The setup is actually fairly simple: would the Republican desire to pass massive tax cuts for its donor class overwhelm its fear of being punished at the ballot box for taking healthcare away from millions of Americans, including their own voters? Under normal circumstances fear of electoral consequences would prevail. But we live in an age of unprecedented partisanship and big money influence, which leads many Republicans to feel insulated from the consequences of even openly cruel actions that damage their loyal constituents. That Republicans would actually destroy Obamacare went from remote possibility to very real.
What that means is anyone's guess, so I'm trying to plot out the scenarios just to determine how fucked we are.
Scenario One: McConnell is somehow able to push through the horrendous Senate version (BCRA) of trumpcare.
By making tweaks to the Senate package, McConnell will try to keep the "moderate" Republicans from bolting - gifting possible holdouts with small relief funding - while giving the Far Right more reason to vote for the bill. While the Democrats could use various procedural rules to delay or hold the bill, given McConnell's track record of bulldozing through his agenda this could also mean those procedures will get napalmed into ash.
Because the Senate bill differs from the House version (AHCA), this means the hot potato goes back to the House for a new vote, and this is where the scenarios can really diverge.
Scenario One-A: The House - despite the griping from the Freedom Caucus (Far Right) that it doesn't go far enough, and the worries of the Tuesday Group (Moderates) fully aware of how the voters hate the bill - passes the Senate BCRA and trump signs it, essentially dooming 18-24 million Americans having their healthcare taken away.
Given the delays written into the Senate bill, most of the damage from it won't be obvious until 2020. But early shifts in Medicaid funds, the loss of maternity care, and the loss of regulatory control protecting pre-existing conditions will be clear early on. The CBO score rated that 11 million could lose their health care by 2018. That's even before the hard cuts to Medicaid kick in.
Scenario One-B: The House Republicans split on the vote. The Tuesday Group were angry about how they were told to vote for a bad bill with the promise that "the Senate will fix it" only to have the Senate pass the buck back to them. They've had months to watch the public outcry against any Repeal-Replace and can refuse to support this next step. Ryan may not have enough favors in his pocket to get enough of them around to support it... while coping with a Freedom Caucus that would never accept any moderate changes to their Repeal-Replace desires.
As a result, the entire Repeal-Replace effort collapses for good. This does turn into a serious problem with Congress, because the real reason the Republicans were so eager to get rid of Obamacare first was to clear the table for bigger issues such as their overall Tax Cut Budget of Doom. They can't push that massive tax cut if there's still a big federal healthcare mandate like Obamacare in the way. The GOP hasn't even looked at a serious budget proposal this session despite several on the table, and the budget is due by September I believe. They're running out of time.
The delay in legislative action is having a cascade effect on everything else: The debt ceiling vote in particular is coming up fast, serious political infighting with the hardcore Freedom Caucus poised to block any debt hike. The Republicans can't afford to let their Repeal-Replace effort wither away, as it would signal a serious rift among their ranks preventing anything from getting done. That lack of effort will discourage their voting base, another midterm woe they'll have to cope with.
Scenario One-C: This goes a little farther than One-B in that the Republican split turns into a party civil war. Failure by Ryan and the House leadership to keep the factions in line leads to a public falling out, where either the Freedom Caucus quits the GOP (likely) to form a third party, or the Tuesday Group quits (unlikely, 'cause they're cowards) and throws in their lot with the Democrats.
There's currently 240 Republicans to 194 Democrats in the House. It would take 47 Republicans quitting the GOP and forming a third party to get them down to 193, giving Dems a plurality. Better still, any Republicans flipping party to the Dems - allowable during the sessions - would boost Democratic numbers into a majority of their own: That would need 24 Republicans switching the aisles.
By numbers, there's 33 official members of the Freedom Caucus: Not enough to form a third party unless they convince - or the SuperPAC deep pocket funders convince - enough regular Republicans to flee with them. They definitely will not flip to the Democrats, so that part of the scenario won't happen. A serious move for this scenario would have to involve enough of the moderate Tuesday Group - 48 in their roster, so either way they can do this - flipping sides or going third party.
Once the Democrats are in control of the House, the whole effort to Repeal-Replace stops.
This is pure fantasy, of course. I'd personally love to see the moderate factions grow a spine and tell the wingnuts to go fuck themselves, but that's not how elected moderates roll. It's possible the Freedom Caucus could pull off a revolt of some kind that would force the Tuesday Group to flee no matter what, or pull off a split with enough members to give the Democrats minority-majority control, but that's next-to-impossible with the current math.
Of the three variances, One-B is the one we can hope for... but don't be surprised if we get One-A. After all, with the Republicans in charge we're all screwed.
Past all this, we move on to Scenario Two: Unable to pass a Repeal-and-Replace package, the GOP Senate - then the House - opts for a straight-up Repeal and let the whole thing crash until people beg for their bad bill(s).
This is the Shoot-The-Hostage strategy. The Far Right factions in both House and Senate would view this as a winning move, because it clearly destroys Obama's signature achievement AND it validates their worldview that government regulations are bad. The logic for this move is that once they reset the nation's healthcare system to how it was in 2009 - which is, shitty - and let the nation stew in horror for six months, the Republicans could force the Democrats to agree to ANY Replace package the GOP would put on the table.
There are several faults in this logic. One, there is nothing the Republicans can do to force the Democrats to cave on this issue. The Dems may genuinely care that millions of Americans need healthcare coverage, but they are competent enough to know that any GOP plan will be a disaster compared to what Obamacare - or a Medicare/Medicaid For All - offers. The only thing Democrats will ever vote on is keeping Obamacare the way it is (or at best fixing its gaps with a Public Option). Plus, the Democrats are smart enough to know that any deal with the devil is no deal at all.
Second, for all the attempts the Republicans will try to pin the blame of losing healthcare on the Democrats, a majority of Americans are fully aware which party - the one yelling and screaming and lying their asses off about Obamacare - will deserve the blame (hint: it ain't Obama). The sudden turnaround of pro-Obamacare support is a clear sign of that. This is what David Frum warned the party about: Once a public benefit is out there - Social Security, Medicare - you can't take it away without getting punished for it.
The Republican leadership may think themselves protected via gerrymandered "safe" districts and via their growing voter suppression efforts, and given the recent history of midterms - 2010, 2014 - going their way they may be right. However, the conditions the GOP are setting up - massive social trauma, the likelihood of economic chaos when the health care industry takes the hit - could make this coming election cycle similar to 2006 when the disasters of Katrina, rising gas prices, and the failing Iraq occupation led to the Democrats flipping the House and Senate with historic gains.
A full Repeal without a Replace would also betray the Republican Moderates who are keen on genuine replacement, and that might lead to the One-C scenario.
Scenario Three: The Senate can't agree on a path forward on their version of trumpcare, and since they'd already pissed on the House version that ends any effort to Repeal. Instead, a genuine effort to Reform the existing Obamacare system (ACA) gets a bipartisan deal in the Senate done. And it goes - with some grumbling - to the House for passage just to get it out of the way.
This is from the noise coming from "moderate" Senators - Collins in particular, with harrumphs from Murkowski, Cassidy and Heller - who are openly opposed to the current Senate bill. Their plan(s) range from just minor cuts of Medicaid funding to changes of the tax model to shift the revenue burdens and placate both sides (mostly), with an eye towards making sure they keep the healthcare loss to a minimum - say, just a million or two Americans - while avoiding the bad optics of kicking children and elderly to the curb.
Whatever they come up with, the plan would have to appease either the Democrats in both the Senate and the House, or the Far Right Republicans.
In short: This could never happen. Not with the existing dogma choking the Republican leadership. The Far Right wants their goddamn tax cuts at all hazards - which would be about $750 BILLION out of ACA - and in order to justify that cut from Obamacare they HAVE to cut spending somewhere - which is why Medicaid is seeing cuts to around $744 BILLION when it's all said and done. Unless the moderates find a revenue source that can cover $744 BILLION - which means a tax hike somewhere in the economy that no wingnut can accept - that one step alone blocks all compromise.
Scenario Four: Aliens show up that can provide free health care to all, making the entire matter moot.
Problem with this is, no sentient lifeform in the universe is going to want to deal with that goddamn con artist sitting in the White House.
So you can kind of see the trouble we're in. The only scenario that looks even remotely possible is One-B where the attempt to Repeal-Replace fails again and Congress is forced to move on to other pressing matters. But knowing the wingnut nature of the modern Republican Party, they are going to get their goddamn tax cuts come hell or high water, which means we're all getting One-A.
At which point our nation DOES go to hell and we all drown in the flood.
Thanks, Russia. Thanks, 62 million trump voters. Thanks, Grover "Drown 'Em In My Bathtub" Norquist. Thanks, spineless moderate Republicans.
We are so royally fucked.