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Things have gone from bad to worse for the Republican effort to dismantle the Affordable Care Act, also known as Obamacare. On Monday night, Sen. Mitch McConnell (R-Ky.) lacked the votes to pass a bill that would undo much of Obamacare and replace the law with a modified system. But the majority leader's back-up plan -- repealing Obamacare entirely right away, with the goal of working out a replacement later -- appears no more likely to succeed.

The dilemma for Republicans contemplating McConnell's new strategy -- repealing the law immediately and figuring out what to do next later -- is that Democrats may be able to stop them from carrying it through. While many Republicans would like to repeal Obamacare wholesale, they can't overcomeDemocrats' opposition without keeping in place somecrucial components of Obamacare.

The GOP can't just repeal every word of Obamacarebecause, in orderto avoid a filibuster by Democratic senators, Republicans are using a special set of rules known as reconciliation. Reconciliation makes legislation easier to pass, as it would allow the GOP to move the measure with just 50 votes and Vice President Pence's tie-breaker,rather than the 60 votes typically needed to break a filibuster.

The power has its limits, however. Reconciliation is only supposed to be used for measures that directly affect the federal budget. In this case, that meansundoing some of Obamacare'staxes, fees, subsidies and safety net programs for the poor but leaving in place a series of health-insurance regulations and other features.

Republicans already did a dress rehearsal for this last year, whenthey used reconciliation to pass a bill through the Senate. That bill eventually died when it was vetoed by President Barack Obama, but now McConnell is advancing it again.

It's unlikelyMcConnell has the votes to the bill passed this time around. Short of a complete repeal, Republicanswould risk creating something nobody in either party would support. Withparts of Obamacare gone, some elements still in force and no new system to replace the law, patients and doctors would be left with a mishmash of incompatible regulationsand requirements that would threaten to destabilize the health-insurance market and leave millions without coverage.

"It would throw the marketplace into chaos," said Stan Collender, a former congressional aide to Democratic lawmakers who worked on both the House's and Senate's budget committees.

Already, three Republicans -- Sens. Shelley Moore Capito (W.Va.), Susan Collins (Maine) and Lisa Murkowski (Alaska) -- have said they will not support McConnell's new strategy. Their combined opposition will probably prevent him from moving forward, although McConnell said Tuesday he plans to hold a procedural vote next week all the same.

Here's why some Republicans are skeptical.

Republicans woulduse reconciliationto eliminatetaxes on the wealthy, on insurance providers and on medical companies.

They would also strike down arequirement that all Americans maintain health-care coverage orelse pay the federal government a fee-- a controversial part of the law known as the "individual mandate." Republicans would eliminate another rule that requires majoremployers to offer an insurance program for their workers.

Republicans can also modify spending. Thebill that McConnell aims to revive from last year would eliminate Obamacare's subsidies for people attempting to buy private health insurance.

Also, Obamacare increased funding for Medicaid, the federal insurance program that covers many poor households, pregnant women and residents of nursing homes. The GOP bill would undo that expansion.

Because these provisions apply to federal taxes and spending, Republicans can eliminate them throughreconciliation. At the same time, other parts of the law would stay.

For instance,Republicans would likely be unable to remove protections forconsumers with preexisting medical conditions who are trying to buy private insurance -- a crucial component ofObamacare. Likewise, insurers would remain unableto charge people depending on where they live or whether they smoke.

Insurers wouldstill be required to offer certain benefits as part of their plans, as they are under Obamacare, andlimits on how much more they can charge older customers would remain in effect.

In short, the legislation would preserve some rules from Obamacare, while eliminating much of the rest of the law. The odd combination could result in serious problems, industry analysts warn.

Before Obamacare, for example, insurance companies were free to charge patients more if they had preexisting conditions, or to deny those customers coverage entirely. That practice existed to ensure that private insurers could break even. Without some way of discouraging the sickest patients from seeking coverage, the cost of treatment would increase uncontrollably.

Obamacare ended that practice, prohibiting insurers from discriminating against patients based on their medical histories. Instead, Obamacare required all Americans to maintain coverage and offered subsidies to encourage them to do so. The goal was to guarantee that insurers would have enough healthier customers paying monthly premiums to cover costs for sicker patients.

The bill McConnell will hold a vote on next week would get rid of that financial assistance and the requirement. Yet it would not allow insurers to examine their customers' medical histories again. Most experts believe that language undoing Obamacare's protections for patients with preexisting conditions would not qualify under reconciliation.

As a result, the only legislation Republicans might be able to pass would restore the system that existed before Obamacare, but without a crucial feature that allowed that system to function.The resulting mismatch -- between rulesDemocrats established under Obamacare and those that existed before --couldprove an embarrassing failure for GOP lawmakers.

"The market could literally disappear entirely," said Edwin Park, a vice president forhealth policy at the liberal Center on Budget and Policy Priorities.

That, in essence, is whatmany analysts are projecting for a GOP bill that partially repeals Obamacare without a replacement.

Insurers would hike premiums to cover the steeper cost of providing health care to a sicker group of patients. Only patients with serious medical problems would be willing to pay those costs, so healthier patients would cancel their policies. In turn, insurers would be forced to increase premiums even more, and so on.

In an analysisin January, the nonpartisan Congressional Budget Office (CBO) forecast that simply repealing Obamacare without a replacement would eventually result in 32 million more Americans going without coverage. Almost immediately, premiums would skyrocket, increasing by 20 percent to 25 percent in the first year on average.

Companies would refuse to sell insurance across swathes of the country because so few patients would be willing to pay the exorbitant premiums insurers would have to charge to turn in a profit while covering a large group of relatively unhealthy patients. In those areas, Americans would have no options for buying private insurance if they did not receive it through the government or an employer. About 10 percent of Americans would live in these areas in the first year, CBO estimated.

If Republicans failed to come up with an alternative system, that figure would eventually increase to 75 percent of thepopulation, while premiums in the individual market would double.

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Here's what health care looks like if Republicans' Obamacare 'repeal and delay' plan succeeds - Washington Post

For decades, the Republican Party has stood for small government and pledged if given the opportunity it would safeguard the countrys financial future by cutting trillions of dollars from federal entitlement programs.

Thatchance finally came this week. The party balked.

At the heart of the failed Senate effort to repeal parts of the Affordable Care Act were irreconcilable differences over the proper role of entitlements and how far the party should go to pursue its small government mantra. Both wings of the GOP revolted senators who rejected steep cuts to Medicaid, a health program for low-income Americans, and others who felt the cuts were not deep enough.

Now, with the split unresolved, the party is struggling to find a way to govern despite controlling the White House and Congress. And that may leave it at risk of failing to pass any landmark legislation.

The division is expected to spill over Wednesday when Republicans in the House Budget Committee are scheduled to vote on a long-term spending plan that projects cuts to Medicaid and changes to Medicare, a health care program for older Americans that President Trump has vowed to protect.

It really boils down to the key question of Whats the role of government? said Mike Leavitt, the former Utah governor who served as Secretary of Health and Human Services during the Bush Administration. And this is a surrogate for that larger question that we often debate.

The splintering GOP philosophy is likely to define numerous other intraparty debates in the coming months.

Do they vote to raise the debt ceiling?

How much should they cut taxes?

Do they vote to cut food stamps? Housing assistance? Health care benefits for low-income children?

The current schism is a sharp break from the unity Republicans demonstrated during President Obamas tenure, when they repeatedly voted to repeal the Affordable Care Act. But lawmakers made those votes knowing the proposals would be blocked by Obamas veto. Now the votes have real power to reshape programs that have been in place since the 1960s, such as Medicaid and Medicare.

Were seeing the challenges of moving from political points to governing, said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, a group that has pushed for deficit reduction. And where that is really most challenging is finding spending cuts that back up the notion of small government.

The federal government is projected to spend close to $4 trillion in 2018, and almost half of that will go to Medicare, Medicaid and Social Security retirement benefits. Trump has promised to protect the Medicare and Social Security money from any cuts, and Republicans have now faltered in their efforts to cut Medicaid.

Reducing the budget deficit without cutting any of these programs or raising taxes is very difficult.

Those programs also provide benefits to between 15 percent and 20 percent of all Americans, almost all of them poor or older than 65. And its the concern about the impact of the cuts on low-income Americans that gave at least four Republican senators second thoughts about backing the Senate GOP health care bill.

Complicating matters for Republicans, the popularity of the Affordable Care Act has reached record levels in recent months as the GOP works to change the law. A Washington Post poll Monday found 50 percent of respondents preferred the current law, while only 24 percent backed the GOP plan. In April, Gallup found that 55 percent of Americans generally approved of the law, up from 42 percent in a survey taken just after the November election.

And the health law, particularly the expanded access to Medicaid, has won over numerous GOP governors who have vocally opposed the congressional GOP effort to cut the program back. Republican lawmakers have also faced furious opposition to their plan during town hall events in their home states.

Thats part of what led centrist Republican Senators from Nevada, Maine, Alaska, Ohio and West Virginia to revolt this week against years of their partys promises to cut spending on Medicaid. But by moving to protect parts of Medicaid, the members have scrambled the partys blueprint for governing.

The basic problem was Republicans got into promising something that could not be delivered, said Robert Reischauer, a Democrat and former director of the Congressional Budget Office. Talking is cheap. Action is politically very expensive.

Key Republicans were frozen by the Congressional Budget Offices forecast that the Senate GOP bill would lead more than 20 million people to no longer have health care coverage in the coming years. Sen. Shelley Moore Capito (R-W.V.), who has voted to repeal the Affordable Care Act in the past, said Tuesday that I did not come to Washington to hurt people.

She said she wanted to see a well-detailed plan to replace the Affordable Care Act before she could vote for anything to cull back its expanded Medicaid coverage.

But there were numerous signs that this stand by a number of Republicans had sparked fury among their colleagues.

Most of those people in our caucus - just about everybody - either voted at one time to repeal or promised to do it, said Sen. Richard Shelby (R-Ala.). They ought to keep their word.

With the Republican Party divided, these fights are expected to continue, and potentially intensify. Trump has shown a ideological openness to support most any GOP bill that has a chance of passage, hoping to notch a legislative victory after experiencing numerous defeats.

The dynamic is expected to accelerate during the budget debate, where White House officials have little experience but need a compromise in order to pave the way for an overhaul of the tax code, another top Trump priority that has languished behind the faltering repeal effort.

But the House budget resolution is already headed for a showdown among GOP members. House conservatives insisted that it contain promises to cut at least $203 billion in spending on programs such as Medicaid over 10 years in order for any tax cuts to win passage, and some are pressing for even deeper cuts. House GOP centrists have complained that this could poison the process and scuttle the budget resolution.

This is a version of the same fight that felled the health bill in the Senate. It ensures that the GOPs governing agenda, which has now become Trumps legacy, will remain in the center of this intraparty tug-of-war in the months ahead.

Now, the votes are not easy, said Ron Haskins, who was a GOP congressional aide who played a central role in the welfare overhaul during the Clinton administration. They are very difficult. These impacts are real.

Mike DeBonis and Kelsey Snell contributed to this report.

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Republicans' health-care split goes all the way to the party's soul - Washington Post

A young man with glasses watching futuristic symbols on a computer screen. Photograph: Erik Tham / Alamy/Alamy

Trumps EPA administrator Scott Pruitt wants to hold televised Red Team/Blue Team climate science debates. The idea is that a Red Team of scientists will challenge the mainstream findings of Blue Team scientists. That may sound familiar, because its exactly how the peer-review process works. But climate deniers have lost the debate in the peer-reviewed literature, with over 97% of peer-reviewed studies endorsing the consensus on human-caused global warming, and the few contrarian papers being flawed and failing to withstand scientific scrutiny.

So Scott Pruitt is trying to put his thumb on the scale, giving the less than 3% of contrarian scientists equal footing on a Red Team. John Oliver showed how to do a statistically representative televised climate debate (so brilliantly that its been viewed 7.4m times), but its probably not what Pruitt had in mind:

Climate Red Teams are a concept that the fossil fuel-funded Heritage Foundation tried four years ago, calling its 2013 NIPCC report part of the groups Red Team mission. But much like climate contrarian research papers, the NIPCC report was riddled with errors and long-debunked myths.

The name also evokes images of the red and blue pills in The Matrix, in which characters could choose to remain in the Matrix (denial) by taking the blue pill, or accept reality with the red pill. In this case the colors are reversed, but the concept is the same by choosing the red team, Pruitt and company are choosing the soothing comfort of denial over the harsh reality of human-caused climate change and the threats it poses.

Fortunately, it seems like a growing number of Republican leaders are choosing the red pill.

In April, Trumps energy secretary Rick Perry ordered a 60-day study of the nations electric grid to determine whether policies promoting renewable energy growth are undermining its stability by crowding out baseload power from sources that are always readily available (ie dont rely on intermittent wind or sunlight). Perrys memo specifically called out regulatory burdens introduced by previous administrations that were designed to decrease coal-fired power generation. He put Travis Fisher in charge of the study, who previously worked for the fossil fuel-funded Institute for Energy Research, where he published a report calling renewable energy policies the single greatest emerging threat to the US power grid.

In short, it appeared as though the Trump administration was putting together a biased report to support its pro-coal agenda. But a draft of the report was leaked to Bloomberg, and it didnt follow the administration playbook. The report was drafted by career staffers at the Department of Energy, who are experts in the field and apparently didnt bow to any potential administration pressure for pro-fossil fuel conclusions. The draft is now under review by administration officials and may change as a result, but the leaked draft ensures that the public sees the experts conclusions.

The report concluded that many recent baseload plant retirements are consistent with observed market forces, often being taken out of commission due to low natural gas price-based electricity prices, low electric demand, environmental regulations, state policies, and competition from renewables. Most of the coal and natural gas baseload plants that have retired are old, inefficient units that were no longer cost-effective. Increased energy efficiency has also curbed American electricity demand. The report concluded that environmental regulations and renewable energy subsidies played minor roles in accelerating baseload plant retirements compared to those other factors.

Most importantly, the draft report concluded that the electric grid remains reliable:

Most of the common metrics for grid reliability suggest that the grid is in good shape despite the retirement of many baseload power plants The power system is more reliable today due to better planning, market discipline, and better operating rules and standards

These conclusions are consistent with the opinions of grid operators including in red states where wind supplies a significant fraction of electricity (including Perrys home state of Texas) that renewables are not undermining grid stability. Theyre also consistent with a major Department of Energy-funded two-year study published in 2012, which concluded:

renewable electricity generation from technologies that are commercially available today, in combination with a more flexible electric system, is more than adequate to supply 80% of total U.S. electricity generation in 2050 while meeting electricity demand on an hourly basis in every region of the United States

Its unclear why Perry thought his 60-day study would overturn the findings of that two-year report, or many other similar studies. Even some Republicans from states that benefit from cheap wind energy were critical of the report. For example, Senator Chuck Grassley (R-IA) wrote to Perry:

Im concerned that a hastily developed study, which appears to pre-determine that variable, renewable sources such as wind have undermined grid reliability, will not be viewed as credible, relevant or worthy of valuable taxpayer resources

In another positive sign that Republican climate denial is cracking, an amendment to cut Department of Defense (DoD) funding for a study on how climate change will impact national security over the next 20 years was defeated by a vote of 185-234, including 46 Republicans (led by 22 of the 24 Republican members of the Climate Solutions Caucus) voting against the amendment.

The US military has long recognized the national security threats posed by climate change. Normally the GOP views itself as the more pro-military party, but on climate change theyve resisted the DoDs findings. While three-quarters of House Republicans voted in favor of the amendment, a significant fraction bucked the climate denial establishment, in this case opting to take the red pill. It may seem like a minor event, but any cracks in the wall of GOP climate denial represent important progress. Perhaps the party needs its own version of Neo to accelerate the process.

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Climate denial is like The Matrix; more Republicans are choosing the red pill - The Guardian

Two House Republicans are actively working to torpedo President Trumps effort to separate air traffic control from the federal government, which would deliver a major blow to one of the administrations chief infrastructure priorities.

Reps. Steve Russell (R-Okla.) and Ralph Abraham (R-La.), who say they agree with Trump about the need to modernize the countrys air navigation system, told The Hill on Tuesday that they have been explaining their concerns over the spinoff plan to colleagues, pointing out contentious bill language and trying move skeptical GOP lawmakers into the no column.

House leadership began whipping members last Thursday on a long-term reauthorization of the Federal Aviation Administration (FAA), which includes the privatization plan endorsed by Trump. A similar effort stalled last year amid opposition from both parties and was never brought to the House floor.

Similarly, GOP leaders are unlikely to bring it up this year unless they are confident it has enough votes to pass. A vote has not yet been scheduled, though amendments were due Monday.

They were going to try to run it this week, Russell said in a joint interview with Abraham in the Speakers lobby. We were able to raise enough concern, just by showing [other lawmakers] language in the bill, that when they whipped the bill, they did not have enough votes to put it on the floor.

Its unclear how many Republicans oppose the plan at this point. Rep. Mario Diaz-Balart (R-Fla.), an appropriator, and Todd Rokita (R-Ind.), a member of the Transportation and Infrastructure Committee, are among those who have publicly come out against the idea.

Russell said he and Abraham have been lobbying colleagues to vote against the measure during in-office visits and vote series.

Weve not tried to unleash any midnight surprise. Weve been very open and out front on where our positions were, he said. We tried to raise these concerns weeks ago. We had asked for a pause to address some of our issues. We asked the chairman, we asked leadership.

While they are appreciative and understand our concerns, they said, Were going to move on, he added.

Proponentsof the spinoff proposal, meanwhile, are also scrambling to bring over lawmakers to their side.

Transportation Chairman Bill Shuster (R-Pa.) has been trying to whip up support during vote series; his office has been blasting out dear colleague letters and fact sheets about the plan; and Rep. Sam GravesSam GravesHouse Republicans work to torpedo Trumps air traffic control plan White House works to sell House Republicans on Trumps air traffic control plan Crunch time for air traffic control push MORE (R-Mo.), a pilot, has been trying to assuage lawmakers worried about protecting the general aviation (GA) community.

The White House has also been doing outreach on Capitol Hill, which has involved making phone calls and sending high-ranking officials to sell wary members on the proposal.

Lawmakers are up against the clock, as the FAAs legal authority expires at the end of September and the House is scheduled to leave town for the August recess at the end of next week.

There is a lot at stake for supporters of the spinoff plan.

If the full House votes on the legislation, it will be the first time that the majority of the chamber will be going on the record on the issue. A strong vote could send a clear message to the Senate, where lawmakers are moving ahead without the spinoff plan.

But a failure to bring the measure to the floor could doom the effort this year. The lower chamber is seen as Trumps best shot for passing the proposal, as the Senate has remained largely opposed to the idea.

There is a broad range of opposition to the proposal, which would transfer the countrys air navigation system to a private, nonprofit corporation governed by a board of directors while keeping the FAA in charge of safety oversight.

Supporters say it will help speed up long-stalled modernization efforts at the agency, which still uses paper strips to track flights in some towers.

For Abraham, a pilot and rural lawmaker, his main concern is that general aviation users and small airports could loose access to the airspace, face higher fees or be inadequately represented under the spinoff model.

Graves, who voted against the proposal last year, worked with Shuster on legislative changes designed to better support the GA community, such as exempting all GA users from the new entitys fees and ensuring a more diverse makeup on the board.

But Abraham said there was no guarantee that board members would vote to protect GA interests.

They did a little, but not enough to really matter, Abraham said. This is the taxpayers airspace. Were going to take that away and give it to a private corporation?

Russell,who has a military background,said he maintains serious national security concerns about putting a nongovernmental agency in charge of air traffic control and removing it from congressional oversight.

There are a few things that you would never let go: National defense, national intelligence and our national air space, he said.

But Shusters office has emphasized that the federal government would still maintain responsibility over those areas, and pointed out that Defense Secretary James Mattis has even supported the effort.

The new entity will provide a service, nothing more, a backgrounder says.

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House Republicans work to torpedo Trump's air traffic control plan - The Hill

Senate Majority Leader Mitch McConnell's latest bidto salvage the GOP campaign to roll back the Affordable Care Act collapsed Tuesday as centrist Republicans balked at legislation to repeal the healthcare law now and develop an alternative later.

Alaska Sen. Lisa Murkowski became the third GOP lawmaker to reject McConnell's new strategy, making it impossible for Senate Republicans to bring up the plan.

Earlier Tuesday, Maine Sen. Susan Collins and West Virginia Sen. Shelley Moore Capito, said they would not back the "repeal and delay" approach.

I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians, Capitosaid in a statement.

McConnell on Monday night floated the plan to vote for legislation repealing most of Obamacarenow with a plan to develop an alternative over the next two years.

That strategy, which GOP leaders once championed, was revived after it became clear that McConnell, of Kentucky, could not get enough Republican votes for his bill repealing and replacing large parts of the 2010 law at the same time.

But the "repeal-and-delay" planwould cause even more widespread disruption to the nations healthcare system and throw millions more Americans off the insurance rolls.

An independent analysis of such an approach by the nonpartisan Congressional Budget Office earlier this year concluded that it would lead to 32 million more uninsured Americans over the next decade.

That is some 10 million more than predicted under the Senate repeal-and-replace plan that was scuttled Monday night, which was projected to increase the number of uninsured by 22 million by 2026.

At the same time, repealing major planks of Obamacarewithout a replacementwould cause insurance premiums to jump by 20% to 25% next year for Americans who rely on insurance marketplaces, budget analysts concluded.

And premiums would double by 2026, according to the report.

Similar warnings came from across the nations healthcare system earlier this year when Republicans contemplated a straight repeal bill that followed the template of a repeal-and-delay plan that Congress sent President Obama in 2015 and which he subsequently vetoed.

Delaying such a replacement could create unacceptable instability in the insurance market jeopardizing the healthcare of more than 20 million Americans many of whom are cancer patients and cancer survivors with a preexisting condition, Chris Hansen, head of the American Cancer Societys advocacy arm, said in January.

Even many leading Republican senators havevoiced major concerns about repealing the current law without some replacement.

Congress should replace and repeal at the same time, which requires figuring out how to replace it before fully repealing it,Senate health committee chairman Lamar Alexander (R-Tenn.) said in December.

UPDATES:

10:20 a.m.: This article was updated with Sen. Murkowski's rejection of the new Obamacare repeal plan.

This story originally published at 8:02 a.m.

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McConnell's latest Obamacare repeal plan also collapsing amid more Republican defections - Los Angeles Times