted for one of the first two proposals: comprehensive repeal and replace, or clean repeal.

If skinny repeal had passed the Senate, it would not have ended the legislative battle, as the House had passed a more comprehensive repeal in May. Many Senators voted for skinny repeal hoping that the House would insist on a plan similar to the May bill. However, if disagreements between the House and Senate were not resolved, the House could have reverted to skinny repeal.

The graph below, from the New York Times, shows the number of people without health insurance that the nonpartisan Congressional Budget Office expected under various scenarios.

Of the Republican proposals, skinny repeal had the least impact on the uninsured, but even that plan would have increased the uninsured by 16 million above that using Obamacare. The more comprehensive Republican plans gutted Medicaid, which provides health care for the poor, and the uninsured would have increased by 20-25 million under these plans.

Republican activists supported the clean repeal option. Under this scenario, an extra 32 million would have become uninsured (the line at the top of the graph).

According to analyst Nate Silver, in an average of the five most recent polls on the comprehensive Senate plan, 24% were in favour and 53% were opposed. In a poll conducted for the right-wing Fox News, 60% thought Obamacare should be kept and improved, while 33% thought "we should throw it out and start over".

Why did Republican Congressional leaders and Trump commit to health care proposals that could be perceived as cruel? First, Republicans hate Obama, and want to gut his legacy; Obamacare is Obama's biggest domestic legacy. Second, Republicans are ideologically opposed to big government, and object to poor people receiving help from the government; hence the opposition to Medicaid.

Analysis of Senate voting by FiveThirtyEight shows that the most conservative Democrat, West Virginia's Joe Manchin, votes with Trump 54% of the time, while the most moderate Republican, Susan Collins, votes with Trump 80% of the time. Other than Collins only three Republicans vote with Trump with less than 90% frequency: Murkowski, McCain and Kentucky's Rand Paul, a libertarian.

Trump's personnel changes

In the last ten days, Trump's former press secretary Sean Spicer, his chief of staff Reince Priebus and his new communications director Anthony Scaramucci have resigned or been fired. Scaramucci was employed by the White House for just ten days.

Spicer and Priebus were both part of the Republican establishment faction in the White House, and that faction has now collapsed. According to this FiveThirtyEight article, the small government/Christian conservative faction is gaining the most ground.

Trump has recently attacked Attorney General Jeff Sessions for recusing himself from the Rusian investigation and allowing Robert Mueller to be appointed to investigate Trump's ties to Russia. Sessions was one of Trump's first supporters in Congress during the Presidential primaries, and is a favourite of the nationalist movement. As a result, media outlets normally supportive of Trump have criticised him over Sessions.

FiveThirtyEight's poll aggregate has Trump at 38.2% approve, 56.2% disapprove for a net approval of -18.0, a record high disapproval. Recent events have not yet been factored into the polls, so Trump's ratings could drop further.

Australian polls: Essential 52-48 to Labor, YouGov 50-50

This week's Essential had primary votes of 38% Coalition, 36% Labor, 10% Greens, 8% One Nation and 4% Nick Xenophon Team. Since last fornight there has been a two point shift from Labor to the Coalition on both primary votes and after preferences. The two-week sample was 1805, with additional questions based on one week's sample.

By 58-24, voters supported four-year fixed terms.

52% thought inequality was increasing, 26% staying much the same, and just 12% thought it was decreasing. Except for increasing the GST and introducing death taxes, proposed revenue measures to reduce the deficit were strongly supported, especially those targeting the wealthy and multinational corporations.

25% (up 5 since March) thought Turnbull best to lead the Liberals, with 20% for Julie Bishop (up 3) and 10% for Tony Abbott (steady). Peter Dutton had just 3% support. Among Coalition voters, it was 40% Turnbull, 19% Bishop, 13% Abbott.

20% (down 1) thought Shorten best to lead Labor, with 13% for Tanya Plibersek (steady) and 13% for Anthony Albanese (up 2). Among Labor voters, it was 34% Shorten and 15% for both Albanese and Plibersek.

Primary votes in last week's YouGov Australian poll were 36% Coalition (steady), 33% Labor (steady), 10% Greens (down 2) and 8% One Nation (up 1). The respondent allocated headline was a 50-50 tie, a 2 point gain for Labor since the last YouGov, despite the decline for the Greens. This poll was taken 20-24 July with a sample of 1005.

After three editions of YouGov, it appears they are leaning to the Coalition relative to other polls on primary votes. YouGov's respondent allocated preferences reinforces that lean, although the skew from previous election preferences is less in this poll than in YouGov's first two polls. This poll would be about 52-48 to Labor by the previous election method.

Approval/disapproval ratings for various politicians were released. Nick Xenophon was easily the best with a 50-25 approval, Pauline Hanson had a 52-39 disapproval rating, Greens leader Richard di Natale a 38-25 disapproval, Christopher Pyne a 44-31 disapproval and Tony Abbott a 56-34 disapproval.

By 48-37, voters would oppose a referendum proposal to amend the Constitution in order to allow dual citizens to run for Parliament.

A Federal Galaxy poll of WA, conducted 26-27 July from a sample of 850, had Labor leading by 52-48 in WA, representing a 7 point swing to Labor from the 2016 election. Primary votes were 39% Coalition (down 10), 37% Labor (up 5), 11% Greens (down 1) and 5% One Nation.The Conversation

Adrian Beaumont, Honorary Associate, School of Mathematics and Statistics, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.