In comments yesterday Anonymous at Work performs a thorough analysis of the Senate and how it could plausibly play out in a repeal and replace scenario.
They make the very good point that red state senators whose residents disproportionately benefit from the ACA are still likely to vote to slash ACA spending.
I think they are stuck in 2017 where the House GOP had over a dozen allowable NO votes while the Senate needed only three NO votes to stop anything. The political leverage is in the House.
Three is the magic number in the House while four is the magic number in the Senate.
What do I mean by that?
Next week, the Senate will be 53 Republicans and 47 Democrats. That means any party line bill in the Senate can lose four Republican votes (assuming everyone shows up) as losing three votes has JD Vance rising from the fainting couch. On an ACA bill, we could plausibly assume that both Murkowski and Collins are likely NO and then…….. I am not sure who #3 much less #4 is. We are not in 2017 where only #3 needed to be found.
There are very few Republican Senators who represent Harris voting states in any cycle so electoral pressure is hard to leverage.
The House is where the leverage lies.
In the House, the current margin is 219 Republicans and 215 Democrats. If Mike Johnson has two Republicans vote NO, the bill fails as ties are stops. Sometime in late January or February with Stefankik and Waltz resign to take executive branch positions, the margin of allowable Republicans voting NO assuming full attendance and 100% Democratic opposition is 0. That number will fluctuate throughout the next two years as resignations and deaths will occur and special elections** will move the margin but in almost any reasonable scenario, the winning GOP NO Vote margin will range between 0 and 5.
There is a universal election in 2026 where the electorate is likely to be bluer than it has been in 2022 or 2024 due to the combination of thermostatic politics AND the changing coalitions where lower turn-out elections have more regular Democratic super-voters than a general election. There are thirteen House Republicans who won in 2024 by four or fewer points. There are two who won by less than 1% point.
There is also a fairly large chaos caucus that will make any GOP whip count an absolute adventure. I am making a strong assumption that Nancy Pelosi is a far better vote counter and wrangler than Mike Johnson when they are working with a miniscule majority during a trifecta.
So let’s work the House as hard as we can by phone calling, protesting, and organizing electoral challenges in the dozen to two dozen electorally competitive seats so that the most marginal GOP representatives are placed in the position where their interests are Vote NO and Hope YES.
** Side point, if you live in a state with a Democratic governor, advocate for them to schedule Dem leaning special elections as quickly as possible and special elections for previously GOP held vacant seats as slowly as legally possible. Grind the clock and place pressure on the most marginal GOP members to take votes that they don’t want to take if they want to have a chance in hell of surviving a blue midterm.
Jimmy Carter, Good President, Great Man (we won’t see the likes of him again)
WaterGirl
Dave, our posts went up within 2 minutes of one another. Yours is an important post, and I didn’t want to step on it, so I moved the post time back 2 minutes on my post.
Tom Levenson
Good post.
I live in a state with a D governor, but…
A completely D Congressional delegation. So yeah–fast specials if any of our folks leave, but can’t help slow walk an R seat.
We do what we can.
Anonymous At Work
Florida, so there’s not much I can do until 2026. Even worse, Debbie Wasserman-Schultz is the Congress-critter. She’s pretty well corporatized. As a big believer in the line, “When someone shows you who they are…”, I’m not hopeful she won’t enrich herself/war chests on crypto and tech-bro finances.
Barbara
I understand where most of the ACA enrollment is, but the red states that will be most disproportionately and negatively affected by any material tampering are Idaho, Kentucky and West Virginia. They have some of the lowest rates of commercial group insurance participation in the country and really depend on federally funded programs. Unlike Texas, Florida and Georgia, they also have expanded Medicaid and cannot afford to lose those federal dollars. Idaho is already medically underserved. Those are the congressional reps that will likely understand the negative consequences for constituents.
Anonymous At Work
@Barbara: Idaho has a very rabid anti-government population that won’t miss the dollars if the money is identified as “federal government” dollars. They’ll miss the brain drain and healthcare operations going belly-up, but their militia’s medic can handle that, right?
Kentucky and West Virginia, you may be correct because the Republicans there are hypocrites when it comes to accepting federal money but rejecting federal government. However, against Moscow Mitch McConnell and Jim Justice, you have Rand Paul and Shelly Capito. But I can’t see McConnell or Justice voting against party, can you?
David Anderson
@Anonymous At Work: Ignore the Senate — except on the policy margin. The decisive policy and votes are in the House.
TONYG
@Anonymous At Work: Idaho is yet another state that gets more in federal benefits than it pays in federal taxes. Yet another state whose dumb-ass residents I am subsidizing as a taxpayer in New Jersey. As far as I’m concerned Idaho can secede. They can rename themselves as The Republic of Dumbfuckistan. Then they can go fuck themselves. The average IQ of the United States will increase accordingly.
Geminid
@Anonymous At Work: Jim Justice is somewhat of a wild card here, I think. He seems like another Joe Manchin but with an “R” after his name. As Governor, Justice seemed more of a pragmatist than an ideologue and the “repeal and replace” question pits ideology against pragmstism
Ed. I got to hear some of Governor Justice’s daily news conferences during the Covid pandemic and he seemed very sound on public health issues.
cmorec
While there are no guarantees 2026 will hold to the historical pattern of a corrective electoral reaction against the party in power from a Presidential election, the odds are favorable that enough of the more marginal voters who put Trump and Rs just enough over the top in 2024 will have buyer’s remorse from the practical fallout from the extemist Trump / MAGA / Heritage RW. Put another way, the fickleness of the marginal 10% of the electorate will likely work enough in our favor to win back at least the House and at least narrow the R Senat majority (although keeping the Ga Senate seat that’s back up in 2026 may be challenging).
In the meantime, the crucial thing is to find as many ways as possible to pour sand into the gears of the extremist R Congressional agenda, to minimize the amount of lasting permanent damage they can do.
Lee
As usual, when Senate Dems want to pass something good, it needs 60 votes. But the GOP only needs 50 to repeal it. Sigh.
Barbara
@Anonymous At Work: Idaho runs its own exchange and has done so from the beginning of the ACA. It has the largest proportion of individuals enrolled in the ACA of any state. Do you live in Idaho? Do you have actual information? Or are you just pre-planning your spiel once the losses go into effect?
RaflW
In thinking about your correct footnote, and wondering if any Dem governors would do it, I end up thinking: They’re still too wedded to the (desirable) forms of governing and democracy to agree to smash-mouth like that.
And to that end, I’m long-posting this thread from Will Stancil. I have my issues with him, but this idea is really strong.
==
Will Stancil @whstancil.bsky.social
January 9, 2025 at 8:54 am
What we’ve done is create a massive information infrastructure which privileges conspiracy theories, demagoguery, bigotry, lies, and hysteria – much larger than the traditional news infrastructure. It’s the main information source for many.
And then new political movements evolved to exploit it.
I think what’s happened has been disguised in part by the fact that we noticed the political changes before we noticed the information changes, and that in the US, the new political movements have attempted to take over existing parties, especially the GOP.
But ultimately what’s happened here is that we built an intellectual and information ecosystem vulnerable to certain kinds of ideas – more vulnerable over time – and then, like a virus evolving to match its host, a new style of authoritarian, demagogic, fascist politics formed out of that ecosystem.
That’s why we’re seeing the rise of this sort of meme-driven clownish fascism worldwide: because the information ecosystem has changed across the globe, and everywhere it happens becomes vulnerable to the same basic political approach.
Worse still, because existing parties did (and mostly still do not) recognize the roots of the problem, they are not taking any real action to arrest the slide. There was no effort, for instance, to keep Musk from taking over Twitter – now he’s using it as a bludgeon against democracies everywhere.
If democracies are going to survive, they need to go to war with social media and the tech oligarchs who oversee it. We cannot have a society governed by mass hallucination.
No functional institution designates as true whichever idea excites people the most. The creation of modern society is in many respects the creation of systems to carefully adjudicate which ideas are true, and act on them. But social media and the internet has dissolved that.
Online, especially in virality-driven social media, especially as all fact-checking and moderation has been abandoned, truth is effectively determined by whoever gets more attention. This is not sustainable, especially since it incentivizes people to create more potent claims and lies for attention.
Trump-like politics is a natural evolution of these incentives. Our new fascist movements gravitate towards whatever gets attention and excites people, which gives them a huge competitive advantage in the new information ecosystem.
And as they’ve responded to the incentives and iterated – and as online media ecosystems have absorbed and compromised more of the traditional news structures – the politics of people like Trump have become angrier, more violent, more hallucinatory. Shaped to thrive within this toxic environment.
I don’t think anyone knows what the endpoint is but there’s no sign this evolution is stopping or slowing. We’ve already accelerated from a border wall to threatening to conquer half the Western hemisphere. From “less censorship” to openly seeking to have neo-Nazi parties replace allied governments.
The physical world still exists and eventually ideas formed in the mass hallucination chamber of social media will collide with it, even for the people in the grips of the hallucinations. And when that happens a lot of people will die.
==
Italics added above.
RaflW
@TONYG: I get the anger but jesus christ. A very lovely friend of mine is the UU minister at the congregation in Boise. She has risked her and her kid’s safety to openly advocate in print for the right of said kid to exist as a trans person.
Seeing you write off people like my friend is the horrible coarsening of society that I cannot stomach. It’s abhorrent coming from MAGAs. It’s no better if it comes from another quarter.
cmorenc
IMO what the Rs are most likely to do is with the ACA is to pour old wine into a new bottle, adultrated with some inferior ingredients and re-brand it as “Trumpcare”. It will be superficially simililar, but with more carved-out holes designed to increase the profitability of health insurers, as well as to mollify health cranks like RFK and the religious right (good-bye to support for anything to do with birth control).
David Anderson
@cmorenc: Georgia Access Model 2020 waivers is what I expect (Ie an operationalization of the proposed Cruz amendments to allow a lot more underwriting with a de facto high cost risk pool back stop)
Steve LaBonne
@RaflW: “For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.” – Richard Feynman
Anonymous At Work
Apologies for focusing on Senate. Republicans won’t overcome a filibuster to repeal and won’t try to replace either.
In House, there’s too many gerrymandered districts to predict. I think looking at Congressional Districts with only 1-2 hospitals left that would go out of business if the GOP removes significant funding. I would imagine that instead of “repeal” funding, they would try to shift the funding from urban to rural hospitals. I can’t think of a large urban area with imperiled hospitals/hospital systems but there are probably plenty of smaller cities but I don’t know the data.
Anonymous At Work
@David Anderson: Those Waivers proved ineffective, or wasteful, in a lot of states, such as Arkansas, I thought. Wouldn’t that make a good target for DOGE’s attempts to cut Medicare?
comrade scotts agenda of rage
@RaflW:
I posted a similar sentiment earlier today:
raven
@comrade scotts agenda of rage: Little Egypt !
David Anderson
@Anonymous At Work: Totally different waiver streams — the Arkansas waiver was a Section 1115 Medicaid work requirement waiver (as well as the current Georgia Medicaid expansion that is not an expansion).
I’m referring to a Section 1332 ACA individual market waiver. Much bigger/longer post in the next week to explain more.
catclub
@Lee: Yeah, why only 50? will this repeal be brought up under reconciliation?
Fair Economist
I’m in Young Kim’s district (R-CA in a swing seat), so maybe I’ll be able to do something this cycle.
Barbara
@RaflW: It’s a fine line between trying to support people living in a hostile environment and constantly pulling punches and using up political capital to protect voters who will never lessen their hostility to Democrats. So I actually understand TONYG’s frustration and I really don’t think the fact that there are nice people in Idaho is an adequate response to his venting.
I don’t actually care if Idaho loses its federal funds and its rural hospitals go bankrupt, but if I can reach an Idaho legislator who does care in order to preserve the greater good for other people nationally, then yeah, I will do that. To the extent diatribes make that less likely — well I doubt if complaining here does that, but it kind of sets the larger stage so I try to avoid it.
Fair Economist
@RaflW:
The extra-horrifying thing is that the oligarchs seem to believe their own bullshit (they’re marinating in the same toxic info environment everyone else is, possibly worsened by their yes-man squads). We are facing a world ruled by lunatics.
Fair Economist
@Barbara: I think the constructive approach is to talk about how the Republicans are going to fuck over Idaho and similar states. That won’t repel normies, won’t result in time being wasted squabbleling about tone hear, and might even penetrate into the RW ecosystem a bit.
Barbara
@Fair Economist: That would definitely be the kind of legislator who might be willing to stand up to the party, although I am continually amazed at the general level of cowardice displayed by all federal legislators. I guess hanging on to that golden ticket of power and influence is the most seductive kind of drug ever devised. Nonetheless, the anti-California rhetoric is going to be constant and ongoing and any R in California should be challenged to explain why they vote in favor of any policy that harms their California constituents.
Geminid
@Geminid: Louisiana Senator Bill Cassidy might be another Republican defector on health care legislation, I think.
Barbara
@Fair Economist: Yeah, doubtful. My usual response these days is something to the effect of “I am not required to care about you more than I care about myself and I am certainly not required to care about you more than you care about yourself. However, I have no wish to harm you and will work as hard as possible to protect your interests where they coincide with mine.”
I think we need to be more self-interested. The impact of being seen as altruistic has clearly peaked. It’s time to protect those that are on our side.
Barbara
@Geminid: Considering that upwards of 70% of infants born in Louisiana are covered by Medicaid you would think that is a no-brainer, but he never ceases to amaze when it comes to willfully leaving his brains at the drycleaners for weeks on end.
Fair Economist
@Barbara: Young Kim has voted against the party line on rare occasions, so it is possible.
We don’t have to be altruistic to express sympathy. My goal for a tagline is “Vote Democratic if you want to live. Republicans will kill you.”
Kosh III
TEnnessee would be adversely affected also. Their hatred of President Illegal alien-Muslim-Colored boy-in-our-WHITE-House has consistently led the Legislature to refuse to expand Medicaid, even when Regressive governors practically beg for it.
Meanwhile, rural hospitals, which are very R areas are closing left and right and many have limited services.
https://tennesseelookout.com/2023/05/11/report-more-than-half-of-all-rural-tennessee-hospitals-no-longer-deliver-babies/
Buttigieg/AOC 2028
Kirk
@Barbara:
But medicaid is permanently tied to “those people” (usually black but other ‘other’ labels as well). It’s the forever fight against denying letting them have sparrows on “their” curtain rods.
Barbara
@Fair Economist: Our first and foremost response does not have to be sympathy of any kind for anyone. We are not required to always be thinking about your poor UU minister friend before we express any opinion about Idaho. If she doesn’t get how frustrating it is for people like me looking at things we love and cherish being destroyed by her neighbors then that’s kind of a sign that maybe she doesn’t care all that much about us. Everything has to be a two way street. Always. FFS.
Barbara
@Kirk: But hospitals that treat Medicaid beneficiaries are not just tied to “those” people. The hollowing out of rural health care is a self-inflicted wound. Louisiana is not as badly affected only because it is a geographically small and dense state.
Geminid
@Barbara: Bill Cassidy voted to convict Trump so he was willing to buck the Party that time. We’ll see what happens, but I don’t dismiss the possibility of Cassidy, Murkowsk, Justice and Collins sticking together on some issues like health care.
But they might just use their leverage to win concessions for their own states. Murkowski did that during Trump’s first couple years.
Like Murkowski’s Alaska, Louisiana has a jungle primary and that gives Cassidy some latitude if he wants to run for Governor, or for another Senate term
I suspect Murkowski, Collins and Justice might not be commited to running for another term, and that may give them some latitude in their Senate votes.
Barbara
@Geminid: I was confusing Cassidy with Kennedy, who is truly a creep.
Sister Machine Gun of Quiet Harmony
@RaflW: Yes! Exactly!
David Anderson
@Geminid: I think Murkowski has a plausible path forward by doing just slightly better than Peltolta did in 2024 and with roughly the same coalition as Peltolta had in 2022.
janesays
If it ever gets to 5 in the next two years, we’re in really, really deep shit, because it will mean that not only will they have retained the three vacant seats that will hold special elections soon (all of which are in deep red districts), but they will have flipped three seats currently held by Democrats. The only plausible way that happens is if a clear majority of Americans approve of Trump’s performance as president at the time those seats are contested in special elections.
I think at most, Johnson (or whoever replaces him when he’s inevitably pushed out of the job at some point) will have 3 golden tickets available, and that only happens if they flip a seat currently held by a Democrat or there are two Democratic vacancies simultaneously after the three vacant and soon-to-be vacant red seats have been filled. If the House stays at 220-215 for the duration of the session after the three special elections, he’ll have just two golden tickets available when all members are present.
Geminid
@David Anderson: Sen. Murkowski and Rep. Peltola campaigned together in the last weeks of their 2022 reelection races.
David Anderson
@janesays: or a car crashes on the Beltway with half of the Massachusetts delegation in it