In the Rasmussen surveys, President Trump has dropped almost 1 point per day – from 53% support to 47% support in one week.  Senator Tom Cotton is correct: the GOP House majority is at grave risk in 2018 if this Ryan plan is a lousy replacement for a lousy plan.  Some of the early statistical analysis suggests that older, poorer, rural people are most damaged, with far lower tax credits than the prior subsidies.  Whom do you think most of these people voted for?

It is important to remember that only 9 million signed up on exchanges this year – 3% of the population – and 13 million on Medicaid, about one third of whom would have qualified under old rules (up to 100% of poverty level, as opposed to 138% for the 31 states that expanded Medicaid).  How Medicaid is handled is a very big deal.  Giving block grants to states could be a good approach to cutting future growth.  But cutting off millions in one year is not a good policy.

The estimate by the CBO is preposterous: 14 million fewer insured in 1 year, 24 million by 2026.  This analysis suggests that no one covered by Obamacare will still be covered (on a net basis) in 2026.  Insurance companies have argued that not enough young healthy people signed up.  Now the CBO says these are the people who will drop coverage without a mandate.  Are they now wired or not?

Ted Cruz's approach to get V.P. Pence to rule that budget reconciliation can be used to deal with the entire Obamacare repeal and replacement is an excellent idea.  The GOP might as well try to come up with a complete plan that is rational, rather than pieces at a time, hoping for more later.  

Hardcore conservatives have to understand that never in American history has a Congress taken a benefit (entitlement) away from 20 million-plus people, and you need more than conservative talking points to substitute something.

If the replacement package can enable plans to cover far fewer things – no requirement for mental health, drug and alcohol, pregnancy, chiropractors, acupuncture – you can offer skinny packages that will cost far less, and lower subsidies through tax credits might work.  If people want more comprehensive packages, fine – they cost a lot more.  Make health insurance more like other insurance, covering catastrophic events rather than covering everything.  Health insurance should not pay for the equivalent of an oil change on a car or basic home repairs.

Obamacare taxes were almost all hitting top earners.  Their repeal now looks like a giveaway for top earners, while the current replacement plan looks as though it hurts poorest the most.  There are not good visuals that can be easily created to show this.  Speaker Ryan has been way too dismissive on the tax aspect of the House plan in his response to the CBO estimates.

Thomas Lifson adds:

Charles Krauthammer yesterday on Special Report articulated a smart strategy (I think) for the GOP.  Instead of the Ryan plan, go for a genuine one-phase plan that would require 60 Senate votes to pass.  Then dare the Democrats to filibuster as Obamacare crashes and burns.  The Democrats would then (again!) be the ones responsible for the health care mess.  If they refuse to allow a complete reform of health insurance to go through – one that fully utilizes market mechanisms to control costs – then the chaos that follows as Obamacare fails will be their responsibility for standing in the way of essential reform.

The old saying "go big or go home" certainly applies here to a host of GOP representatives and senators.  Do it right, and let the Democrats stand in the way and take responsibility for the failure of Obamacare.