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
Newly uninsured
by 2019
Republican senators
Up for re-election in 2018
or in 2020
0
500,000
1 million
1.5 million
2.0 million
2.5 million
Marco Rubio
FLA.
Ted Cruz
TEX.
John Cornyn
TEX.
Thom Tillis
N.C.
Patrick J. Toomey
Pa.
David Perdue
GA.
Richard M. Burr
N.C.
Jeff Flake
ARIZ.
Cory Gardner
Colo.
Johnny Isakson
GA.
Roy Blunt
MO.
Bill Cassidy
LA.
John McCain
ARIZ.
John Kennedy
LA.
Dean Heller
NEV.
Ron Johnson
WIS.
Todd Young
IND.
Mitch McConnell
Ky.
Tom Cotton
ARK.
Rand Paul
Ky.
Lindsey Graham
S.C.
Joni Ernst
IOWA
Pat Roberts
KAN.
Lamar Alexander
TENN.
John Boozman
ARK.
Thad Cochran
MISS.
Steve Daines
MONT.
Shelley Moore Capito
W.VA.
Dan Sullivan
ALASKA
Jim Risch
IDAHO
Deb Fischer
NEB.
Roger Wicker
MISS.
Mike Rounds
S.D.
Lisa Murkowski
ALASKA
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
Marco Rubio
Ted Cruz
John Cornyn
Thom Tillis
Patrick J. Toomey
David Perdue
Florida
TEXAS
TEXAS
North Carolina
PENNSYLVANIA
GEORGIA
Difference between margin of victory and number uninsured
1,516,897
1,304,790
1,285,856
979,392
869,310
808,723
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.
Election turnout
80.2
By annual income
By age
76.9
73.8
71.4
68
66.2
63
58.4
56.9
55.8
50.4
46.9%
45.8
43.4%
100k - 149k
10k - 14k
15k - 19k
20k - 29k
30k - 39k
40k - 49k
50k - 79k
75k - 99k
150k+
18 - 29
30 - 44
45 - 59
60+
<10k
Note: Data for 2012. Source: Demos.org
Note: Data for 2016
Source: ElectProject.org
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.
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