In it, but not of it. TPM DC

Since Republicans embarked on their effort to dismantle the Affordable Care Act, the question of how to handle preexisting conditions has roiled their negotiations. On the one hand, GOP leaders including President Trump have repeatedly sworn to protect sick people’s access to affordable insurance. On the other hand, Republicans have consistently folded to the demands of conservatives to gut those protections. The tradeoff that Republicans have not figured out is how to lower premiums for healthy people without screwing over those with expensive health care issues.

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In spite of his polarizing image and sagging approval ratings, President Trump has yet to suffer a major loss at the ballot box. That may change on Tuesday — because Trump embraced the establishment.

Trump called into the “Rick & Bubba Show” in Alabama on Monday morning to talk up appointed Sen. Luther Strange (R-AL), who’s facing off against hardline conservative and former Alabama Supreme Court Chief Justice Roy Moore (R) in Tuesday’s primary to fill out the Senate term of Attorney General Jeff Sessions.

I’m 5-0 in these races. And I want to keep it, I want to make it 6-0,” Trump bragged about his special election record since becoming president. “He is a good man. We can’t lose him.”

But it looks like that streak’s about to end. Every public survey of the campaign has found Moore in the lead, including a trio of polls released in recent days that show him with a double-digit edge. And while most strategists in the state think the contest is a bit closer than that and say Trump has helped Strange close that gap some in the race’s home stretch — “The race is close, it’s been closing,” Sen. Richard Shelby (R-AL), a Strange backer, told TPM on Monday — most also think that Moore is the odds-on favorite to win on Tuesday.

The conversation in Alabama today is what’s the margin of the Moore victory going to be, not who’s going to win,” said one Alabama GOP strategist who’s backing Strange in the race. “Trump is not a pied piper who is going to lead people blindly down a path.”

Strange has been dogged from the start by how he got the appointment in the first place. He was given the job by disgraced then-Gov. Robert Bentley (R), who had to resign shortly afterwards amidst a sex scandal. Strange had been the state’s attorney general at the time and in charge of investigating Bentley, and many see the appointment as fishy — something Trump himself admitted on Monday.

Because he was appointed by a little bit of a controversial guy I guess as I understand it, now it makes the race tough,” he said, shortly after blaming Senate Majority Leader Mitch McConnell’s (R-KY) unpopularity as hurting his candidate in the race. 

And while Trump came in to help Strange in a Friday rally, he admitted during that speech that “I might have made a mistake” politically in backing the underdog in the race.

It’s clear the race hasn’t been Trump’s overriding focus — he twice referred to Moore as “Ray,” not Roy, in his Monday interview, and he spent almost as much time in his Alabama rally attacking NFL players who dared kneel during the national anthem as promoting Strange (and much more time in subsequent days). But a loss there will show the limits of his ability to move base conservatives, especially when he gets crossways with them.

While Trump’s endorsement has likely kept Strange in the race at all, Moore has benefitted from the backing of a constellation of big-name Trump supporters, from Breitbart head and former chief White House strategist Steve Bannon to former Alaska Gov. Sarah Palin (R) to Housing & Urban Development Secretary Ben Carson to Fox News host Sean Hannity.

They jumped on the bandwagon, but Moore has led the race from the start — equally because of his rabid base following and because of Strange’s issues.

And while whoever wins the primary will be the heavy favorite to replace Sessions, Democrats haven’t completely ruled out helping former State Attorney Doug Jones in the general election. Former Vice President Joe Biden is heading to the state to help his old friend, and national Democrats are taking a wait-and-see approach on whether he might be competitive against Moore given his penchant for comments that are polarizing even in Alabama.

The [National Republican Senatorial Committee] might have to spend money to protect this seat, which is crazy in my mind,” said Alabama GOP strategist Chris Brown, who ran another candidate’s campaign in the first round of the primary and is reluctantly voting for Strange. “This is not going to be a race we’ll stop talking about after this week.”

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Sen. John McCain (R-AZ) isn’t thrilled with how his close friend, Sen. Lindsey Graham (R-SC) and others are trying to tweak their Obamacare repeal bill to buy off skeptical senators like him with more money for their states.

“It seems the bazaar is open, and that’s not the way to legislate. That flies in the face of everything I’ve been talking about and arguing for. ‘What would it take to get that vote — $10 billion, $15 billion?’ I mean, it’s unsavory,” McCain told TPM when asked about the changes to the bill Graham and Sen. Bill Cassidy (R-LA) are pushing that would give more money to states like Alaska and Kentucky that are home to key swing votes on the bill.

McCain all but killed the bill when he announced his opposition on Friday, forcing those trying to win over reluctant supporters to try to buy off senators with big handouts for their states.

His comments were rather similar to what Sen. Rand Paul (R-KY), another no vote and a senator McCain has long sparred with, had to say about the bill earlier in the afternoon (Paul called the buy-offs “unseemly”).

He laughed when TPM said that was the closest he’d sounded to Paul in a long time.

“Well, if you live long enough,” he said with a grin.

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The Congressional Budget Office on Monday said that the last-ditch Obamacare repeal bill Senate Republicans would result in “millions” fewer people with “comprehensive health insurance that covers high-cost medical events.”

“That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear,” the CBO said in its preliminary report of the bill, known as the Graham-Cassidy proposal, for its sponsors Sens. Bill Cassidy and Lindsey Graham.

Because the CBO was working on a tight deadline — Republicans hope to vote on the bill by the end of this week  — it said it it could not provide specific numbers on the coverage losses.

“CBO and JCT would need at least several weeks to provide point estimates of the effects on the deficit, health insurance coverage, and premiums,” it said.

Nonetheless, it pointed to three main reasons that coverage would drop drastically if the Graham-Cassidy bill became law: its cuts Medicaid funding; coverage losses in the individual market because insurance subsidies would be less generous; and the elimination of the penalty for people who do not have insurance.

The report will likely to little to address the concerns hesitant GOP senators have had about the hasty process leading up to the bill or its substance. Additionally the CBO appears to have analyzed an outdated version of the proposal, and it’s not clear how tweaks made to the revised version would affect its general conclusions.

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Sen. Rand Paul (R-KY) made clear he still isn’t anywhere close to backing Republicans’ latest attempt to repeal Obamacare — and called last-ditch efforts to add buy-offs for him and other no-leaning senators “unseemly.”

“If you’re going to say the whole country is short of money, which we are … everybody should get the same thing,” he told reporters Monday afternoon, ripping the last-second cash infusions Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) have made for states like Kentucky and Alaska, home of Sen. Lisa Murkowski (R-AK), a key undecided vote. “No, it doesn’t seem right.”

Paul made it clear he’s still strongly opposed to the bill, both because of the process and the policy.

“I’m just not for a trillion-dollar grant program that keeps most of the Obamacare spending,” he said. “This is thrown together sort of in a slipshod way … A lot of this is about electoral politics.”

And he made it clear the basic structure of the bill is unacceptable to him.

“In my mind a compromise does not include block grants,” he said. “I just don’t think this is repeal. … I believe that it represents Republicans accepting a trillion dollars of Obamacare spending.”

He and Sen. John McCain (R-AZ) are both hard noes on the bill and Sen. Susan Collins (R-ME) is leaning no, enough to kill the bill, while Murkowski and a handful of other have expressed deep reservations.

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The latest version of the last-ditch Senate Obamacare repeal bill is — not surprisingly — a mess, and one of the areas bringing the most confusion and inconsistency is what the legislation has to say about protecting those with pre-existing conditions.

As Michigan Law Professor Nicholas Bagley pointed out, those provisions appear to be sloppily drafted, and in some places, contradictory of one another. But according to Bagley and other health care experts, the ambiguity probably does not matter at the end of day if you look at another, particularly wonky provision: one allowing for states to permit insurers to operate separate risk pools.

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Hours before the sole hearing on the GOP’s last-ditch bill to repeal the Affordable Care Act, hundreds of activists from around the country set up camp in the halls of the Senate office building, waiting to grab a seat in the room and register their opposition to the legislation.

Under the watch of several dozen armed Capitol Police officers, the activists put on Grim Reaper costumes, donned bright red shirts blaring “I AM A PRE-EXISTING CONDITION,” and periodically struck up chants of “Kill the bill.” Many planned to be arrested protesting the bill.

“It’s the most horrible legislation in our lifetimes,” New York City retiree Judy Cutler told TPM. “It will kill people, literally. And it will cost our family so much I don’t think we can afford our care.”

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Amid crumbling support for the Senate GOP’s last-ditch bill to repeal the Affordable Care Act, the authors of the Graham-Cassidy repeal bill dropped revised text late Sunday night in an attempt to woo dissenting Republicans back into the fold.

The changes attempt to offer something for everyone: more insurance deregulation and the weakening of protections for people with pre-existing conditions for far-right skeptics like Sens. Rand Paul (R-KY) and Ted Cruz (R-TX), re-jiggered state numbers to soothe the fears of moderates Susan Collins (R-ME) and Lisa Murkowski (R-AK), and an extra sweetener for the home state of bill author Bill Cassidy (R-LA).

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