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Republicans withdrew the American Health Care Act moments before a scheduled vote on March 24, after failing to woo enough lawmakers to support it. Here are the key turning points in their fight to pass the bill. (Jenny Starrs/The Washington Post)

Why were Republicans rushing to vote on a health-care plan that they'd barely finished drafting, that budget scorekeepers hadn't had a chance to fully evaluate, and that, insofar as people did know about it, was widely despised?

In part, it's because their plan was so unpopularand because it got more unpopular the more people learnedabout it.But it's also because only by rushingto reshape a full sixth of the American economy without knowing exactly how they would be reshaping it would Republicans be able to use health care to pave the way for the rest of their agenda, including tax reform.In other words, the GOPdidn't want to let a detail like tens of millions of people losing theirhealth insurance get in the way of two tax cuts for the rich.

Here's what we knewabout the Republican plan. The latest version that the nonpartisan Congressional Budget Office had a chance to analyze would have, over the course of 10 years, cut taxes by$1 trillion, disproportionately benefiting the rich; cut Medicaid spending by $839 billion, exclusively harming the poor and sick; and cut the Affordable Care Act's health insurance subsidies by about $300 billion, mostly hurting older people of modest means. Add it all up, and the CBO estimated that 24 million people would have lost their health insurance as a result. Not only that, but premiums would have increased 15 percent to 20 percent more than they otherwise would have in the next four years before so many older people were priced out of the market that premiums would have started to come down, and deductibles, according to the Kaiser Family Foundation, would have been an average of $1,550 higher. In short: The GOP would have made insurance more affordable for younger people by making it unaffordable for older people and worse for everyone.

This wasn't just a matter of higher premiums and higher deductibles, though. Trumpcare also would have repealed the essential health benefits that plans are required to cover now. States would have been allowed to write their own rules, so, depending on where you lived, insurance companies might have been able to sell you insurance that didn't coverhospitalizations, prescription drugs, maternity care, mental health care and preventive care, and also imposedannual and lifetime limits on your benefits. People who couldn't afford insurance that actually, you know, insured them might have bought these skimpy plans with their skimpy tax credits why not use them on a fake something instead of a real nothing? but neither the CBO nor they themselves likely would have thought of this as being covered.

The surprising thing, then, isn't that as few as 17 percent of people approved of the American Health Care Act. It's that as many as 17 percent did.

But there's a reason the GOP was pushing a bill that would have taken everything people don't like about the health-care system and made it worse. That's the fact that it would have allowed them to pass two permanent tax cuts for the rich. Anyone, you see, can pass a tax cut that expires after 10 years. But if you want to make it last and you don't have 60 votes in the Senate then you need to find a way to pay for it (or at least look like you did). Taking health insurance away from poor and sick people would have done just that for the Obamacare taxes, which primarily hit people in the top 1 or 2 percent. Indeed, as you can see below in the chart from the Urban Institute, the combination of tax cuts for the rich and benefit cuts for the poor that was the GOP health-care plan would have been areverse Robin Hood that redistributed income from people making $50,000 or less to mostlythose making $200,000 or more.

Now, the crazy thing is that this first tax cut for the rich (in the form of Obamacarerepeal and replace) would have made a secondone (this one coming in the form of tax reform) look more affordable.

That's because, due to parliamentary rules, tax revisions can't lose any revenue outside the 10-year budget window if it's going to be permanent. The question, though, is lose revenue compared to what. If Republicans had repealed the Affordable Care Act's $1 trillion worth of taxes before they revised taxes, that's $1 trillion less they'd have to come up with to make it look like money wasn't being lost. Now, without those phantom savings, tax restructuring, Speaker of the House Paul D. Ryan (R-Wis.)admitted, willbe more difficult. Not that it was ever going to be easy. After all, the $1 trillion they were trying to save witha border adjustment tax seems to be on political life support, since every major retailer, including big GOP donors such as Walmart, is opposed to it. And, as you might have guessed, there aren't an extra $2 trillion of savings lying around for them to replace the ones they thought they were going to get from this and repealing the Affordable Care Act.

Which is to say that Republicans will either have to scale back their ambitions for how deeply they will cut taxes or how long they will. Whatever they choose, though, the top tax rate isn't going to stay under 30 percent.

And for the GOP, that's the real tragedy of 24 million people keeping their health insurance.

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Why Republicans were in such a hurry on health care - Washington Post

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Who Stopped the Republican Health Bill? New York Times President Trump met with them in the days before the scheduled vote in an effort to sway them. Republican leaders finally acquiesced late Thursday to one of their demands and amended the bill to weaken the requirement that health insurers provide a ... Republicans' failure on health care bill also hurts prospects for Trump's tax reformMassLive.com Steve Bannon Thought He Could Bully Republicans On Health Care. He Couldn't.Huffington Post Republicans Admit Defeat On Health Care Bill: 'Obamacare Is The Law Of The Land'NPR AOL -Washington Post -CNBC all 5,032 news articles »

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Who Stopped the Republican Health Bill? - New York Times

While President Donald Trumps first major legislative push hurtled toward a major defeat, one of his top advisers, his son-in-law Jared Kushner, was photographed with his wife, Ivanka Trump, on a ski gondola in Aspen.

Kushner may not have been the lead White House negotiator on the doomed healthcare bill. But the image of Trumps top consigliere hitting the slopes at perhaps the most critical moment of his young presidency sent a message loud and clear: The White House wanted a win, but health care was not the dominant priority for Trump that it was for the Republican members of Congress who actually had to take a vote.

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"Their heart was not in the healthcare battle, said a top Republican who was in meetings with the president and his team but declined to be identified because those conversations were supposed to be private. Think about the level of intensity on the executive orders for the travel ban, or on the wiretapping claims. He certainly checked the boxes on healthcare, to his credit. But it's self-evident there was not a certain level of intensity devoted to this."

White House officials have insisted that Trump understood that a legislative victory was crucial at this stage of his administration -- he is struggling to boost a 42.2 percent approval rating according to FiveThirtyEight.com, the lowest of his presidency so far -- and that he was lending the full force of his office to the cause.

"The president and vice president left everything on the field," press secretary Sean Spicer wrote in an email on Saturday. "They were making calls and having members to the White House all week. In total, we spoke or met with over 120 members of Congress." And Kushner, other White House officials insisted, was never deeply involved in health care to begin with.

But according to Republican Hill staffers, in the weeks leading up to the doomed vote, Trumps mind seemed to be elsewhere.

The president made it clear at rallies over the past few weeks that healthcare was just something he needed to get through, in order to move on to the next thing. "We want a very big tax cut, but cannot do that until we keep our promise to repeal and replace the disaster known as 'Obamacare,'" he told an adoring crowd at a rally in Louisville last week.

The president also has been distracted in recent weeks by other issues, like questions about possible collusion between Russia and his campaign, and the evidence-free accusation that President Barack Obama had wiretapped Trump Tower during the 2016 election.

The top Republican said that in one healthcare meeting with the president and his top aides in the Oval Office, it was a challenge to keep Trump focused on the health care vote. "Halfway through that meeting, he stopped to talk about Gorsuch, the source said. His mind was bouncing around. I never felt they were dialed into this."

Trump gamely climbed to the Hill this week, making a last-minute, full-throttle push for the bill in the final hours -- even devoting his news-driving Twitter feed, uncharacteristically, to the health care fight.

But on the Hill, the presidents effort was viewed by Republican operatives as a case of too little, too late. The impression Trump left there, according to multiple sources who did not want to criticize the president on the record, was that Trump didnt know that much -- or care that much -- about healthcare policy That made it hard for him to go tit for tat with members of the Freedom Caucus and get into the weeds on details of the bill. There were other distractions they were dealing with, said one top Republican staffer on the Hill.

And after just 64 days in office, the short-attention span president told the New York Times on Friday he was just happy to finally to move on. Its enough already, he said of the healthcare talks.

Republicans trying to understand what went wrong on Saturday also pointed to the fact that the two lead negotiators on Trumps team, Health and Human Services Secretary Tom Price and Budget Director Mick Mulvaney, were slowed down by delayed confirmations. Price was only confirmed on Feb. 10, and Mulvaney was confirmed a week later, which prevented them from being totally devoted to the health care cause.

The approach of Trump, who sold himself on the campaign trail as a master negotiator who promised that repealing and replacing Obamacare would be so easy, stands in stark contrast to how his predecessor worked to get the Affordable Care Act passed seven years ago. Former aides to Obama said he devoted the better part of a year working on his healthcare bill, with staffers devoted full-time to its passage.

Obama's commitment to health reform was passionate and unstinting, said his former top political adviser David Axelrod. He was moved by people he had met who were working hard and needed care. He had seen his own mother dealing with cancer and grappling with insurance in her final months.

Trumps predecessor in the Oval Office was steeped in the details of the law and what needed to be done to pass it, Axelrod added. There were many times along the way that it appeared as if all paths were blocked and the bill would fail, and he simply would not let it die.

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Trump defenders pushed back on the notion that the replacement bill failed because the White House didnt care enough. The problem with the bill was the bill, former House Speaker Newt Gingrich said in an interview on Saturday. He also shrugged off Kushners ill-timed vacation, and the optics problem of the presidents top adviser, who reportedly thought supporting the bill was a mistake, hitting the slopes.

This is going to be a long eight years, people need to pace themselves, Gingrich said. This was not a crisis. This was a very important project, which Jared probably thought was under control when he left. The loss of confidence is only three or four days old.

For his part, the president put on a happy face in public and appeared unfazed. On Friday, answering questions from reporters gathered in the Oval Office, he spun the stunning defeat as a victory. "Perhaps the best thing that could happen is what happened today," Trump said. "It will go very smoothly."

On Saturday, he wrote on Twitter: ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry! before heading to the links at the Trump National Golf Club in Virginia.

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Republicans wonder whether Trump's heart was in healthcare fight - Politico

Social Security, which is arguably America's most important social program for seniors, is on the precipice of being in deep trouble.

The program is currently bringing in more in revenue than it's paying out in benefits each year. However, by 2020, according to the Social Security Board of Trustees' 2016 report, the program will begin divvying out more money to beneficiaries than it's bringing in each year. Based on the Trustees' estimates, the program's more than $2.8 trillion in spare cash will be exhausted by 2034.

Image source: Getty Images.

If there is a silver lining here, it's that Social Security isn't going bankrupt, and it will be there to provide benefits for many future generations of retirees. Social Security is predominantly funded by the payroll tax, so as long as Americans keep working and keep paying FICA taxes based on their earned income, Social Security will always be generating revenue.

What isn't clear, though, is just how much retired workers in the future can expect from Social Security come retirement. As of the January 2017 snapshot from the Social Security Administration, the average retired worker was bringing home $1,363 each month. But if Congress is unable to figure out a way to fix Social Security's imminent slide, benefit cuts of up to 21% may be needed on an across-the-board basis to sustain it through 2090. This would, in 2017 dollars, put the average retired worker right on the cusp of the poverty rate. For millions of seniors and future retirees, that outlook is unacceptable.

Ironically, the holdup in Washington has nothing to do with how to fix Social Security. There have been well over a dozen different proposals to fix America's ailing social program. Perhaps the biggest issue is that Republicans and Democrats both (rightly) believe that their plans will work and help bridge Social Security's more than $11 trillion budgetary shortfall, and neither side has backed down.

With Republicans currently possessing a majority in both houses of Congress, and budget director Mick Mulvaney no stranger to calling for reforms of Social Security, there's a genuine possibility that Republicans may choose to tackle Social Security reform during the Trump presidency.

What might a Republican reform of Social Security entail? Based on their history of Social Security proposals, one or more of the following four solutions would be likely.

Image source: Getty Images.

Unquestionably, the most likely solution to be proposed by Republicans in Congress is to raise the full retirement age.

Your full retirement age is the point at which the Social Security Administration (SSA) deems you eligible to receive 100% of your Social Security benefits. You can locate your full retirement age, which is based on your birth year, by using this handy table from the SSA. If you claim Social Security between age 62 (the earliest age you can do so) and the month prior to your full retirement age, you'll receive a permanent reduction in your monthly payout. If you wait until after hitting your full retirement age, your benefit will increase. On average, your benefit increases by 8% for each year that you wait to file.

The current full retirement age is slated to hit 67 by 2022 for persons born in 1960 and later. If Republican lawmakers get their way, the full retirement age might increase to 68, 69, or even 70. It's important to note that this wouldn't impact current retirees at all. However, it would mean that future generations of retirees may have to wait longer to collect 100% of their benefit. Either that, or they'd have to be willing to accept a steeper reduction in benefits.

The idea behind raising the full retirement age is that it would account for lengthening life expectancies, as well as encourage healthier seniors to remain in the labor force, thus encouraging them to save more and generating additional payroll tax revenue for the Social Security program.

Image source: Getty Images.

Another popular Social Security solution is to change how annual cost-of-living adjustments (COLA) are calculated. Social Security's COLA is the "raise" that beneficiaries get on a near-annual basis.

Currently, Social Security's COLA is tied to the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). The average reading from the third quarter of the previous year serves as the baseline measure of a predetermined cost for a basket of goods and services, while the average reading in the third quarter of the current year serves as the comparison. If prices for this basket of goods and services rises, then Social Security recipients get a commensurate raise, rounded to the nearest 0.1%.

Republicans often want to abandon the CPI-W, implying that it doesn't accurately reflect the costs that seniors are facing. Instead, they'd like to see the Chained CPI used in its place.

The Chained CPI is set up in much the same way (i.e., measuring the change in price for a predetermined basket of goods and services), but with one pretty sizable difference. The Chained CPI takes substitution into account. In other words, if the price of a certain good or service becomes very high, the Chained CPI assumes the consumer will trade down to something more affordable. Thus, the Chained CPI grows at a slower pace than the CPI-W, providing smaller annual increases in pay to seniors.

Image source: Getty Images.

Republicans, including President Donald Trump, have also favored the idea of means-testing individuals prior to paying Social Security benefits.

The concept behind means-testing is pretty simple: reduce or halt Social Security benefit payouts to retired workers who have more than enough income or assets to live comfortably. During his campaign, Trump opined that he would forgo his own Social Security benefits during retirement, and that other wealthy Americans should do the same.

What might means-testing entail? Unfortunately few lawmakers have ever put their nose to the grindstone and come up with a specific dollar denomination, but as an example, individuals earning more than $80,000 or $100,000 per year in retirement might see their benefits reduced or halted altogether.

By itself, means-testing won't bridge Social Security's budgetary shortfall. However, when used in combination with other fixes it could narrow the gap.

Image source: Getty Images.

Though it's the longest shot of them all, a partial privatization of Social Security can't be entirely ignored given that Donald Trump, Mike Pence, and a few notable members of his cabinet have, at one time, all supported the idea.

Privatizing a portion of Social Security means setting aside a percentage of an individual's payroll tax contributions toward the program into a separate account. This account would be managed by the individual and invested how he or she sees fit.

Why privatize? Right now, Social Security's more than $2.8 trillion in spare cash is entirely invested in special issue bonds and, to a lesser extent, certificates of indebtedness. Because the Federal Reserve has kept lending rates low for a long period of time, the rate of return on newly issued bonds has been between 1.375% and 3% -- not very appealing. Privatizing a portion of Social Security allows people the opportunity to seek out higher-yielding (but riskier) investments. It would also partially reduce the role of the federal government for retirees, which Republicans on Capitol Hill would probably like.

Assuming Republican lawmakers do try to tackle Social Security reform, which is far from a guarantee, privatization isn't very likely. On the other hand, raise the retirement age, means-testing, and tying COLA to the Chained CPI all seem quite probable.

The good news for senior and future retirees is that Social Security reform is off the table for the 2018 budget. However, budget director Mulvaney has made it clear that changes could be suggested in 2019 and beyond.

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Speaker Paul Ryan says the collapse of the House Republican health care bill means former President Barack Obama's health care law will be around for the foreseeable future. (March 24) AP

Health care activists march to the Trump International hotel during a protest in March in Washington, D.C.(Photo: MANDEL NGAN, AFP/Getty Images)

WASHINGTON Rep. Luke Messer, R-Shelbyville, was waiting for his turn to speakin favor of the GOP health care bill Friday when it was yanked from the House floor in the last minutes of debate.

Vote! Vote! Democrats shouted as Messer and other stony-faced Republicans filed off the floor to a closed-door meeting where the Rolling Stones You Cant Always Get What You Want played.

Republicans seven-year effort to get rid of President Barack Obamas signature health care bill was dead.

I dont know what else to say other than Obamacares the law of the land, House Speaker Paul Ryan, R-Wis., told reporters after the short caucus meeting ended. Were going to be living with Obamacare for the foreseeable future.

Indianas uninsured rate had dropped from 13 percent before major provisions of the 2010 Affordable Care Actbegan to 9 percent in 2015. But Republicans argued it imposed too many taxes and regulations on the health care system, without lowering costs.

Most of Indianas seven GOP House members, as well as Gov. Eric Holcomb, had backed the repeal and replace bill.

One Indiana House member, freshman Rep. Trey Hollingsworth of Jeffersonville, issued a statement after the vote criticizing career politicians for lacking the courage to act, but he never said if he supported the bill.

Sen. Todd Young, R-Ind., also had not said if he backed it.

WHAT HAPPENED:Failure to repeal Obamacare ends terrible week for Trump, GOP

The two major components of the ACA which increased coverage an expansion of Medicaid and subsidies for people who buy insurance without help from an employer would have been scaled back. Taxes the ACA imposed on the wealthy and sectors of the health care industry to pay for the ACA would have been repealed.People would not have been fined for not having insurance and larger employers would not have had to offer coverage to workers.

An estimated 24 million fewer people would have had insurance under the bill in 2026 compared with no changes to the law. Some would have gone without by choice. Many would have done so because they could not afford it, according to the nonpartisan Congressional Budget Office.

The bill lost support of some more moderate Republicans concerned about the loss of coverage, while too many hard-line conservatives opposed the bill for not going far enough to undo Obamacare.

When it was clear not enough lawmakers had been swayed even after additional changes were made to the bill Thursday night, Vice President Mike Pence canceled an out-of-town trip and huddled Friday afternoon with members of the House Freedom Caucus. Leaving the meeting, Pence ignored shouted questions from reporters about whether the bill had the votes to pass.

Vice President Mike Pence and Health and Human Services Secretary Tom Price leave the Capitol Hill Club on Capitol Hill March 24, 2017 in Washington, DC. While Pence visited with lawmakers Speaker of the House Paul Ryan (R-WI) traveled to the White House to meet with President Donald Trump to discuss the fate of the American Health Care Act.(Photo: Chip Somodevilla, Getty Images)

As the debate continued on the floor, Democrats remained united in their opposition.

Rep. Pete Visclosky,D-Merrillville, said the bill would jeopardize care for the more than 400,000 Hoosiers on HIP 2.0, Indianas alternative Medicaid program that was expanded through the ACA. The GOP bill would have phased out the Medicaid expansion, as well as cut funding for Indianas traditional Medicaid program, which covers children, pregnant women, the disabled and low-income seniors.

Medicaid spending is the source of two-thirds of federal funding received by Indiana for a program used by about 1 in 5 Hoosiers.

Holcomb earlier this year asked the federal government for permission to continue HIP 2.0, and to expand access to substance abuse disorder services for an estimated cost of $70.75 million a year.

But he backed the GOP bill this week, saying in a letter to congressional leaders that Obamacare had diverted resources away from Medicaids core mission. He praised recent changes to the bill that would have allowed states to impose work requirements on some Medicaid recipients, and allowed states to accept less funding than in the original bill in exchange for more leeway on how to run the program.

Its a huge step forward in giving states the flexibility in deciding who really needs this assistance, how they should get it and what they should get, Rep. Todd Rokita, R-Indianapolis, said on the House floor.

U.S. Rep. Todd Rokita(Photo: File photo)

Rep. Larry Bucshon, R-Newburgh, said the voters who fought against Obamacare because it caused them to lose coverage or pay higher premiums had put Republicans in charge of Congress and the White House in part so the law could be repealed.

Its an opportunity for us to fulfill our promise to our constituents, he said.

PresidentDonald Trump carried Indiana by 19 percentage points. But a majority of voters 56 percent opposed the GOP bill while only 17 percent supported it, according to a Quinnipiac University surveyed of 1,056 voters taken March 16-21.

Replacing Obamacare will come with a price for elected representatives who vote to scrap it, say many Americans, who clearly feel their health is in peril under the Republican alternative, said Tim Malloy, assistant director of the Quinnipiac University Poll.

Republicans said they need some time to reflect on what happened Friday, but will quickly regroup.

NEXT STEPS:With Obamacare repeal dreams dashed, what can GOP accomplish?

Health care reform, however, is no longer on the table, said a subdued Messer.

Were going to wake up tomorrow morning and weve still got a lot of work to do for the American people, said Messer, chairman of the House Republican Policy Committee. Today is a disappointing day, but were going to have to move on to other issues.

House Minority Leader Nancy Pelosi called the failure of House Republicans to bring their health care bill to a vote 'a victory for the American people.' (March 24) AP

Contact Maureen Groppe at mgroppe@gannett.com. Follow her on Twitter: @mgroppe.

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