Republicans aimed for Obamacare, hit Medicaid, and now face tumultuous debate

Reporting from Washington  —  For President Trump, Sen. Mitch McConnell and tens of millions of Americans who receive health coverage through Medicaid or by buying policies as individuals, it’s all coming down to one, big gamble on the Senate floor.

Within days — most likely Thursday or Friday of next week — the Senate will vote on repeal of the Affordable Care Act. It won’t be exactly the bill McConnell unveiled Thursday for public review, but, rather, an amended version, known in full only to him and a few others, that he’ll put forward at the last minute in hopes of capturing the last two or three votes.

If it passes, probably with Vice President Mike Pence casting the deciding vote, Republicans will have succeeded in the biggest rollback of the government safety net ever.

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.

HIGH NOON FOR HEALTHCARE

Read the text of the healthcare bill that McConnell unveiled Thursday, and you find an audacious bait and switch.

For years, Republican leaders have talked about repealing Obamacare — it’s been the centerpiece of their campaigns since 2010.

But conservatives like Sens. Rand Paul of Kentucky and Mike Lee of Utah are correct when they say McConnell’s plan doesn’t truly repeal Obama’s signature healthcare law. Instead, it makes it cheaper and able to cover fewer people — how many fewer, the Congressional Budget Office will estimate next week.

Like the measure that passed the House last month, the Senate plan really takes aim at a bigger, older and more established part of the healthcare safety net — Medicaid. If it passes, the new law will mark the biggest cutback of that program since Lyndon B. Johnson pushed it through Congress a half century ago.

[Here’s our side-by-side comparison of the Senate plan, the bill that passed the House last month and current law].

Republicans did not make Medicaid cuts a key element of their campaigns. Indeed, Trump specifically said he would not cut Medicaid. But shrinking the program has long been a prime goal for conservatives, led by House Speaker Paul Ryan, who argue that it costs too much and encourages dependency.

As Noam Levey and Lisa Mascaro explained, the impact on Medicaid would be dramatic. Instead of an open-ended entitlement, with spending rising or falling depending on need, states would get a fixed amount of money. That amount would be allowed to increase at less than the rate of inflation for years to come, steadily squeezing the program.

States would be allowed to decide for themselves how to cope with that shrinking federal aid, but they would have little choice but to push more and more people off the program.

Those cuts would reduce federal spending by hundreds of billions of dollars over the next decade, enough to fund the tax cuts that the GOP plan includes. It would also, almost certainly, take away health coverage from millions of low- and middle-income Americans, including many in nursing homes — Medicaid currently covers about 60% of seniors in nursing homes nationwide.

Another especially fraught aspect of the potential cuts would be their impact on the national crisis of opioid addiction. As Levey wrote, Medicaid helps pay for addiction treatment for tens of thousands of people, many of them in hard-hit states like Ohio and West Virginia, which Trump carried in the last election.

The Republican senators from those two states, Shelley Moore Capito and Rob Portman, are among the last undeclared votes on the healthcare bill.

The bill’s tax cuts would take effect immediately — indeed, a reduction in capital gains taxes would actually be retroactive to Jan. 1, giving wealthy Americans who sold stocks or other assets this winter an unexpected bonus.

But the spending cuts would not completely take effect for years. The plan delays the full Medicaid cutbacks until 2023, conveniently past the reelection of any of the Senate’s current members. That worries some conservatives who fear that as the date approaches, future Congresses will repeatedly extend the deadlines.

That might or might not happen. But the extended timetable all but guarantees that if the bill passes, healthcare will continue to roil the nation’s politics election cycle after election cycle.

So will it pass?

The math is familiar by now: The Senate has 52 Republicans, and no Democrat will vote for the bill, which contradicts everything the party espouses. So McConnell can afford to lose just two of his members.

As Mascaro wrote, the next week will resemble a frenzied marketplace, as roughly a dozen GOP senators, including four on the right and several in the center, demand concessions in return for their votes. Here’s a list of several of those key senators.

The conservatives want more cutbacks, implemented faster, the centrists want fewer and more delays. Balancing their demands will be tricky.

McConnell’s gamble, however, is that as the final vote approaches and the number of undeclared senators dwindles, no Republican will want to cast that last vote that saves Obamacare.

The future health coverage of millions of Americans, plus hundreds of billions of dollars in federal spending, hang on whether he’s correct.

DEMOCRATS GO 0 FOR 4

Four months ago, if a Democrat had come within a few points of winning Georgia’s 6th Congressional District, in Atlanta’s heavily Republican suburbs, the result would have seemed close to a victory for the party.

But after spending tens of millions of dollars and lavishing the district with attention, the actual result, Republican Karen Handel beating Democrat Jon Ossoff by 52%-48%, came as a stinging defeat.

The Georgia race was the fourth special election in a Republican-held district that Democrats lost this spring.

What does that say about their prospects in 2018?

The answer isn’t so clear, as Evan Halper and I wrote. In all four elections, Democrats ran well ahead of their past performance. And a lot of other districts in play for the 2018 midterm elections aren’t as heavily Republican as these four.

Still, the loss disappointed many Democrats, and it’s led to another round of finger-pointing, including calls for House Democratic leader Nancy Pelosi of San Francisco to step aside.

On Thursday, Pelosi dismissed such calls. “I’m worth the trouble, quite frankly,” she said.

She may be right. It’s true that Republicans love to feature her in ads, knowing how she motivates their voters. But the argument that she’s a uniquely attractive target flies against history.

Republicans previously targeted House Speakers Tip O’Neill of Massachusetts and Jim Wright of Texas. Democrats targeted former Speaker Newt Gingrich of Georgia and Majority Leader Tom DeLay of Texas.

Indeed, it’s easier to come up with names of leaders the opposite party targeted than to think of ones who avoided that fate.

GERRYMANDERING HITS THE HIGH COURT

One move that would clearly change the electoral landscape would be to limit political gerrymandering of congressional districts.

The Supreme Court is about to look at whether to do so.

The issue before the justices, as David Savage explained, is whether the Constitution puts any limits on the ability of one party to use its control over drawing district lines to lock the opposition out of power for years to come.

Arguably, that’s what Republicans did in Wisconsin, where they packed as many Democratic voters as possible into as few districts as they could, producing big legislative majorities for their party even in years in which Democrats won significant majorities of the state’s votes.

The justices will hear arguments in the case in the fall, with a ruling likely next spring.

If the court does limit gerrymandering, they’ll be taking on a tradition as old as the American political system, Mark Barabak wrote.

But it’s a system that’s been enhanced in recent years by computer technology, which makes data on voters much easier to compile and manipulate.

Technology also can put that voter information at risk of being stolen by identity thieves or others, as a recent incident highlighted. A firm working for the GOP inadvertently left information on almost every voter in the U.S. in an unprotected file for days, the Republican National Committee admitted.

As Evan Halper and Paresh Dave reported, there’s no evidence that hackers or other nefarious characters discovered that huge file before a data security firm uncovered the problem and the contractor fixed it.

But the case highlights an uncomfortable reality — unlike other firms, companies who work for political groups have almost no liability if they mishandle personal data.

A FOCUS OF TRUMP’S ATTENTION

As Brian Bennett reported, Trump’s intelligence briefers sometimes have trouble holding his attention, but not when the subject turns to individual Americans held captive overseas.

“What are we doing for that kid in North Korea?” Trump repeatedly asked, referring to Otto Warmbier, a U.S. official familiar with the Oval Office meetings told Bennett.

That focus has allowed Trump to win freedom for some Americans imprisoned in other countries.

But there’s a downside, too: Trump’s attention makes Americans more valuable as hostages. North Korea released Warmbier, who was in a coma and died this week, but only after imprisoning two more Americans in April and May.

Meantime, as Tracy Wilkinson reported, Secretary of State Rex Tillerson and Defense Secretary James Mattis met with top Chinese officials on Wednesday as the administration continues to try to get China to pressure North Korea to end its nuclear program.

DREAMERS STILL PROTECTED

One campaign promise that Trump has conspicuously not fulfilled — much to the displeasure of some of his backers — is his pledge to end Obama’s DACA program, which provides a shield against deportation for young people who came to the U.S. illegally as children.

Within the administration, sharp divisions over how to handle DACA remain, and they became very visible late last week as the Homeland Security department moved to formally end another Obama program that had been blocked in court.

As Mike Memoli and Brian Bennett wrote, the day of rumors and conflicting accounts helped highlight how much the fate of the so-called Dreamers remains a difficult issue for the president.

THE POLITICS OF GUNS

A new study from the nonpartisan Pew Research Center details the wide gulf in attitudes and experiences between the 30% of Americans who own guns and the majority who don’t.

Most fundamentally, a majority of gun owners don’t think that more guns generate more crime, while a plurality of non-owners do.

Slightly more than half of gun owners say that the country would have less crime if more people were armed. Only about one in eight gun owners say they believe more guns would mean more crime.

By contrast, among non-owners, nearly half say that more guns would bring more crime; fewer than one in four say that more guns would reduce crime.

I’VE GOT TAPES — OR MAYBE NOT

Who knows what went through Trump’s mind before he sent his Twitter message suggesting that he might have tapes of his meetings with former FBI Director James B. Comey.

Thursday, he finally brought a close to his six-week game of tease, conceding, in another tweet, that “I did not make, and do not have, any such recordings.”

As Mike Memoli noted, Trump couldn’t resist creating a new controversy, however, with a tweet that implied he believes his own intelligence and law enforcement agencies may be monitoring him.

“With all of the recently reported electronic surveillance, intercepts, unmasking and illegal leaking of information, I have no idea whether there are ‘tapes’ or recordings of my conversations,” he wrote.

Just a week ago, as Memoli and Sarah Wire wrote, Trump used Twitter to stoke speculation that he was aiming to fire special counsel Robert S. Mueller III.

ALL THE PRESIDENT’S TWEETS

Twitter has long been Trump’s favored means of pushing his message. White House officials concede that Trump’s tweets are official statements of administration policy. 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 Monday 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.

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@davidlauter