Maybe you’ve noticed that DOCTOR’S recent posts on TrumpCare are curatorial, not editorial. Only when congressional consideration is finished, and a bill is passed or not passed, will there be time to assess the impact.
“The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.
Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.
The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.”
“With the defeat of the comprehensive replacement bill and the “clean” repeal bill, GOP leaders are now looking to pass a “skinny repeal” bill that would make limited changes to Obamacare. It would likely strip out the law’s tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.
If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.
Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.” (B)
“The Congressional Budget Office estimated the proposal would have resulted in 32 million more uninsured over the next decade. Three-quarters of the nation would live in areas with no insurers participating in the individual market by 2026, CBO said, leaving many without an option if they do not have employer-provided or government health insurance, such as Medicare or Medicaid.”
Back in 2015, the passage of that bill was largely viewed as a political messaging exercise: GOP lawmakers were keenly aware that Obama would not sign it into law.
But now, with Republican President Donald Trump in the White House and ready to sign a bill, the stakes are real — as are the realities of voting to repeal the current health care law without a replacement in place.” (C)
“Ignoring overwhelming public opposition to legislation that would destroy the Affordable Care Act, Senate Republicans voted on Tuesday to begin repealing that law without having any workable plan to replace it.
The majority leader, Mitch McConnell, browbeat and cajoled 50 members of his caucus to vote to begin a debate on health care without even telling the country which of several competing bills he wanted to pass. Vice President Mike Pence provided the tiebreaking vote. The proposals vary in severity, but all of them would leave millions more people without health insurance and make medical care unaffordable for many low-income and middle-class families. It is clear that Mr. McConnell does not much care which of these proposals the Senate passes; for whatever reason — pride, White House pressure, sheer cussedness — he just wants to get a bill out of the Senate. It could then go into conference with the House, which passed its own terrible bill in May.
That committee would hash out a compromise behind closed doors, sending whatever it comes up with to both chambers, which would then vote with limited public debate and no opportunity for amendments. This is far less transparent than the process that produced the A.C.A. and that the Republicans have been complaining about for seven years. Former President Barack Obama and a Democratic-led Congress spent a year working on the law with many public hearings and amendments from both parties.” (A)
(A) The Senate’s Health Care Travesty, By THE EDITORIAL BOARD, https://www.nytimes.com/2017/07/25/opinion/senate-health-care-vote.html
(B) Where we are now on the Senate health care bill: Clean repeal dead as GOP plods through debate, by Erin Kelly and Eliza Collins, https://www.usatoday.com/story/news/politics/2017/07/26/senate-health-care-bill-whats-happening-now/511889001/
(C) Health care debate: Senate rejects full Obamacare repeal without replacement, by MJ Lee and Phil Mattingly, http://www.cnn.com/2017/07/26/politics/health-care-bill-wednesday/index.html
“With Vice President Mike Pence casting a tie-breaking vote, Republicans moved forward on health care reform Tuesday as the Senate successfully passed a key motion to proceed to debate on repealing and possibly replacing Obamacare.
Momentum built over the course of the day as several previously skeptical members announced they would support Senate GOP leaders after they began detailing plans for more votes over the next days to shape the details of the legislation.
Sen. John McCain, who was recently diagnosed with brain cancer, returned to the Senate from Arizona to cast a key vote and Pence broke the tie after two Republicans — Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska — and all the Democrats voted against it.
The vote was a key moment in the GOP’s seven-year campaign promise to repeal and replace the Affordable Care Act, but the final may fall short of that goal, and could well end up as a “skinny” repeal that disposes of just a few components of the law, known as Obamacare.” (A)
“Republican leaders Tuesday are trying to thread any needle they can to appease other holdouts.
“The only goal is to get onto the bill. Nothing happens until we do, so that’s the only goal,” a Republican aide said.
“These are the moments legislatively when you get creative. We’re getting creative.”
Leadership was floating a strategy Tuesday morning that lays out a series of proposals that attempt to give everyone they want, even though nearly every element is destined for failure on the floor during the amendment process.
That strategy is as follows, in terms of amendment order:
The full repeal bill that Paul backs.
A bill including the “consumer freedom amendment” from that Sens. Ted Cruz and Mike Lee originally advocated for, that includes a request from Sen. Rob Portman for $100 billion in additional Medicaid funding. That would require 60 votes to pass.
The GOP bill proposed earlier this month that McConnell pulled when too many Republicans opposed it.
Finally, a “skinnier” repeal bill that repeals Obamacare’s individual and employer mandates.” (B)
“Senate Republicans are considering passing a dramatically scaled-down version of their ObamaCare repeal bill as a way to pass something and set up negotiations with the House, according to GOP aides.
The measure, known as a “skinny bill,” is intended to be something all Republicans can agree on, so they can pass a bill and move to a conference committee with the House.
Aides say the scaled-down bill would likely just repeal ObamaCare’s individual and employer mandates and the medical device tax.
That would be a far narrower measure than the most recent Senate replacement bill, which also scaled down ObamaCare’s subsidies and cut Medicaid.
Experts warn, though, that repealing the individual mandate without any replacement measures would destabilize the insurance market and spike premiums.
The Congressional Budget Office previously found that repealing the individual mandate would lead to 15 million more uninsured people and increase premiums by around 20 percent.
A conference committee with the House, however, could potentially change whatever the Senate passes.
The consideration of the scaled-down measure is a sign of how much trouble Senate Republicans are having coming to agreement on any more significant bill.” (C)
(A) Pence Breaks Tie, Senate Votes to Move Forward on Health Care Bill, by Leigh Ann Caldwell and Vaughn Hillyard, http://www.nbcnews.com/politics/congress/senate-sets-sights-skinny-repeal-obamacare-tuesday-s-voting-n786296
(B) By Lauren Fox, MJ Lee, Phil Mattingly and Ted Barrett, http://www.cnn.com/2017/07/25/politics/senate-health-care-vote/index.html
(C) Senate GOP floats scaled-down healthcare bill, by Peter Sullivan,http://thehill.com/policy/healthcare/343611-senate-gop-floats-scaled-down-healthcare-bill
“Congress gives more care and consideration to bills renaming post offices than it has to legislation with staggering consequences for the health care system.” (B)
“After a strangely quiet weekend, this week Senate Republicans are scheduled to push through votes on a budget-reconciliation bill designed to repeal and/or replace Obamacare. There are at least six big questions that are hanging fire at the moment:
Can McConnell find a formula for a version of BCRA that snags 50 votes?
Will an ailing John McCain show up to save McConnell’s bacon?
Will Mitch McConnell go for broke on bringing up the bill even if he’s not sure he has the votes?
Where are Paul and other wavering senators on beginning debate?
Is a “straight repeal” of Obamacare truly doomed?
How will Republicans deal with potentially calamitous Senate parliamentarian’s rulings?
In theory, McConnell and his advisers will need to answer all six of these questions before he takes that first leap into a MTP, which at the moment is supposed to take place as soon as Tuesday. Considering how strange and unpredictable the whole process has been over the last six months, additional twists and turns could most definitely appear in the road just ahead.” (C)
“Apparently short of votes even to begin that process, President Trump ratcheted up pressure for Republican senators to get on board, criticizing them for inaction and warning that they risked betraying seven years’ worth of promises to gut the health law and revamp it if they did not….”
“The remarks from Mr. Trump, who has been largely absent from the policy debate, had the ring of a threat by a president who has grown frustrated watching Republicans repeatedly try and fail to reach consensus on his promise to immediately roll back the health law and enact a better system. He said their constituents would exact a price for inaction — “you’ll see that at the voter booth, believe me” — and hinted that any Republican who did not support the bid to open debate on an as-yet-determined health bill would be painted as complicit in preserving a health law passed on the basis of “a big, fat, ugly lie.”” (D)
“Sen. Rand Paul, R-Kentucky, a holdout on the bill, said confusion reigns among lawmakers.
“We have no earthly idea what we will be voting on,” Paul said on Fox News Monday afternoon. “Last week they said we’re going to vote on a clean repeal. I said hooray, that’s what we promised. Now I’m told it may be the new Senate leadership bill, which is a big insurance bailout that I’m not for and doesn’t repeal Obamacare. So nobody has told us.”” (E)
(A) Senate Republicans Don’t Know What Health Care Bill They’re About To Vote For. That’s Nuts., by Jeffrey Young, http://www.huffingtonpost.com/entry/senate-republicans-dont-know-what-health-care-bill-theyre-about-to-vote-for-thats-nuts_us_59761b30e4b0e79ec19ae12b
(B) GOP lawmaker suggests duel with female senators, by Jacqueline Thomsen, http://thehill.com/business-a-lobbying/343477-gop-lawmaker-female-senators-are-responsible-for-healthcare-bill-failure
(C) Six Key Questions About the Senate Health-Care Bill As the Endgame Approaches, By Ed Kilgore, http://nymag.com/daily/intelligencer/2017/07/six-final-questions-about-the-senate-health-care-bill.html
(D) Senate Heads Toward a Health Care Showdown Vote Tuesday, by Thomas Kaplan and Julie Hirschfeld Davis, https://www.nytimes.com/2017/07/24/us/politics/senate-health-bill-obamacare-repeal-and-replace-trump-mcconnell.html
(E) Trump: Senate GOP needs to fulfill promise to end ‘Obamacare nightmare’, by Jeremy Diamond, MJ Lee and Lauren Fox, http://www.cnn.com/2017/07/24/politics/senate-trump-health-care-vote/index.html
“I don’t know whether we’re proceeding to the House bill, a new version of the Senate bill, the old version of the Senate bill, the 2015 repeal-and-hope-that-we-come-up-with something-in-two-years bill. I truly don’t.” (Senator Collins) (A)
“Deductibles could become so high under the GOP plan, the CBO said, that many low-income people might decide not to purchase a health insurance plan, even if the premiums were low.
“Senate Republicans have run into another problem in passing their ObamaCare replacement bill: it could increase deductibles by thousands of dollars, potentially alienating moderates who are already skeptical of the bill.
An analysis released Thursday by the nonpartisan Congressional Budget Office concluded that a single policyholder purchasing a standard benchmark plan under the GOP bill could face a deductible of $13,000 in 2026.
Under current law, an individual making $56,800 would have a deductible of $5,000, while someone making $26,500 would have an $800 deductible.
Higher deductibles is the tradeoff that Republicans made when they decided that lowering premiums would be a top priority for their legislation; plans with lower premiums generally have higher deductibles.”” (B)
“Republican Senate leaders aim to hold a procedural vote as early as Tuesday to take up legislation to repeal or replace Obamacare, but it remained unclear which version of the bill senators would vote on…
Senator John Thune, a member of the Republican leadership, told “Fox News Sunday” the initial vote was simply a way to open debate on the bill so that senators from both parties could offer amendments.
“The first vote, which will occur sometime this week, will be to proceed to the consideration of that legislation and to at least have a debate where we can have an open amendment process,” Thune said.” (C)
“Sen. John Barrasso (R-Wyo.) said Sunday that the Senate will vote this week on a motion to proceed on a healthcare bill passed by the House of Representatives.
During an appearance on CBS’s “Face the Nation,” host John Dickerson asked Barrasso which legislation the upper chamber will come up for a vote.
“Well, it’s a vote, a motion to proceed to the bill that passed the House,” Barrasso said.
“That then comes to the Senate, and then we can vote, once we get on that bill, to amend it in various ways. And lots of members have different ideas on how it should be best amended to replace what is really a failing Obama healthcare plan.” (D)
New York Daily News editorial (E)
“Enough already. Just stop. The Senate needs to call it quits on ever more pathetic attempts to slay the beast they call Obamacare, for the love of the 22 million or more Americans doomed to end up without coverage and insurance markets now dizzied with uncertainty…..
A replacement bill would, even in its second, supposedly kinder iteration, roll back Medicaid expansion that has enabled workers with low wages to afford decent coverage, and slash subsidies that make health insurance affordable for the working class. A cap on Medicaid, which has covered the poor for decades, would gut the program’s power to grow with the population.
All this enables tax cuts for the wealthy, scaled back from earlier version of the bill but still significant — and far fewer insured than before in the estimation of the Congressional Budget Office….
Failing that, another gambit would yank away Obama’s Affordable Care Act , phased out over two years — a repeal that the Congressional Budget Office projects would leave (gulp) 32 million fewer insured . Even if the Senate swallows this deadly pill, the House, having already passed an Obamacare replacement package Trump now decries as “mean,” would then have to take a repeal vote with no replacement plan on the horizon.
An embarrassment wrapped in cruelty wrapped in political disaster.”
(A) Obamacare vote nears with key details still missing, by Noam N. Levey, http://www.latimes.com/politics/la-na-pol-senate-obamacare-chaos-20170721-story.html
(B) GOP wrestles with soaring deductibles in healthcare bill, by Jessie Hellmann, http://thehill.com/policy/healthcare/343220-gop-wrestles-with-soaring-deductibles-in-healthcare-bill
(C) Republican strategy on healthcare bill in flux ahead of vote, Amanda Becker, https://www.reuters.com/article/us-usa-healthcare-idUSKBN1A80QG
(D) Top Republican: Senate will vote to proceed to House healthcare bill, by Mallory Shelbourne , http://thehill.com/homenews/senate/343372-top-republican-senate-will-vote-to-proceed-to-house-healthcare-bill
(E) The Senate’s sickness: A compulsion to keep trying a failed health care bill, http://www.nydailynews.com/opinion/senate-health-care-sickness-article-1.3346010
“The official rules keeper in the Senate Friday tossed a bucket of cold water on the Senate Republican health bill by advising that major parts of the bill cannot be passed with a simple majority, but rather would require 60 votes. Republicans hold only 52 seats in the Senate.
Senate Parliamentarian Elizabeth MacDonough said that a super-majority is needed for the temporary defunding of Planned Parenthood, abortion coverage restrictions to health plans purchased with tax credits and the requirement that people with breaks in coverage wait six months before they can purchase new plans.
The Senate is using a budget process called “reconciliation” that allows Republicans to pass a bill with only 50 votes (and the potential tie to be broken by Vice President Mike Pence). But there are strict rules about what can and cannot be included, and those rules are enforced by the parliamentarian. Those rules can be waived, but that requires 60 votes, and all the chamber’s Democrats have vowed to fight every version of the bill to “repeal and replace” the Affordable Care Act, which is set for a possible vote next week.” (A)
“In a blow to the insurance industry, the parliamentarian has advised that two key market stabilization provisions in the bill would be against the rules. First, the legislation can’t appropriate the cost-sharing reduction subsidies insurers rely on to keep premiums and deductibles low; it can only repeal them.
Additionally, a “lockout” provision requiring consumers with a break in coverage to wait six months before buying insurance also violates the rules, according to the guidance.”
“The parliamentarian has also not yet ruled on a controversial amendment from Sen. Ted Cruz (R-Texas) that would allow insurers to sell plans that do not meet ObamaCare regulations. If that provision were struck, conservative support for the bill would be in doubt.”
“Republicans are trying to use the budget reconciliation process to pass their healthcare bill with only a simple majority. The provisions deemed impermissible under that process can be stripped if a senator on the floor raises an objection.”
“The result is that the arcane rules of the Senate could end up making the bill harder for Senate Majority Leader Mitch McConnell (R-Ky.) to pass.” (B)
“In general, the parliamentarian has taken an already very difficult process for enacting health care legislation in the Senate and made it nearly impossible—unless Mitch McConnell is willing to blow up every Senate precedent without even knowing if it would be enough to persuade 50 senators from his own party. It will be a painful weekend for those whose dreams involve the repeal or replacement of Obamacare.” (C)
(A) Senate Parliamentarian Upends GOP Hopes For Health Bill, by Julie Rovner, http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/
(B) Parliamentarian deals setback to GOP repeal bill, by Nathaniel Weixel, http://thehill.com/policy/healthcare/343234-parliamentarian-deals-setback-to-gop-healthcare-bill
(C) Senate Parliamentarian May Have Dealt the Last, No-Kidding-Final, Blow To Trumpcare, by Ed Kilgore, http://nymag.com/daily/intelligencer/2017/07/parliamentarian-deals-potentially-terminal-blow-to-trumpcare.html
As we head towards next week’s vote, you might take a look at an excellent New York Magazine analysis.
Here Is Where Things Stand With the Senate Health-Care Bill , by Ed Kilgore, highlight and click on http://nymag.com/daily/intelligencer/2017/07/where-things-stand-with-the-senate-health-care-bill.html
“Getting Senate moderates to vote for a bill with a Medicaid per capita cap and the Cruz amendment is where the whole process has ground to a halt. But it seems the strategy is for McConnell to throw absolutely every nickel of funding at his disposal (somewhere in the neighborhood of $200 billion in “excess” deficit reduction, according to the latest Congressional Budget Office’s assessment of the revised BCRA) at the states to ease immediate coverage concerns caused by the rest of the bill.
But there is an existential threat to this scheme that could emerge as early as today, when the Senate parliamentarian informally lets senators know of her rulings as to whether various provisions of the pending bill (and various likely amendments) pass muster under budget rules requiring that all items are germane to federal spending and revenue levels. According to a handful of experts assembled by the Times, there is a decent chance the parliamentarian will deem the Cruz amendment unallowable. If so, that would leave McConnell with the unsavory choice of finding some way to regain conservative support for yet another revision of BCRA or, worse yet, overturning the parliamentarian’s ruling on the Senate floor. This latter contingency would, many fear, lead to a de facto abolition of the legislative filibuster, since a simple majority could at any time rule any provision germane to a budget bill, which cannot be filibustered.”
“All in all, the odds of legislation successfully emerging from this nightmarish tangle remain quite low, despite the insistence of the GOP leadership and the president that failure is not an option. The fundamental problem remains that just enough Republican senators either absolutely demand or greatly fear, a reversal of the movement toward universal health coverage that Obamacare represented and partially achieved. That is a conundrum that even Mitch McConnell’s role model, the Great Compromiser Henry Clay, would have struggled to resolve.”
“A new official analysis released Wednesday finds that repealing much of Obamacare without a replacement law would increase the number of people without health insurance by 32 million people, double insurance premiums in the individual plan market and leave most of the United States without an insurer selling such plans by 2026.
The report comes as Republican leaders in the Senate, desperate to pass some kind of health-care law, have said that next week they might consider a possible Obamacare repeal bill that could eventually be amended to include a replacement.
The Congressional Budget Office estimated Wednesday that with a repeal-but-no replacement bill the number of uninsured is expected to be 17 million higher than if Obamacare remains in place. And by 2020 there would be 20 million more uninsured people, CBO said.
That tally would grow to 32 million by 2026, the report said.
The projections assume the end of the Obamacare rule requiring most Americans to have insurance or pay a find, the end of subsidies to help low- and middle-income people buy individual plans, and an end in 2020 to federal funding for the expansion of Medicaid to more poor adults under the Affordable Care Act.” (A)
“President Trump did not do much to sell the Senate health care bill before its failure. But he gave the sale a shot Wednesday in the White House before cameras and a captive audience of nearly all the Republican senators. His comments were at times confusing, and in some cases, outright incorrect.
It shows the challenge for a president who doesn’t dive deeply into policy to sell his agenda.” (B)
To look at everything Trump said, with some fact checks and context: highlight and click on http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care
“….Trump claimed at the lunch that “we’re very close” to passing a repeal-and-replace bill. It was the latest sign of the disconnect between the president and the Senate. It also came a day after Trump tweeted “let ObamaCare fail” — and two days after he called for a repeal-only bill.” (C)
“Majority Leader Mitch McConnell spurred Republican senators Thursday to resolve internal disputes that have pushed their marquee health care bill to the brink of oblivion. Yet the GOP’s reeling effort to dismantle much of President Barack Obama’s health care law may face even longer odds because of Sen. John McCain’s jarring diagnosis of brain cancer.
“Dealing with this issue is what’s right for the country,” McConnell, R-Ky., said. He added, “It was certainly never going to be easy, but we’ve come a long way and I look forward to continuing our work together to finally bring relief.”
Nursing a slender 52-48 majority, McConnell has been unable to muster the 50 votes he’d need to approve his party’s health care overhaul. Vice President Mike Pence would cast the tie-breaking vote….
Aiming to finally resolve the issue, McConnell has said he’ll force a vote on the legislation early next week….” (D)
“If Collins is a no vote on any form of the legislation and Paul won’t support a replacement, and Capito and Murkowski won’t support the repeal-only approach, and Lee and Moran won’t support the replacement, and it’s unclear if McCain will be back next week … Republicans simply don’t have the votes throughout all the confusing scenarios. And that’s to say nothing of Dean Heller (R-Nev.), who has been cagey all along on any form of the legislation.” (E)
“The vote is a reward to the ultras who sabotaged repeal and replace by allowing them to posture one more time as purists who have not forsaken the true faith. It punishes the cautious senators who recoiled from huge Medicaid cuts by thrusting upon them a clear alternate they would prefer to evade. It intensifies mutual suspicion and ill-feeling inside a caucus where two senators—Nevada’s Dean Heller and Arizona’s Jeff Flake—have been explicitly threatened by the president and head of party.” (F)
“Under the humane approach, with a stronger health care system a shared goal, Republicans and Democrats would work together to fix the marketplace problems and restore confidence among insurance companies. In counties with no insurers, Congress could require the Federal Employees Health Benefits Program to offer coverage. State governments, working with the Trump administration, could create reinsurance programs to reduce the risk that insurers would lose money because of a few very sick patients. This could lower premiums and encourage insurers to operate in sparsely populated parts of the country.
If it chooses to set partisan point-scoring aside, the Trump administration would continue subsidy payments to insurers, House Republicans would drop their lawsuit and, going forward, Congress would appropriate money for these payments so that they could not be used to undermine the health care law. Quick action is needed on all fronts because insurers and state and federal regulators must finalize rates and policies for next year in the coming weeks.
In the longer term, the 19 states that have refused to expand Medicaid under the A.C.A. ought to reconsider. The program helps lower-income, older and disabled people, with positive results for beneficiaries and the economy. It reduces uncompensated care at hospitals, and the people who receive treatment are healthier and more productive. About four million people could gain coverage if these last states expanded Medicaid, making it a big win for the country.” (G)
(A) CBO: Obamacare repeal bill would raise number of uninsured by 32 million by 2026, by Christine Wang and Dan Mangan, http://www.cnbc.com/2017/07/19/cbo-obamacare-repeal-bill-would-raise-number-of-uninsured-by-27-million-by-2020.html
(B) Fact Check: Trump’s Confusing Remarks To Senate Republicans On Health Care, by Danielle Kurtzleben, http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care
(C) Trump threatens electoral consequences for senators who oppose health bill, by Sean Sullivan, Kelsey Snell and David Nakamura, https://www.washingtonpost.com/powerpost/trump-challenges-senators-to-resurrect-obamcare-repeal-effort-were-close/2017/07/19/468c2dc0-6c8f-11e7-9c15-177740635e83_story.html?utm_term=.bd1cd4cb38f1
(D) McConnell prods senators on health care bill, amid dim odds, by Erica Werner and Alan Fram, http://abcnews.go.com/Health/wireStory/gop-senators-ditch-rescue-health-care-bill-48740322
(E) Senate Republicans Report New Life On Their Health Care Bill, by Matt Fuller, http://www.huffingtonpost.com/entry/senate-republicans-new-life-health-care_us_59702f8be4b0aa14ea7711b7
(F) The Paradox of Mitch McConnell’s Repeal-Only Vote, by David Frum, https://www.theatlantic.com/politics/archive/2017/07/the-paradox-of-mitch-mcconnells-repeal-only-vote/534129/
(G) The Trumpcare Bonfire, https://www.nytimes.com/2017/07/18/opinion/trumpcare-obamacare-let-it-fail.html?smprod=nytcore-ipad&smid=nytcore-ipad-share