One of the health care bills under consideration by Republican leaders would take health insurance away from 32 million people over the next decade, creating a cohort of Americans who could be motivated to vote against senators who approved the measure.
The Senate could vote as early as Tuesday, but it is not yet clear which of the two bills in contention that the majority leader, Mitch McConnell, intends to bring up. The plan that would leave 32 million without coverage would repeal some of the most important parts of the Affordable Care Act without any replacement.
If they pass the bill, some Republicans might put themselves in a difficult situation because many of them won their last election by fewer votes than the number of people who would lose health coverage in their state under the proposed legislation. The comparison shows the scale of the problem some Republicans might face in close races in 2018 and 2020.
Margin of victory
in last election
Up for re-election in 2018
or in 2020
Patrick J. Toomey
Richard M. Burr
Shelley Moore Capito
Note: Excludes senators where the margin of victory is greater than the number of uninsured.
Of course, not everyone who faces a tougher insurance market will be swayed to vote against incumbent Republican senators who backed the bill, if only because voters won’t see the effects immediately. Under the repeal without replacement bill, Obamacare’s expanded Medicaid coverage would end in 2020, after the 2018 midterm election. Under the other Senate bill under consideration, the Better Care Reconciliation Act, big cuts to Medicaid would start in 2021, the year after the next presidential election.
Still, many voters might be worried about the prospect of losing coverage, or entering an insurance market that no longer has the protections of the Affordable Care Act, as they cast their votes next year and in 2020.
Republican Senators Most at Risk
Patrick J. Toomey
Difference between margin of victory and number uninsured
Among Republican senators, 31 are running for re-election in 2018 and 2020.
Of those, 22 are running in races where the number of uninsured under the repeal without replacement bill would be greater than the margin of victory in their last election, a sign that voters affected by the Republican health plan could possibly sway the outcome against them.
Low Turnout May Help Republicans
Many Republicans who are up for re-election and support the repeal bill are surely counting on people upset about this legislation to not show up to vote, or to vote for them regardless.
That might be a reasonable political calculation because low-income Americans, who would be among the most hurt by the destruction of the A.C.A., tend to vote at lower rates than more affluent families.
But Republican senators ought to remember that older Americans, for whom this bill would also have devastating effects, tend to vote at higher rates than younger people. In the last presidential election, many of these voters broke for Donald Trump, but they might be less inclined to back Republican candidates once this bill becomes law.
By annual income
100k - 149k
10k - 14k
15k - 19k
20k - 29k
30k - 39k
40k - 49k
50k - 79k
75k - 99k
18 - 29
30 - 44
45 - 59
Note: Data for 2012. Source: Demos.org
Note: Data for 2016
The Senate repeal without replacement bill would cut Medicaid spending by $842 billion over 10 years compared to current law, according to the Congressional Budget Office.
Nearly two-thirds of Americans are opposed to such drastic cuts, including the vast majority of Democrats and a solid majority of independents, according to a Kaiser Family Foundation poll. But about 54 percent of Republican voters support big cuts to the program, which may help explain why some lawmakers from the party are ambivalent about or hostile toward the program.
In addition, the deep Medicaid cuts in the Senate bill would have a disproportionate impact on older people. That’s because 64 percent of people in nursing homes rely on the program, including many middle-class people who have depleted their savings.