Can Sen. Mitch McConnell round up enough Republican votes to force the destruction of Medicaid and other punishing measures on working people, while preserving huge tax cuts for the rich?

The outcome of the latest Republican effort to upend the Affordable Care Act will come down to three or four Republicans considered “moderate” in the context.

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Meanwhile, the opposition will be strong. A morning sampler:

* American Medical Association:


The revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage. The additional funding to address the opioid epidemic is a positive step, however, those suffering from substance use disorder have other health care needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion. While stabilizing the individual market is an initial step, more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of health care.” 

* Impact on women and other living beings. from Vox:

The Affordable Care Act ensures that all FDA-approved birth control methods are covered without a copay if you have health insurance, with few exceptions.

But the revised Senate health care bill would scrap the birth control mandate — allowing insurance companies to sell plans that don’t include any of the currently mandated women’s preventive health services, from birth control to HPV testing.

This change is part of a broader rollback of preventive benefits: If the Senate bill becomes law, health insurers will be able to offer plans that don’t cover a range of these services, from cancer screenings to childhood immunizations. Under the Affordable Care Act, all insurers are required to cover them.

* Economist Gene Sperling:


BCRA = assault on women’s health: Defunds Planned Parenthood; deep price hikes for maternity care; slashes Medicaid that funds 50% of births

* Columnist Paul Krugman:

The original Senate bill got a lot of justified bad press for slashing Medicaid while offering big tax cuts for the rich. So this version rolls back some though by no means all of those tax cuts, which sounds like a concession to moderates.

At the same time, however, the bill would allow people to use tax-favored health savings accounts to pay insurance premiums. This effectively creates a big new tax shelter that mostly helps people with high incomes who (a) can afford to put a lot of money into such accounts and (b) face high marginal tax rates, and hence get big tax savings.

…The most important change in the bill, however, is the way it would effectively gut protection for people with pre-existing medical conditions. The Affordable Care Act put minimum standards on the kinds of policies insurers were allowed to offer; the new Senate bill gives in to demands by Ted Cruz that insurers be allowed to offer skimpy plans that cover very little, with very high deductibles that would make them useless to most people.

Did I mention the legislation takes care to preserve gold-plated government health insurance for the senators themselves?

Sens. Tom Cotton and John Boozman
claim, from in hiding through spokespeople, to still be in serious contemplation of this latest bit of Republican meanness. When the roll is called, they’ll be there with Mitch. Book it.