I've got yer American Carnage for ya right here

In public, President Donald Trump is all-in on the Senate’s final chance to repeal Obamacare. But privately, there’s ambivalence in the White House about the bill’s contents and its chances of clearing the tightly divided chamber next week.

Trump spent time between meetings at the United Nations calling senators and other senior White House officials about the Graham-Cassidy bill, asking for updated vote tallies and how to woo senators for the bill. White House officials have considered tweaking the state funding to win a vote from GOP Sen. Lisa Murkowski of Alaska — and others. Trump has also publicly excoriated Kentucky Sen. Rand Paul for voting against the legislation, telling aides he would go after other senators.


"Repeal and Replace!" he said. Trump also defended Sen. Bill Cassidy (R-La.) from Jimmy Kimmel’s scathing criticisms of the bill, concluding that Cassidy is a “class act.”

The public stance is coupled with a sense of doubt inside the White House, though, about the bill and deep concerns about whether it can pass the Senate or House, according to administration officials and congressional sources. These people say the president and his team have little sway with some key members, like GOP Sens. Susan Collins of Maine, John McCain of Arizona and Murkowski, the trio that tanked Republicans’ repeal attempt in July.

In fact, many Republicans on Capitol Hill believe that Trump cost them Murkowski’s vote in a private phone call this summer. And the president has refrained from making as many calls this go-round, one person familiar with his whipping said...

One official said the concerns from governors have alarmed some in the White House — and that "we really aren't sure what the impact will be” of passing the bill. They also fear that the bill could bring political blowback from the left and right.

Trump has publicly expressed enthusiasm about the bill, tweeting about it repeatedly. But in conversations with aides, he has turned back to one topic: What can the White House do that is seen as "repeal and replace?" a phrase he likes to repeat.

After 2020, the bill would also sharply cut back federal funding for states that expanded Medicaid, gutting some state budgets by tens of billions of dollars.

“Some states might elect to begin the process of winding down their Medicaid expansion prior to 2020, which could also add to coverage losses during this period,” the report noted.

Brookings also notes that there is nothing in the bill to prevent states from spending the federal block grants that used to be their Medicaid and ACA marketplace budgets for completely unrelated purposes, such as cutting taxes.

After 2026, the losses would become far more severe, with more than 30 million people losing insurance “because of the additional changes to the Medicaid program under this legislation.”