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Will Obamacare outlast Trump? The odds improved this week.

Will Obamacare outlast Trump? The odds improved this week.
-- (LAT)

In the heady days just after their surprise victory in November, Republicans talked optimistically of repealing Obamacare in January.

After all, they said, a previous Republican-controlled Congress already had passed a repeal bill, which President Obama vetoed. Now, they could simply pass it again and have it on President Trump's desk the day he was sworn in.

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January became March, and March became May, and July will begin with the Affordable Care Act still the law of the land. Tuesday, Senate Majority Leader Mitch McConnell (R-Ky.) direly warned that if his caucus failed to reach agreement soon, they might have no choice but to negotiate with Democrats for a deal.

Good afternoon, I'm David Lauter, Washington bureau chief. Welcome to the Friday edition of our Essential Politics newsletter, in which we look at the events of the week in Washington and elsewhere in national politics and highlight some particularly insightful stories.

SOLVING THE PROBLEM BY MAKING IT BIGGER

The problem for Republicans is that at each step along the legislative way, the task of repealing Obamacare has gotten bigger.

The first major leap in complexity came in December. At that point, Republican leaders had a strategy with appealing simplicity: Repeal the law now, promise to come up with a replacement later.

Fairly quickly, however, Republican members of Congress realized that that approach was untenable (although, Trump and a couple of conservative GOP senators revived the idea in a Twitter message Friday morning).

Repeal now, replace later would upend the health coverage of millions of Americans, including a lot of Republican voters. GOP leaders reluctantly concluded that after seven years of promising a replacement without ever agreeing on one, they would actually have to deliver.

Writing a replacement forced Republicans to confront a second reality, one they had waved aside during their campaigns: Most of the Affordable Care Act has always enjoyed wide public support.

Americans strongly dislike one part of the law — the mandate that people buy health insurance or pay an extra tax. And a small but influential slice of Americans dislikes the higher premiums the law has required some people to pay.

But poll after poll has shown that the public likes most of the rest of Obamacare — the ban on insurance companies denying coverage to people with health problems, the end of lifetime limits and the billions of dollars of subsidies to help people of modest means pay their premiums.

Not only does the public like those parts of the law, so do a lot of Republican members of Congress. They might have said in their campaigns that they favored repealing Obamacare in its entirety, but they never really meant it.

Any bill to replace the current law would have to include those key elements in at least some form, Republican lawmakers decided.

That realization led to a second big jump in complexity early this spring: Conservatives, who really did want to repeal all of Obamacare, not just pieces, would agree to partial repeal only if they got something else out of the deal.

To solve the problem of keeping conservative support, Republican leaders devised a bill that not only would repeal parts of the Affordable Care Act, but also achieve the long-sought conservative goal of dramatically scaling back Medicaid.

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Conservatives have argued the program of assistance to low-income Americans, which has formed a central part of the social safety net for more than half a century, costs too much and makes people too dependent on government help.

Cutting Medicaid, in turn, would free up money for a major tax cut that mostly benefits wealthy Americans.

The bill that McConnell unveiled in the Senate earlier this month achieved that goal with a vengeance. On Monday the Congressional Budget Office reported that within a decade, the Senate plan would knock more than 15 million people off Medicaid coverage.

The extent of those cuts, along with the other changes the plan would create, threaten huge disruptions across the healthcare system, as Noam Levey reported.

Even before the budget office report, one lawmaker whose vote McConnell had hoped for, Sen. Dean Heller of Nevada, announced that he planned to vote against the bill. For Heller, who faces a tough reelection fight next year, the healthcare debate offers nothing but headaches, David Montero and Mark Barabak reported.

Thursday, an additional budget office report looked further into the future and projected that McConnell's plan would restrict money so tightly that it would slice Medicaid by more than a third over the next two decades.

The program currently insures about 75 million Americans, including almost 4 out of 10 children and 6 in 10 nursing-home residents.

Trump, who had promised in his campaign that he would not cut Medicaid or other entitlement programs, tried to deny the budget office's assessment. The White House put out a statement Monday saying the budget analysts had a "history of inaccuracy" and should "not be trusted blindly."

Even among Republicans, that argument didn't go far. House Speaker Paul Ryan (R-Wis.), noted to reporters Tuesday that the head of the budget office had been appointed by Tom Price, who at the time was the chair of the House Budget Committee and now serves as Trump's secretary of Health and Human Services.

"It is important that we have a scorekeeper. We can always complain about the nature of the score," Ryan said. "Having said that, it's important that we have a referee."

As Levey reported, the budget office report immediately put passage of the Senate bill in doubt. Within 24 hours, McConnell gave up on trying to push the bill through the Senate this week. He hoped to reach a new agreement by week's end, but as Lisa Mascaro reported, that deadline came and went as well, with no quick fix in sight.

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The debate has highlighted a split that threatens to paralyze Republicans on other issues: The party's traditional conservative faction and its more blue-collar, less affluent populist wing have very different needs and priorities.

McConnell spent the week trying to scale back the Medicaid cuts to win over not just Heller but other Republican lawmakers, including Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia, Rob Portman of Ohio, and Lisa Murkowski of Alaska, who represent states with large numbers of white, blue-collar constituents.

But putting more money back into Medicaid, and perhaps scaling back the tax cuts, makes the bill less appealing to conservatives.

McConnell has a reputation as a master negotiator, but his strategy for the healthcare bill always depended on stealth and speed. He feared that prolonged public exposure would kill the bill's prospects.

And, indeed, several new polls this week showed opposition rising, with only a fifth of Americans, or fewer, supporting the Republican bill.

With senators heading home for a weeklong Fourth of July recess, they will soon be in position to hear that opposition directly from constituents. The fate of Obama's signature domestic policy program — and health coverage of some 22 million Americans — hangs in the balance.

EXPANDING GOVERNMENT HEALTHCARE IS HARD TOO

Even as Republicans in Congress try to cut back federal spending on healthcare, Democrats in California want to expand it.

Earlier this spring, the state Senate passed a plan — or the outline of a plan, anyway — to create a statewide, government-run, single-payer health plan.

This week, however, Assembly Speaker Anthony Rendon called a halt, saying the Senate plan was "woefully incomplete" and that his chamber would not take it up this year.

Rendon, an advocate of single-payer, has taken a lot of heat from his left, especially from the state's politically active nurses union. But columnist George Skelton says Rendon was right. The Senate plan would have massively increased the state budget, and no one had any idea how to pay for all of it.

"Single-payer failed because one state can't handle it alone," Skelton wrote. "Fortunately, one legislative leader had the common sense and courage to stop the foolishness."

SUPREME COURT ENDS ITS TERM WITH A BAN

Most eyes were on the Senate and healthcare this week, but the Supreme Court also wrapped up its work for the year on Monday.

Among their final acts for this term, the justices came up with a compromise that allowed the administration to start implementing part of Trump's travel ban. As David Savage explained, the ruling allowed the 90-day ban on travel from six Middle Eastern and North African countries to go into effect for visa applicants who don't have existing ties to the U.S.

As the administration interpreted it, that ruling meant that people from the six countries who had children or parents in the U.S. could still get visas. So could students admitted to a U.S. college.

No grandmas need apply, however, the State Department said. Family relationships beyond the first generation wouldn't count. Hawaii officials, who had challenged the ban initially, quickly announced they would go back to court to argue the rules were too restrictive.

The high court announced a number of other rulings in the last few days of the term. Here's Savage's summary of their notable rulings this year.

As the term ended, one thing stood out — the court's newest member, Neil M. Gorsuch, was already have an impact, pushing the court to the right on religion, guns and gay rights, Savage wrote.

A FEW OTHER NOTABLE STORIES

Trump boasts of dumping many Obama-era regulations. Lauren Rosenblatt took a look at what those regulatory changes mean in practice.

Border wall prototypes could start going up in San Diego this summer, Joe Tanfani reported. But officials continue to make clear that a huge wall from one end of the border to the other isn't in the plans, despite the president's rhetoric.

The White House panel looking into voter fraud wants states to turn over information about voters. California's top elections officer said no, John Myers reported. Democrats fear the panel, co-chaired by Kansas Secretary of State Kris Kobach, is looking for excuses to propose new voting restrictions.

POLITICS IN THE TRUMP ERA

Trump has succeeded where Obama failed in spawning a new wave of liberal activism, Barabak reports. Across the country, groups are springing up to oppose the new administration, bringing new energy to politics on the left.

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But despite that energy, Democrats face a big problem in the 2018 midterm elections, Cathy Decker wrote: Trump's name won't be on the ballot. Opposition to Trump energizes Democratic voters, but the party has not yet proven it can translate that enthusiasm into races further down the ballot, she said.

ALL THE PRESIDENT'S TWEETS

Amid the debate over healthcare, the fight against the Islamic State militants in Syria and Iraq, the investigation into Russian meddling in the 2016 election and everything else, Trump decided to begin a Twitter war with a couple of TV hosts.

The president's blasts against Mika Brzezinski and Joe Scarborough of MSNBC drew exasperated reactions from many Republican lawmakers.

It almost certainly won't. Trump continued the latest Twitter fight on Friday.

Some Democrats believe Trump has a grand strategy of trying to divert attention from other issues. The evidence suggests the more likely explanation is that he simply can't control his pique at what he sees as personal attacks and that he relishes the tabloid-style headlines that first made him famous.

His tweets seem to hurt him more than they help, and there's certainly no evidence that they've kept public attention away from the healthcare debate.

In either case, Twitter has long been Trump's favored means of pushing his message. We're compiling all of Trump's tweets. It's a great resource. Take a look.

LOGISTICS

That wraps up this week. My colleague Christina Bellantoni will be back Wednesday after the holiday weekend with the weekday edition of Essential Politics. Until then, keep track of all the developments in national politics and the Trump administration with our Essential Washington blog, at our Politics page and on Twitter @latimespolitics.

Send your comments, suggestions and news tips to politics@latimes.com.

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