There’s been some movement on healthcare and it’s caused the Democrats to take notice.  As expected, the Trump administration understands that in the current political environment the GOP’s agenda must go through the Freedom Caucus in the house.  With the Democrats unwilling to work with Trump, the group of about 35 conservatives have the ability to hold up any legislation and exercised this power during the first round of Obamacare repeal legislation.  This group was widely castigated for blowing up the first attempt, but it appears their gamble was able to extract additional policy concessions.  The burden to pass the legislation has now shifted to the more moderate wing of the Republican party.  While the spotlight has been on the freedom caucus, there were a significant number of Republican congressmen who had reservations over potential losses of insurance due to reductions in government subsidies.  Their opposition was far more quiet, but with the latest version carrying less state intervention, their concerns will only increase.  Hoping to increase the political downsides of passage, the Democrats have upped the ante by threatening a government shutdown if the bill goes forward.  Arguments over procedure are nearly almost insincere and this action is only a reflection of the increased division over policy direction, which has played itself out in similar manners while Obama was president.  House leaders are now struggling to bring on the moderates on board, but even if successful, the bill faces precarious prospects in the Senate.  The GOP holds 52 seats and they can only lose two and still pass the bill by reconciliation. 

Despite voting for outright repeal many times during Obama’s years, now that they will actually have to live with the consequences some congressmen have gone wobbly.  With only modest market oriented changes, the plan is far from the free market panacea that is promised to pass.  The majority of these changes are promised in the third phase of the repeal plan, but the process to pass this legislation is not feasible in the current political environment.  If the GOP passes this latest iteration, it and a series of administrative actions will be the sum of reform barring a major political shift.  If the GOP can’t gain traction in this latest effort it’s not clear what their path forward is.  Conservatives will have balked perceived minor change, while centrist will have balked at a more comprehensive approach.  If there is no party cohesion, the US will be stuck with Obamacare for the foreseeable future.