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Senate Majority Leader Mitch McConnell is keeping the pressure on Republicans, knowing that to get Trumpcare—and the massive tax breaks for the wealthy at its core—done, he's got to ram it through as fast as possible. With five senators now declaring opposition—four from the far-right and one from the moderate-ish center-right—he's got to do some horsetrading. Like what's being called the Klondike Kickback by some.
The House and Senate bills would convert Medicaid from an open-ended entitlement program to a system of per-capita payments for beneficiaries. A novel feature of the Senate bill would redistribute federal Medicaid money from higher-spending states like New York to lower-spending states like Alabama.
One noteworthy exception to this provision is tailor-made for Alaska. “This paragraph shall not apply to any state that has a population density of less than 15 individuals per square mile,” it says.
Only five states — Alaska, Montana, North Dakota, South Dakota and Wyoming — meet that criterion, and Alaska’s two Republican senators have expressed concern about the bill’s potential effects on their state, where medical costs are exceptionally high.
That could be enough to keep Alaska's Lisa Murkowski, though she's also raised hell about Planned Parenthood defunding, as has Susan Collins (ME). That defunding could very well be jettisoned to get at least one of those two on board. There are, of course, other concerns from the Heller-type moderates from Medicaid expansion states, who don't want to take the heat for tens of thousands of their own constituents being kicked off the program. For those folks, expect McConnell to come up with some kind of extra stability funds, or a specific fund for dealing with the opioid crisis to appease them.
Make your Republican senator feel the heat. Call their office EVERY DAY at (202) 224-3121 to demand that they say NO to ripping health care away from millions of Americans. No on Trumpcare. Then, tell us how it went.
The far right might be more complicated with the Koch brothers now having weighed in. They say it's not a complete Obamacare repeal, an argument you hear primarily from Sen. Rand Paul (R-KY). The other three conservatives in his opposition bloc—Ted Cruz (TX), Mike Lee (UT), and Ron Johnson (WI)—have been far less vocal and more willing to say their support is possible. For example, Johnson, who went on the Sunday shows to argue that the vote shouldn't be happening this week, that the Senate needs more time, but suggested to conservative radio host Hugh Hewitt Monday morning that if "forced to vote" this week, he'd support it.
That back-against-the-wall capitulation is what McConnell is counting on—that his Republicans will be overwhelmed by the argument that they have one chance to fulfill their promise of the past seven years to repeal Obamacare, and this is it. That's why it's been so rushed, why it's been so secretive. It's a big gambit on McConnell's part, and probably not the only trick up his sleeve. Which makes it imperative that we keep the pressure on.