Repeal And Replace Fails–Perhaps Congress Had The Wrong Target

The Republicans have failed to repeal and replace Obamacare, primarily because they never had a sensible replacement plan. It took three Republicans to block the final attempt, with John McCain casting the deciding vote. Now that he will not be on the ballot again, it was easiest for McCain to do this, allowing other Republicans who opposed the bill to cast a politically safer party-line vote. McCain might have also felt some satisfaction in thwarting Trump’s agenda after Trump’s past attacks on McCain, claiming McCain was not a war hero because he was captured.

Hopefully attempts at repealing Obamacare are dead–at least until a more liberal Congress has the votes to pass a single payer plan to replace it. Some are still claiming that they can propose a new bill which can achieve fifty-one votes, but any new efforts will have the same problems trying to please both wings of the party.

A more hopeful sign is a bipartisan group in the House which claims to be working together to improve Obamacare rather than repeal it. So far there has been no sign of bipartisan cooperation on health care, but there is a remote chance that matters have changed now that the Senate has been unable to pass any of its attempts at repeal. Sensible Republicans should realize that they will be held accountable for the success or failure of health care. Obamacare is the law of the land. Donald Trump and the Republican Congress now own it.

Maybe repeal and replace isn’t such a bad concept after all, except that Congress had the wrong target.

How about repealing the authorization to go to war and replacing our failed foreign policy? How about repealing the Patriot Act and replacing it with a policy which provides for needed security while respecting our Constitutional rights? How about repealing the drug war and replacing it with treatment where needed?

Of course this will never happen as there will be too much opposition from both parties. Can we just repeal and replace our current dysfunctional two-party duopoly?

Investigations Of Trump Expand Along With Speculation That He Will Repeat Saturday Night Massacre

News reports discussed two avenues of investigation being pursued regarding Donald Trump. One of them, his business ties, appears to be of value. The other is of more questionable value–fake news on Facebook.

Bloomberg is reporting that Robert Mueller is expanding the investigation into Trump’s business ties:

The U.S. special counsel investigating possible ties between the Donald Trump campaign and Russia in last year’s election is examining a broad range of transactions involving Trump’s businesses as well as those of his associates, according to a person familiar with the probe.

FBI investigators and others are looking at Russian purchases of apartments in Trump buildings, Trump’s involvement in a controversial SoHo development in New York with Russian associates, the 2013 Miss Universe pageant in Moscow and Trump’s sale of a Florida mansion to a Russian oligarch in 2008, the person said.

The investigation also has absorbed a money-laundering probe begun by federal prosecutors in New York into Trump’s former campaign chairman Paul Manafort.

The Wall Street Journal has further information related to the investigation of Paul Manafort:

Mr. Manafort, a Republican political consultant, spent years working for a pro-Russia party in Ukraine. He served as Mr. Trump’s presidential campaign manager for roughly three months in 2016 before resigning.

New York Attorney General Eric Schneiderman and Manhattan District Attorney Cyrus Vance Jr. also are investigating Mr. Manafort’s real-estate transactions, The Wall Street Journal has reported, with both offices examining his dealings for possible money-laundering and fraud. Messrs. Schneiderman and Vance are Democrats.

Mr. Manafort has spent and borrowed tens of millions of dollars in connection with properties in the U.S. over the past decade, including a Brooklyn, N.Y., townhouse and California properties being developed by his son-in-law, the Journal has reported.

The nature of the investigation, along with the contempt for law enforcement expressed by Donald Trump in an interview with The New York Times, has many predicting that Trump will wind up firing Paul Manafort in a scenario reminiscent of Richard Nixon’s Saturday Night Massacre. Periodically I receive comments that such criticism of Trump comes from out of touch left wingers, so I will note that the conservative National Review also predicts, Yeah, Trump Is Probably Going to Fire Robert Mueller.

While I hope to see Manafort pursue investigations into the business dealings of Donald Trump and his associates, I question whether Congressional investigators will really find out much of value in an investigation of fake news and Facebook. CNN reports:

Virginia Sen. Mark Warner, the top Democrat on the Senate intelligence committee, met with Facebook officials in California more than a month ago as part of his committee’s investigation into potential collusion or election interference, and he’s convinced the company can explain whether anyone from the Trump campaign helped Russians boost fake news articles targeting Democratic presidential nominee Hillary Clinton. Warner is testing the theory popular among Democratic operatives that Russia was behind spikes in fake news that were anti-Clinton and that Russia had help targeting those articles from US political operatives…

At the core of Warner’s questioning is a theory among Democratic operatives and former top-level Clinton campaign staff that Russia had help from domestic political operatives to micro-target fake news articles. No evidence has been uncovered to prove that theory.

Last month, Senate intelligence staff interviewed Brett Horvath, a social media technology expert who argues it’s possible that Russian operatives got political data that could then be used for successfully micro-targeting swing voters on Facebook.

“Facebook has all the data that could prove this is happening or not happening, that’s the starting point,” Horvath, a veteran Democratic political operative, told CNN.

The key line above is, “No evidence has been uncovered to prove that theory.”

There certainly was fake news spread during the campaign, as there also was against Barack Obama and John Kerry in their presidential campaigns. Only the Clinton campaign has gone so far as to blame Russia for this, with reporters covering the campaign to write the book Shattered reporting that Clinton developed the strategy of blaming Russia and others for her loss within twenty-four hours of losing, failing to take responsibility for her own mistakes. Whether or not the fake stories being spread came from Russia, they did far less harm to Clinton than the damage caused by her violation of State Department rules (as verified by the State Department Inspector General), and then repeatedly being caught lying about the matter. The truth was far more damaging than fiction.

The questionable business ties involving Donald Trump and others in his family and campaign appears to be worth investigating, but I bet it will be a mistake to divert resources from the more important issues to pursue partisan fantasies. If Democrats rely upon such weak attacks they risk allowing the Republicans to survive the actual Trump scandals.

Clinton’s Popularity Continues To Decline, Possibly Affecting Democratic Voter Enthusiasm

Democrats lead in the generic Congressional polls, but there are warning signs for Democrats. A new Washington Post-ABC News poll shows that by a 52 to 38 percent margin voters want Democrats to control Congress to be a check on Trump. However, 65 percent of Republicans and GOP-leaning adults say they are “almost certain to vote,” only 57 percent of Democrats and Democratic-leaning voters say they are likely to vote.

There are probably many reasons why Democratic-leaning voters are less likely to vote, but the damage to the Democratic brand caused by the nomination by of Hillary Clinton in 2016 cannot be underestimated. For those who have voted Democratic in protest against the policies of the Bush administration, it was a great disappointment to see the Democrats nominate a candidate with essentially the same agenda. The undemocratic manner in which the party establishment essentially picks the nominees, despite the charade of a primary system, creates further disenchantment with the party. As bad a choice as Donald Trump was, at least he was nominated due to beating the establishment candidates in a year in which many voters from both parties did not want another Bush/Clinton, with the Republican establishment accepting the decision of its voters.

Normally losing candidates do better in the polls after the election. With Donald Trump doing such a terrible job and dropping in the polls, if she followed traditional patterns Hillary Clinton should be seeing a boost in her support. Instead a Bloomberg National Poll shows that Clinton’s support has declined and that she is even more unpopular than Donald Trump.

This is not based upon opposition to the party in general  as Barack Obama and Joe Biden’s popularity has increased since they left office, and Bernie Sanders has become the most popular politician in the country.

The poll doesn’t provide reasons for Clinton’s further decrease in popularity. Just losing to a candidate as terrible as Donald Trump further highlights how weak a candidate she was, with reports such as those in Shattered providing further confirmation. I would also bet that many people expressed positive views of Clinton in the context of an election campaign against Donald Trump, but now that the campaign is over have no reason to hide their distaste for her.

Clinton’s actions following her loss give additional reasons for an already unpopular politician to now receive even less support. Her frequent statements blaming others for her loss, while downplaying the serious mistakes she made, shows her lack of character. While her far right wing views on civil liberties has received too little attention, her call for Congressional action against fake news, which amounts to censorship of material critical of her, is alarming in light of her long standing support for restricting freedom of speech and dissent.

Clinton’s anti-Russia hysteria, going well beyond what has been proven in the investigations to date, might be fooling some Democratic partisans, but is alarming to others. Clinton does not benefit politically from the revelations involving the Trump administration and Russia when fear of world war with Russia was a motivating factor for some who voted for her. A recent study suggests that her ultra-hawkish views might have played a significant role in her loss. News out of Syria provides further reason to oppose Clinton, considering her push for greater interventionism, even to the point of risking direct conflict with Russia.

Clinton has been out of step with more liberal voters on other issues, including economics, trade, the drug war, and health care policy. While many Democratic leaning voters support a single-payer system (as promoted by people including Bernie Sanders and Al Gore), Hillary Clinton also showed she was out of step in campaigning against  Medicare-for-all.

It is hard for many independents, along with principled Democrats, to be enthusiastic about the Democrats after nominating a candidate which so many dislike for good reason. The attacks on liberals and progressives opposing Clinton from partisan Democrats, showing a gross lack of respect for the basic principles of democracy in thinking that those who oppose her had some obligation to vote for her, further alienates potential Democratic voters. If Democrats are to expand their base and win elections, they need to show more respect for the views of those who oppose their move to the right.

Democrats have done poorly in 2010, 2014, and again in 2016 after moving to the right and running as a Republican-lite party. Bloomberg reports that Democrats are again looking at promoting more conservative candidates in 2018, failing to learn that voters see no reason to turn out to vote for candidates who do not stand for anything. The Democrats should do well in 2018 in response to the Trump disaster, but they also appear capable of pulling defeat again out of what should be sure victory.

Yes Donald Trump, You Are President, And Therefore You Do Own Obamacare

In the past Donald Trump claimed that he alone could fix Obamacare. He turned out to have no plan of his own, leaving this to the Republicans in Congress. They did not have a real plan either. Now he says that Obamacare should be repealed and that, “We’re not going to own it. I’m not going to own it. I can tell you, the Republicans are not going to own it.”

Sorry, Donald, you do own Obamacare. You took an oath to faithfully execute the Office of President of the United States. The Affordable Care Act remains the law of the land, and as head of the executive branch, you are responsible for administering the program.

Despite Republican claims, the Obamacare exchanges are not in a death spiral. The program was strong when Donald Trump assumed responsibility for it, and if it fails, it is his fault.

Donald Trump not only fails to understand the policy. He doesn’t even understand the process to attempt to repeal and replace it. He called for an end to the filibuster saying, “The U.S. Senate should switch to 51 votes, immediately.” While some things the Republicans would like to do would require sixty votes, only fifty-one votes were required for the Senate health care plan, and they couldn’t come up with that many.

The Republican plans to repeal and replace Obamacare failed because they had no real plan to replace it with. Fortunately a handful of Republicans have also announced they will not vote for the next plan–repeal without a replacement at this time.

In stopping the Republicans from repealing Obamacare, there is a sign that resistance works which should be applied to other areas of the Republican agenda. It will be even harder for Republicans to ram through unpopular legislation next year during an election year. After that, they will hopefully suffer loses making it even harder for them.

If the Republicans want to please voters and work for the good of the country, they should work with Democrats to strengthen and improve Obamacare. High premiums and out of pocket expenses were characteristic of the individual market prior to Obamacare, and more action is needed to fix this. A public option and/or Medicare buy-in is needed. Of course it is pure fantasy to think that the Republicans will do this, so if we are going to fantasize, we might as well encourage them to pass a single payer system.

Opposition Continues To Republican Health Care Plan

Little has changed on health care legislation. The Republican plan for replacing Obamacare continues to provide inadequate coverage. This includes reducing coverage for Medicaid and destabilizing the individual market, now with a provision written by Ted Cruz. As Ezra Klein wrote, The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick. This is especially true for those who do not receive coverage through an employer, or ever get sick enough that they cannot continue working to keep that coverage.

Fortunately the Republicans remain in a difficult position with regards to passing their plan. They can only afford to lose three Republican votes, and at this point two Republicans, Rand Paul and Susan Collins, say they will not vote for it. Several other Republicans are undecided. Mitch McConnell plans on holding a procedural vote on Tuesday to consider the measure, and there very well might not be enough votes to proceed.

There continues to be wide spread public opposition to the Republican plan, with multiple medical groups working to oppose the bill. This includes  the American Academy of Family Physicians, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association. Putting further pressure on Republican Senators, the Cook Political Report also notes that 94 percent of ads have been opposed to the bill.

There has been some talk that the Republicans would work with the Democrats on a bill to shore up the exchanges should the Republican measure fail. It is doubtful that the Republicans would agree to the types of measures which would be best to cover those obtaining coverage on the individual market such as a public option or Medicare buy in. It is even more unlikely that the Republicans, or even enough Democrats, would back the most sensible solution–a single payer plan.

Democratic Congressman Files Article Of Impeachment Against Donald Trump

It was only a matter of when. A California Congressman has introduced an article of impeachment against Donald Trump. The Hill reports:

Rep. Brad Sherman (D-Calif.) formally introduced an article of impeachment against President Trump on Wednesday that accuses the president of obstructing justice during the federal investigation of Russia’s 2016 election interference.

This is the first time a lawmaker has offered an impeachment article against Trump, and it comes as Democrats have debated whether it is politically wise to press the case for impeachment at this time…

In filing his impeachment article, Sherman argues that Trump’s abrupt firing of James Comey as FBI director in May amounts to obstructing justice and “high crimes and misdemeanors” amid the probes of whether Trump’s campaign colluded with the Russian government to swing the election…

He cites Comey’s allegations that Trump pressured him to drop the FBI’s investigation into ousted former White House national security adviser Michael Flynn, as well as Trump’s shifting story on why he fired Comey.

“In all of this, Donald John Trump has acted in a manner contrary to his trust as president and subversive of constitutional government, to the great prejudice of the cause of law and justice and to the manifest injury of the people of the United States. Wherefore, Donald John Trump, by such conduct, warrants impeachment and trial, and removal from office,” the article of impeachment states.

So far only one other member of Congress, Al Green of Texas, is supporting the action.

Of course it is rather early and the number of members supporting impeachment could increase after the current investigations, which are still in an early stage, are concluded. The firing of James Comey does certainly appear to have been done in order obstruct his investigation. At present there is far further evidence of a cover-up on the part of Trump and members of  his administration than of the actual crime. While it is possible that evidence of collusion with Russia to swing the election will be uncovered during the course of the investigation, there is not yet clear evidence that Donald Trump did collude with Russia.

I have suspected that, at least, Trump was acting to protect members of his administration, and that any crimes very likely involved their financial dealings. The recent revelation of Donald Trump Jr.’s meeting with an attorney close to the Russian government, based upon an offer of information about Hillary Clinton, along with actions of Jared Kusnher, suggest that Donald Trump might have engaged in obstruction of justice to protect members of his family, along with members of his campaign staff and administration.

In order for impeachment to succeed it would require a simple majority vote in the House, but also require a two-thirds vote in the Senate to remove the president. Therefore it would require bipartisan support to remove Trump regardless of how well the Democrats do in the 2018 election. So far only two presidents have ever been impeached, including Bill Clinton, and technically no presidents have ever been removed from office by this route. Richard Nixon was forced to resign when his impeachment and conviction appeared inevitable.

An alternative mechanism under the 25th Amendment could also be used to remove Trump if he could be declared unfit to perform the duties of the presidency. While a quicker mechanism, this would be even more difficult to achieve as it would have to be initiated by the vice president and requires the support of two-thirds of each House should the president contest the action.

Democrats Looking At 25th Amendment Option For Removal Of Trump

Donald Trump’s bizarre behavior in his attacks on Joe Scarborough and Mika Brzezinski has led to further talk about the possibility of removing Donald Trump from office if found to be mentally unfit. Twenty-five House Democrats are pursuing a bill to create a panel which could evaluate Trump’s mental competency under the 25th Amendment. Yahoo! News reports:

… 25 House Democrats, including the ranking member of the House Judiciary Committee, are now pushing an equally radical alternative: They are backing a bill that would create a congressional “oversight” commission that could declare the president incapacitated, leading to his removal from office under the 25th Amendment to the U.S. Constitution.

At 12:56 p.m. Thursday, barely four hours after Trump tweeted attacks against MSNBC cable host Mika Brzezinski in crude, personal terms, Rep. Jamie Raskin, D-Md., the chief sponsor of the bill, sent out an email to his colleagues, urging them to get behind the measure, writing it was of “enduring importance to the security of our nation.”

“In case of emergency, break glass,” Raskin told Yahoo News in an interview. “If you look at the record of things that have happened since January, it is truly a bizarre litany of events and outbursts.” Asked if Trump’s latest tweets attacking Brzezinski and her co-host Joe Scarborough — which were roundly condemned by members of both parties as beneath the dignity of his office — strengthened the grounds for invoking the 25th Amendment, Raskin replied: “I assume every human being is allowed one or two errant and seemingly deranged tweets. The question is whether you have a sustained pattern of behavior that indicates something is seriously wrong.” After Trump’s Thursday morning tweets, four more Democrats signed on to Raskin’s bill, his office said Friday. (Brzezinski and Scarborough’s response to Trump’s tweets ran in today’s Washington Post under the headline, “The President is not well.” White House spokeswoman Sarah Huckabee Sanders defended Trump’s tweets Thursday, saying he “fights fire with fire.”)

…Raskin, a former constitutional law professor, has seized on some largely overlooked language in Section 4 [of the 25th Amendment] as the basis for his bill. It turns out it doesn’t have to be the Cabinet that makes a finding of presidential incapacity. The section also permits “such other body as Congress may by law provide” — along with the vice president — to reach the same conclusion.

Yet in the 50 years since the 25th Amendment took effect, Congress has never set up such a body. Raskin’s bill would do so. It calls for the creation of an “Oversight Commission on Presidential Capacity.” The commission would be a nonpartisan panel appointed by congressional leaders composed of four physicians, four psychiatrists and three others — such as former presidents, vice presidents or other former senior U.S. government officials. The commission, if directed by Congress through a concurrent resolution, would be empowered to conduct an examination of the president “to determine whether the president is incapacitated, either mentally or physically.”

Removal of the president under the 25th Amendment could be more difficult than impeachment. Impeachment requires the support of a simple majority of the House and then two-thirds of the Senate to remove the president. The 25th Amendment  requires the Vice President to support the process. If the president should be declared to be incapacitated, he could then challenge the action. It would take two-thirds of both Houses to agree in order to prevent the president from being reinstalled in office.

The advantage of this mechanism would be that it is much quicker than the full impeachment process, provided that the Vice President and super majorities of both Houses agree. It is far fetched that this could currently be done, but does provide an option if Trump’s behavior should deteriorate further to the point that there is agreement that he must be removed.

Why The CBO Report On The Senate Republican Health Care Bill Is Devastating

The Congressional Budget Office released its scoring of the Senate health care bill. The New York Times summarizes:

The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

The results can be seen in the above graph.

The American Medical Association gave this assessment of the bill:  “Medicine has long operated under the precept of primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”

The increase in uninsured would come from reductions in the number of people covered by Medicaid and by private coverage. Beyond the severe cuts in Medicaid, the Senate bill would provide less assistance in purchasing private plans. One devastating paragraph from the CBO report has been receiving attention:

Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income — also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.

The plan also fails to lower premiums for most people, or help to increase the number of insurance plans offered. In other words, it fails to solve the problems which Republicans criticize Obamacare over.

The Republicans face two fundamental problems in trying to develop their own health plan. The first is that Obamacare is essentially the Republican alternative to Hillary Clinton’s health care plan. Obamacare does more than the old Republican plan to regulate insurance companies, but the basic structure is the same. Republicans widely supported the individual mandate and the other aspects of Obamacare which they now attack before it was proposed by Obama. This forces them to come up with something different, and there really are not that many ways to handle health care coverage.

The other problem is that the problems we now see on the individual market were not created by Obamacare. Insurance coverage has always been expensive for those buying coverage on their own, as opposed to being in an employer or government plan, provided that the insurance provided decent coverage. The market has never been able to solve this problem and the only realistic options short of a single-payer plan are ones which involve further government involvement, such as a public option or Medicare buy-in. Republicans are not going to back this.

It is also questionable if enough Republicans will back their current plan for it to even pass in the Senate.

Russia Not Working As Political Issue For Democrats

It looks like, unless new evidence should arise, the Democrats need to change their strategy of counting on attacks against Donald Trump based upon Russia to improve their political fortunes.  A  Harvard-Harris Poll reported by The Hill shows that sixty-two percent believe that there is no hard evidence of collusion between Donald Trump and Russia to alter the results of the election.

This does not mean there is no concern over the issue: “On the question of collusion, 52 percent said they don’t believe Trump coordinated with Moscow to influence the 2016 presidential election. But 54 percent said they believe Trump’s associates may have been involved.”

There are results in this poll which both supporters and opponents of Trump would be happy with. It does appear from this and other polls that a majority think that Congress should be dealing with other issues but do support the investigation by Robert Mueller:

Fifty-six percent of voters said it’s time for Congress and the media to move on to other issues, compared to 44 percent who said the focus should stay on Russia.

But other surveys have found strong support for the special counsel investigating the Russia probe. A Harvard-Harris survey released last month found 75 percent support for former FBI Director Robert Mueller’s investigation.

There is evidence in the Harvard-Harris survey that voters are taking the investigations seriously: Fifty-eight percent say they’re concerned by allegations of obstruction of justice against Trump, with the same number worried about possible dealings between Trump and the Russian government.

I have to disagree with the majority here. Considering what the Republican Congress is likely to do if not distracted by Russia, such as the terrible health care bill, I think that anything which interferes with the Republicans in pursing their agenda is a good thing. Plus there is  benefit to a Congressional investigation in addition to an investigation by a special counsel. An investigation by a special counsel is centered on actions which can lead to prosecution, and the details of their investigation might never become public. A Congressional investigation can be involved with investigation of all pertinent acts, including potentially unethical behavior which might not lead to actual indictment, and such a report should be made public. Of course there are also concerns regarding the reliability of any Congressional investigation with a Republican majority.

At this time there is far more evidence of possible obstruction of justice and potential financial irregularities than of collusion to tamper with the election results.It is also doubtful that Russia actually had any meaningful impact on the election. Earlier this week Former Homeland Security Secretary Jeh Johnson said in his Congressional testimony: “To my current knowledge, the Russian government did not through any cyber intrusion alter ballots, ballot counts or reporting of election results.”

Russia remains suspected of being responsible for hack of DNC material leaked by Wikileaks but this only led to the release of information about Clinton and the DNC which was already widely suspected, and often already demonstrated by other sources. The alleged fake news and other propaganda attacks from Russia were probably trivial compared to all the noise already present in the media and on line. The claims of some Clinton supporters that anti-Clinton sentiment was a creation of Russian propaganda totally ignores the strong opposition to the Clintons on both the right and left which existed long before Russia allegedly tried to tamper in the election results. Russia certainly is not responsible for numerous bad decisions made by Clinton and her campaign which contributed to her loss. Shattered revealed that Hillary Clinton developed the strategy of blaming Russia for her defeat withing twenty four hours of her loss.

In the investigations of Donald Trump and his administration, obstruction of justice and  financial impropriety currently look  like a much more significant avenue for investigation than collusion to alter the election results. It is also worthwhile to look at any risks of future hacking of elections, regardless of source, to improve cyber-security in the future. If they want to break their current losing streak, Democrats also need to develop a better strategy than talking about Russia and avoiding principles.

Republicans Have Neither Tapes Of Trump/Comey Meetings Or A Viable Health Care Plan

Today we found that Donald Trump does not have any secretly recorded tapes of James Comey and the previously secret Senate Republican health care plan has been released. Neither was a surprise. If Trump had any tapes proving he was telling the truth, he would have already released them, and if there happened to be tapes which showed he was lying, he would never admit to having them. Also, as expected, the Senate plan includes deep cuts to Medicaid, decreases subside for lower income individuals, and increases costs for those who are older.

Barack Obama described the plan:

Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

I hope our Senators ask themselves – what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid? What will happen if you have a medical emergency when insurance companies are once again allowed to exclude the benefits you need, send you unlimited bills, or set unaffordable deductibles? What impossible choices will working parents be forced to make if their child’s cancer treatment costs them more than their life savings?

To put the American people through that pain – while giving billionaires and corporations a massive tax cut in return – that’s tough to fathom. But it’s what’s at stake right now. So it remains my fervent hope that we step back and try to deliver on what the American people need.

It is far from certain that the Republicans can even pass this plan, despite using reconciliation so that they only need fifty votes. They can only afford to lose two votes, but four conservatives have already expressed reservations. From NPR:

Senate Republicans’ health care bill may already be on life support, with four key lawmakers announcing their opposition just hours after the GOP’s latest effort to repeal and replace the Affordable Care Act was released.

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” Sens. Rand Paul, R-Ky.; Ted Cruz, R-Texas; Mike Lee, R-Utah; and Ron Johnson, R-Wis., said in a statement Thursday afternoon.

They cannot easily move further to the right to appease the conservatives as some more moderate Republicans already have their own objections:

Sen. Dean Heller, R-Nev., who faces a competitive re-election race in 2018, says he has “serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”

“As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not — I won’t,” Heller said.

Annie Clark, a spokeswoman for Sen. Susan Collins, R-Maine, said the centrist has some misgivings about the bills as well.

Whether or not it passes, Republicans will now be able to tell their constituents that they have attempted to keep their promise to repeal and replace Obamacare. If their plan fails, the blame could be placed on Democrats and whichever Republicans vote against it, as opposed to the party as a whole. If that doesn’t work, McConnell could always take something from the Clinton playbook and blame Russia.