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Monica Akhtar

President Trump says the Senate health-care bill needs <a href="https://www.washingtonpost.com/politics/2017/live-updates/trump-white-house/gop-health-care-bill-the-latest-news-and-reactions/trump-says-senate-draft-bill-needs-negotiation/?utm_term=.32a1e6a50347">more negotiation</a>. (So what foolish lawmaker would sign onto it now?) <a href="http://www.twcnews.com/nys/capital-region/news/2017/06/21/planned-parenthood-officials--organization-is-in-jeopardy-if-gop-healthcare-bill-is-passed-.html">Planned Parenthood</a>, <a href="http://www.politico.com/tipsheets/politico-pulse/2017/06/22/the-senate-bill-is-here-big-gives-for-insurers-dont-expect-trump-to-be-top-salesman-220988">hospitals</a>, every Democratic lawmaker and a number of conservatives have panned the bill.

Conservatives and libertarians oppose the bill because, to a greater extent than the House bill, it<a href="https://twitter.com/philipaklein/status/877908703214788608"> temporarily props up Obamacare</a>. <a href="https://twitter.com/AP_Politics/status/877954982116503552">Already four Republicans</a> — Sens. Rand Paul (Ky.), Ron Johnson (Wis.), Ted Cruz (Tex.) and Mike Lee (Utah) — have said they cannot support it because it does not fully repeal Obamacare or do enough to lower costs.

The same groups and lawmakers that opposed the House’s American Health Care Act because of cuts to Medicaid are likely to like the Senate bill even less; it rolls back Medicaid expansion less slowly than does the AHCA but thereafter would begin cutting back support by using a slower inflation measure.

Senate Republican leadership has managed to hit the sweet spot — it found a bill even more objectionable than the House’s. That’s not surprising, as splitting the difference to please those who want no remnant of Obamacare and those who want the same protections as Obamacare results in something neither likes much at all.

And just to make matters worse, an <a href="http://www.nbcnews.com/politics/first-read/nbc-news-wsj-poll-public-overwhelmingly-disapproves-house-health-care-n775491">NBC News-Wall Street Journal poll</a> released Thursday shows:

By a 3-to-1 margin, the American public holds a negative view of the American Health Care Act, legislation that House Republicans passed last month and that President Donald Trump supports.

Just 16 percent of adults believe that House health care bill is a good idea, versus 48 percent who say it’s a bad idea.

In May’s NBC/WSJ poll, it was 23 percent good idea, 48 percent bad idea.

Strikingly, even Republican respondents in the poll are lukewarm about the House bill, with only 34 percent viewing it positively (and 17 percent viewing it negatively).

By contrast, 73 percent of Democrats and 48 percent of independents view it negatively.

Few observers would imagine that the Senate version (which contains a good deal of what’s in the AHCA) gets a more favorable response than the AHCA.

Perhaps Republicans should take a step back and ask whom they are trying to please. If the answer is the slice of the party that wants to vastly curtail federal support for health care and instead use money to give the rich tax breaks, they should say so. (Understand this is exactly the opposite of Trump’s populist message.) That would have the virtue of honesty. But they won’t come clean, of course, because that’s a politically toxic. So how, then, do Republicans sell something they know to be unacceptable to so many Americans? Well, they rush it through and strong-arm members, I suppose.

If Republicans really are trying to address rising costs, they should look at the rate of premium increases under Obamacare and demonstrate what specific measures will reduce that trend, and bend the cost curve downward. (I’ll save them the trouble — no one knows exactly how to do that.) Deregulating health care could provide cheaper options, but it’s far from clear that would make the coverage consumers now enjoy any cheaper. Those cheaper options, by the way, are the high-deductible plans voters complain about.

If Republicans want big tax cuts for the rich, they should propose them (won’t they do so in the tax bill anyway?) and not make Medicaid and coverage under Obamacare worse.

Ironically, the bill does reveal something quite remarkable: Republicans know how to repair Obamacare, at least in the short range. <a href="https://www.axios.com/what-we-know-about-the-gop-senate-health-bill-2445712499.html">It’s in their bill</a>: Fund the Affordable Care Act’s cost-sharing subsidies and put in place a “four-year reinsurance program to help states stabilize their marketplaces.” That might not be a long-term solution, but it is the answer to breakdown of the exchanges. Republicans could do this even without the rest of their bill, but that, of course, would contradict the argument that Obamacare has failed and cannot be fixed.

Unfortunately, there is little agreement among Republicans, as we have said, as to what they want the bill to do. More or less government? Less or more state control over Medicaid? Until they address those basic questions, they won’t be able to come up with a coherent bill. But they should be forewarned: Polls show the very things voters want to keep in place or make more generous — Medicaid funding, the list of guaranteed minimum benefits, full protection against increased prices for those with preexisting conditions, lower premiums (with smaller deductibles!) — are what Republicans want to reduce or eliminate. In other words, conservatives’ idea of health-care “reform” has very little popular support — less support than Obamacare — and moderate Republicans’ idea of reform won’t please GOP hard-liners.

University of California at Berkeley, BA in history

University of California at Berkeley, JD

Jennifer Rubin writes reported opinion for The Washington Post. She is the author of “Resistance: How Women Saved Democracy from Donald Trump” and is host of the podcast Jen Rubin's "Green Room."

Jennifer Rubin

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The Washington Post Opinions section features opinion articles, op-eds, editorials by the Editorial Board, global opinions and letters to the editor on the issues of the day. Offerings include columns by Washington Post opinion writers, political cartoons by editorial cartoonists Ann Telnaes and Michael de Adder and podcasts by James Hohmann and Jonathan Capehart.