THE PROGNOSIS

Ken Cuccinelli, president of the Senate Conservatives Fund. (Photo by Win McNamee/Getty Images)

Conservatives are furious – furious – that Senate Republicans got close to repealing big parts of Obamacare and are now on the verge of walking away from the effort altogether, possibly leaving President Obama’s health-care law on the books for the foreseeable future.

No issue motivated conservative activists more over the past seven years than repealing Obamacare, with groups on the right expending huge dollars and resources to get Republicans elected across two branches of government so they could finally pass a repeal bill.

Their path seemed clear. First, the GOP took the House in 2010. Four years later, Republicans seized the Senate majority. And then in November, when President Trump unexpectedly won, conservatives thought victory was theirs. Just about every Republican who won a national election since the ACA was passed had promised to repeal it as part of their platform.

“You add together all the tweets and social media posts, you add all the interviews and news conferences — my guess is that Republicans in Congress have pledged to repeal Obamacare well over a million times,” Media Research Center President Brent Bozell told reporters yesterday.

Jenny Beth Martin, co-founder and national coordinator of the Tea Party Patriots. (Photo by Edmund D. Fountain for The Washington Post)

The tea party movement, which helped mobilize voters to give Republicans big victories several elections in a row, largely grew out of opposition to the Affordable Care Act, Tea Party Patriots founder Jenny Beth Martin noted on a call with the press.

“If there is a single unifying issue in the tea party movement, it is the desire to repeal Obamacare,” Martin said.

Now, nothing is turning out as they’d hoped. Senate Majority Leader Mitch McConnell (R-Ky.) intends to hold a vote early next week to start debate on a repeal bill. But unless senators can hash out an agreement on how to treat Medicaid spending — as they tried to do in a meeting last night in Sen. John Barrasso’s (R-Wyo.) office — it will likely fail. It’s also unclear when — or if — Sen. John McCain (R-Ariz.) will return to Washington after announcing last night that he was diagnosed with brain cancer.

At least four centrist Republicans — Sens. Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio – have said they’ll vote against even starting debate on the measure without a better ACA replacement ready to go. That’s got conservatives seething, and plotting their revenge.

FreedomWorks is prepping a “Freedom Traitor Award” along with a bust of Benedict Arnold to deliver to the offices of any Republicans who help block the repeal effort next week. Spokesman Jason Pye told me the group is “aggressively targeting” Portman and Capito’s offices with phone calls and emails pressuring them to support it.

Do you think officials who defend #ObamaCare from repeal should switch parties? Give them a call and tell them to support the 2015 repeal. pic.twitter.com/sgnwRXeVtG

— FreedomWorks (@FreedomWorks) July 19, 2017

Tea Party Patriots and Club for Growth launched a website called “Obamacare Repeal Traitors” featuring photos of Murkowski, Capito and Portman, listing multiple previous quotes where they’d slammed the ACA and promised to repeal it and providing the phone numbers to their offices.

“They campaigned on REPEAL, they got to Washington on that promise…and now they are betraying their constituents by joining with Democrats to defeat Obamacare Repeal efforts!” the website says.

Former Hillary Clinton spokesman Jesse Ferguson recoiled at how the groups are using the word “traitor:”

Disgusting. @FreedomWorks calls Senators “traitors” if they won’t take away health care from 32m ppl & force premiums to double https://t.co/3qs0vELx2e

— Jesse Ferguson (@JesseFFerguson) July 19, 2017

Ken Cuccinelli, president of the Senate Conservatives Fund, warned reporters of political repercussions. He said “the solution is good, conservative candidates in primaries with these folks” — although that might be a ways off, since neither Murkowski, Capito or Portman are up for reelection next year, as Dave Weigel noted:

Up in 2022, 2022, and 2020. Hard to pressure. https://t.co/BheE7qHU0h

— Dave Weigel (@daveweigel) July 19, 2017

Tony Perkins, president of the Family Research Council, also said his group will go after Republicans who don’t follow through on their Obamacare repeal promises.

“If Republicans cannot repeal Obamacare now, they’re going to call hospice because their majority is not long for this world,” Perkins said.

The political right has persistently used Obamacare as political fodder in elections. In the 2014 midterm elections, for example, Republicans used ACA messaging in 84 percent of their political ad spots, compared to just 15 percent of ads run by Democrats, according to an analysis by Kantar Media.That year, more than 1.3 million health insurance and political ads aired, half of them referencing the ACA.

Conservative groups had criticized the first version of the Senate health-care bill, saying it didn’t go far enough in repealing the ACA’s insurer regulations. But the Heritage Foundation, FreedomWorks, Club for Growth and others had mostly come around with the addition of an amendment from Sen. Ted Cruz (R-Tex.) expanding the opt-out for insurers.

In the end, it was two conservatives – Sens. Mike Lee of Utah and Jerry Moran of Kansas – who became the third and fourth senators to come out against the Senate’s Better Care Reconciliation Act. Yet conservatives are still placing the blame on moderate senators, who were uncomfortable with how the bill would have phased out Medicaid expansion and enacted deeper underlying cuts to the program.

More moderates were unwilling, at the end of the day, to repeal Obamacare’s health-coverage expansions than conservatives had bargained for, Heritage Action spokesman Dan Holler said.

“There was just no sense in the Senate negotiations that the more moderate or liberal Republicans had a desire to get to yes,” Holler said.

If the Obamacare repeal effort goes down in flames – and that’s looking like the most likely outcome at this point, despite a confusing lunch at the White House yesterday where Trump made his own electoral threats to at least one naysayer  – it will be a dark day for conservatives.

“There’s a lot of frustration, and in some quarters, anger,” Holler said.

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AHH, OOF and OUCH

Sen. John McCain (R-Ariz.) announced yesterday he has been diagnosed with brain cancer. (Photo by Melina Mara/The Washington Post)

AHH: McCain has been diagnosed with a brain tumor, the Arizona Republican said yesterday. The announcement from the 80-year-old McCain, who’s a long-standing political figure and former POW in Vietnam, prompted former presidents, members of Congress and other Washington officials to put aside bickering and partisan gridlock for a moment.

“Senator John McCain has always been a fighter,” Trump said of the senator he once slammed for having been “captured” in Vietnam. “Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. Get well soon.”

Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. pic.twitter.com/SO4XYgnyug

— President Trump (@POTUS) July 20, 2017

Former President Obama, who ran against McCain in the 2008 presidential election, called McCain “an American hero & one off the bravest fighters I’ve ever known.” 

John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.

— Barack Obama (@BarackObama) July 20, 2017

–The Mayo Clinic Hospital in Phoenix said tests revealed a primary brain tumor known as a glioblastoma associated with a blood clot above McCain’s left eye that was removed last week, The Post’s Alex Horton reports

“The Senator and his family are reviewing further treatment options with his Mayo Clinic care team,” said the hospital in a statement. “Treatment options may include a combination of chemotherapy and radiation.”

“McCain’s type of cancer is particularly aggressive, with commonly poor prognoses, according to medical experts,” Alex writes. “The late senator Edward M. Kennedy (D-Mass.) survived less than 15 months after he was diagnosed with the same condition.” The Post’s Laurie McGinley, Lena H. Sun and Lenny Bernstein answer five questions about glioblastoma here.

McCain’s daughter Meghan tweeted out a statement from the family:

Statement regarding my father @SenJohnMcCain: pic.twitter.com/SMte9Hkwkq

— Meghan McCain (@MeghanMcCain) July 20, 2017

Other past and present lawmakers, both Democrats and Republicans, reacted with sadness. From Senate Majority Leader Mitch McConnell, per my colleague Mike DeBonis:

McConnell statement on @SenJohnMcCainpic.twitter.com/FfAJoEDQXp

— Mike DeBonis (@mikedebonis) July 20, 2017

House Speaker Paul D. Ryan (R-Wis.):

.@SenJohnMcCain has always been a warrior. It’s who he is. All of us, not as Republicans or Democrats, but as Americans, are behind him. pic.twitter.com/B6iDpPultM

— Paul Ryan (@SpeakerRyan) July 20, 2017

House Majority Whip Steve Scalise (R-La.) (who is still recovering from being shot last month):

Praying for my friend @SenJohnMcCain, one of the toughest people I know.

— Rep. Steve Scalise (@SteveScalise) July 20, 2017

Senate Majority Leader Charles E. Schumer (D-N.Y.):

.@SenJohnMcCain, you are a true fighter & I’ll be praying for you until you beat this. I know you will.

— Chuck Schumer (@SenSchumer) July 20, 2017

Sen. Chris Murphy (D-Conn.):

Heartbreaking news. I’ve traveled the world w @SenJohnMcCain. I learned a lot from him – first and foremost, there is no one tougher. pic.twitter.com/gPtHDW1RlE

— Chris Murphy (@ChrisMurphyCT) July 20, 2017

From Hillary Clinton:  

John McCain is as tough as they come. Thinking of John, Cindy, their wonderful children, & their whole family tonight.

— Hillary Clinton (@HillaryClinton) July 20, 2017

HuffPost’s Matt Fuller tweeted a clip of Republican Sen. Lindsay Graham (S.C.), McCain’s BFF, responding to the news:

Lindsey Graham responds to news of John McCain’s brain cancer diagnosis.

“This disease has never had a more worthy opponent.” pic.twitter.com/4S6cssfJCv

— Matt Fuller (@MEPFuller) July 20, 2017

From my colleague Kelsey Snell via Karoun Demirjian:

“I’ve been through worse,” @SenJohMcCain tells @LindseyGrahamSC of his cancer fight, via @kelsey_snell

— Karoun Demirjian (@karoun) July 20, 2017

Conservative commentator Rush Limbaugh. (AP Photo/Julie Smith)

OOF: Like conservative activists, media figures are also calling Republicans “traitors” if they don’t vote for a bill repealing most of Obamacare, Weigel reports.

“Conservative activists and media figures have settled on a message that could fall flat: Do it for President Trump,” Dave writes. “From Tuesday night through the announcement of yet another Republican meeting on their repeal bills, pundits and outside groups cast senators as ‘traitors’ if they did not deliver a victory for the president.”

“On the right, the final repeal push has been framed as a rematch of Trump’s 2016 victory — a chance for Republicans to go with their president, or reveal themselves as sellouts. Coverage of the health-care fight on Fox News, which had occasionally vanished from prime time, returned Tuesday night in the form of attacks on congressional failure,” he writes.

Here’s what some conservative media figures said yesterday:

Fox’s Sean Hannity: “Coming close doesn’t count…You people in Congress — you are pampered. You are overpaid. You are spoiled.” 

Rush Limbaugh: “Republicans don’t really want this to be repealed and don’t really want Trump to win…They never sell the plan.”

“Fox and Friends” co-host Brian Kilmeade: “These people are being true to their school, just not true to their party, and maybe not true to their country.” Kilmeade also asked a guest why Congress had “let Trump down.”

President Trump, flanked by Sens. Dean Heller (R-Nev.) and Tim Scott, (R-S.C.), speaks at a luncheon with Republicans about health-care yesterday (Photo by Jabin Botsford/The Washington Post)

OUCH: Trump still hopes the Senate health-care bill is only mostly dead, not all dead. The president lunched with Republican senators yesterday, where he exhorted them to resurrect the failed measure.

My colleague Sean tweeted a photo of the senators departing for the White House:

Bus full of GOP senators is on the way to the WH to have lunch with President Trump. pic.twitter.com/i2cZhlUMjD

— Sean Sullivan (@WaPoSean) July 19, 2017

Sen. Chuck Grassley (R-Iowa) was buckled up and ready to go:

I’m eager to replace Obamacare and I’m the first one on the bus to the Whitehouse to find the magic to get to “yes”

— ChuckGrassley (@ChuckGrassley) July 19, 2017

“People should not leave town unless we have a health insurance plan, unless we give our people great health care,” Trump said at the beginning of the lunch. “We’re close, very close … We have to hammer this out and get it done.”

White House press secretary Sarah Huckabee Sanders also said yesterday the president would stay in Washington for the duration of the health-care effort, when asked by reporters. Per TIME’s Zeke Miller:

Will POTUS cancel vacation/stop golf course travel? Sanders: “The president is committed to being here and working on the healthcare bill”

— Zeke Miller (@ZekeJMiller) July 19, 2017

Trump even threatened electoral consequences for GOP senators who oppose him, suggesting that Sen. Dean Heller of Nevada could lose his reelection bid next year if he does not back the effort. Heller was one of several centrist Republicans who disliked the health-care bill’s deep cuts to Medicaid.

“Any senator who votes against starting debate is really telling America that you’re fine with Obamacare,” Trump said.

Check out Heller’s face when Trump said that:

NBC’s Frank Thorp:

Sen Heller’s reaction when Pres Trump says “And he wants to remain a Senator, doesn’t he?” is priceless –> https://t.co/83EyrSmwbr

— Frank Thorp V (@frankthorp) July 19, 2017

Trump also made some rather ridiculous promises to senators during the lunch. Per NBC News’s Benjy Sarlin: 

If Senators were looking for signs Trump is dialed in on health care at lunch, him promising 70% (!!!) premium reductions probably wasn’t it

— Benjy Sarlin (@BenjySarlin) July 19, 2017

He said his selling across state lines plan would pass in a separate bill and reduce premiums 60 to 70 percent. “People don’t know that!”

— Benjy Sarlin (@BenjySarlin) July 19, 2017

“Trump’s remarks prompted some of them to reopen the possibility of trying to vote on the sweeping legislation they abandoned earlier this week. But there was no new evidence that the bill could pass,” my colleagues Sean Sullivan, Kelsey Snell and David Nakamura report. Not even after another meeting last night on Capitol Hill, where Vice President Pence, Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services director Seema Verma met with roughly two dozen GOP senators.

“The meeting was arranged by the White House to help persuade wavering senators to back the repeal-and-replace bill,” my colleagues write. “Following the meeting, several senators described the talks as productive, but none would name specific areas of progress or new agreement that resulted from the gathering.”

Per Axios, one senior GOP aide dismissed the chances for actual progress, given that the conservatives and moderates want completely different things. “This is just the death rattle,” the aide said.

TRUMP TEMPERATURE

President Trump speaks at a luncheon with GOP leadership about healthcare in the State Dinning Room of the White House in Washington. (Photo by Jabin Botsford/The Washington Post)

–In the last few days, as the Senate health-care bill failed, and then McConnell promised to bring a repeal-only bill to the floor, and then it became clear that lacked the votes too, Trump’s rhetoric on Obamacare has gone from “it’s a threat” to “it’s failing” to “it’s dead” to … whatever this is:

The Republicans never discuss how good their healthcare bill is, & it will get even better at lunchtime.The Dems scream death as OCare dies!

— Donald J. Trump (@realDonaldTrump) July 19, 2017

“Trump seems to think that the problem was one of salesmanship, as a hammer might have only one idea of what to do with a nail. Tell America that the health-care bill is good and then they will like it, the theory seems to go, and then you can pass it,” The Post’s Philip Bump writes.

But there are a few problems with Trump’s strategy. “The first is that people actually have a good sense of what’s in Republican bills introduced in the House and Senate — and they don’t like it,” Philip writes. “The broader problem that Republicans have in “discuss[ing] how good their health care bill is” is that there aren’t a lot of non-Republican-politician types that are willing to help make that case.”

–If Trump sticks to his “let Obamacare fail” strategy, there are a few ways he could actually make it fail, The Post’s Carolyn Johnson reports. If marketplace premiums skyrocket next year, a big part of the reason could be because Trump discontinued making billions of dollars in payments to insurers that help defray the cost of deductibles and out-of-pocket expenses for lower-income Americans.

“Those payments, called cost-sharing reductions, have been projected to add up to $7 billion this year,” Carolyn writes. “A White House spokesman said Wednesday that the cost-sharing reduction payments would be made on time this month, but the administration had not made a decision on whether to continue paying them long-term.”

“What the president is doing is actually undermining the Affordable Care Act. It’s very disingenuous to say, ‘I’m going to sit back and let it fail,’” Pennsylvania Gov. Tom Wolf (D) said in an interview. “By virtue of … things he has already done and could do in the future, he’s actually destroying the Affordable Care Act, he’s not just letting it fail. He’s taking it to failure.”

INDUSTRY RX

(AP Photo/Noreen Nasir)

–Considering that Senate Republicans weren’t able to pass a bill estimated to cost 23 million Americans their coverage, it’s highly unlikely they’ll approve a bill next week that would result in 32 million more Americans lacking coverage. But doctors associations, who lobbied hard against the GOP replacement package, aren’t making any bets. Six groups issued a statement yesterday opposing the ACA repeal-only bill that GOP leadership will try to advance next week.

“We oppose any effort by the U.S. Senate to repeal the ACA’s Medicaid expansion, premium and cost-sharing subsidies, and other coverage and consumer protections….A vote to repeal the ACA absent such consensus would further destabilize the health insurance marketplace, cause massive premium increases, and leave our patients without access to affordable, comprehensive health care coverage,” says a statement from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association and the American Psychiatric Association.

HEALTH ON THE HILL

–Last night, the Congressional Budget Office released an updated score on a bill only repealing — and not replacing — large sections of the ACA. Congress already passed this repeal-only bill at the end of 2015, and it’s now the legislation Senate GOP leaders are trying to advance. The CBO said the bill would increase the number of people without health coverage by 17 million next year and 32 million at the end of a decade. The forecast is nearly identical to prior CBO estimates.

The new report also said the legislation would decrease federal deficits by $473 billion over that 10-year window. Let’s just say the new forecast probably won’t help motivate senators to vote for it.

Some reactions from the Twittersphere:

The liberal Center on Budget and Policy Priorities:

CBO confirms: repeal w/o replace is even more harmful than #BCRA: https://t.co/ebwgr9lf1fpic.twitter.com/xB0u72h9QT

— Center on Budget (@CenterOnBudget) July 19, 2017

Ohio Gov. John Kasich, a Republican who has sharply criticized the Senate health-care bill:

Enough is enough. It’s time to reboot this whole process — it’s time to work together. https://t.co/WA1hZe37cl

— John Kasich (@JohnKasich) July 19, 2017

From Democratic Sen. Chris Murphy of Connecticut:

CBO scored repeal without a replacement – it’s a humanitarian disaster of incomprehensible scale. 32M lose insurance. Premiums go up 100%.

— Chris Murphy (@ChrisMurphyCT) July 18, 2017

Democratic Sen. Elizabeth Warren of Massachusetts:

Data nerds at the CBO confirm that the @SenateGOP “health care” bill would knock 32 million off their insurance. https://t.co/kgHxexC67X

— Elizabeth Warren (@SenWarren) July 19, 2017

Yesterday there were more protesters on Capitol Hill trying to block efforts to repeal Obamacare. From my colleague Karoun Demirjian:

The few but loud protesting health care in Hart pic.twitter.com/dYAxejaVFI

— Karoun Demirjian (@karoun) July 19, 2017

And an arrest. pic.twitter.com/isKU2HHj4W

— Karoun Demirjian (@karoun) July 19, 2017

From CNN’s MJ Lee: 

Protesters start being led away in handcuffs from McConnell’s office in Russell building pic.twitter.com/8wNgTYH50x

— MJ Lee (@mj_lee) July 19, 2017

CHART CHECKER

–The Senate health-care bill is mostly dead at the moment, but let’s rewind for a few minutes to de-tangle more of the political rhetoric around it. Remember how Trump and other Republicans claimed it didn’t cut Medicaid but did cut taxes? Well, you can’t have both, Post Fact Checker Glenn Kessler explains. “If a politician says there are tax cuts, they must also say there are Medicaid cuts. If a politician says Medicaid spending is growing, they must also say taxes are growing. Anything else is just spin,” Glenn writes.

But why? It’s because everything is measured against the government’s expected future spending, called a baseline. 

The Congressional Budget Office projected that in the initial version of the Senate health-care bill, Medicaid spending would be $772 billion less over 10 years than under current law — even though the raw dollars would increase from $393 billion in 2017 to $464 billion in 2026. So while Medicaid spending would be higher by 2026 under the Senate bill, it would still be $160 billion lower than under current law.

Same thing goes for the bill’s tax reductions. The initial Senate bill includes the repeal of Obamacare taxes that totaled $563 billion. But tax revenue would still go up, year after year. All that would happen is the growth in revenue would be slowed, to the tune of $84 billion in 2026.

The bottom line: “If a politician wants to claim that the Senate bill includes increases in Medicaid spending, to be accurate, you’d have to say there are increases in tax revenue — which is something most politicians never want to say,” Glenn writes. “Politicians can’t have it both ways. Both the reductions in Medicaid spending and the reduction in taxes need to be measured against a current-services baseline in order to measure the potential impact.”

A few more reads around the web: 

MEDICAL MISSIVES

DAYBOOK

(Reuters/Shannon Stapleton)

Today

  • The Hill is hosting an event on the prescription drug delivery system.
  • The House Energy and Commerce Subcommittee on Health will hold a hearing on bipartisan legislation to improve Medicare.

SUGAR RUSH

Sen. John McCain (R-Ariz.) was diagnosed with brain cancer: 

Senate Majority Leader Mitch McConnell (R-Ky.) vows senators will take a procedural vote on health care next week:

President Trump says “most” GOP senators “never saw” the Republican health-care bill:

How Senate Republican women stopped the latest attempt at ACA repeal: 

Sen. Ron Johnson (R-Wis.) agrees: Senators should not leave for recess before passing a health-care bill: 

Deputy White House press secretary Sarah Huckabee Sanders says the “battle over health care isn’t over”: 

Here are some highlights from Tuesday’s late-night shows following the collapse of the Senate health-care bill: 

Jared Kushner, Donald Trump Jr. and Paul Manafort are scheduled to appear before Senate committees next week. Here’s what’s at stake for them:

Stephen Colbert on President Trump’s undisclosed second meeting with Russian president Vladimir Putin: 

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