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President Trump, accompanied by Vice President Pence, center, and House Speaker Paul Ryan (R-Wis.), in January in Philadelphia. (Matt Rourke/Associated Press)

The Hill reports:

Rep. Billy Long (R-Mo.) said Monday that he opposes the revised GOP ObamaCare replacement bill because it weakens protections for people with pre-existing conditions.

Long’s announcement was unexpected, and a bad sign for GOP leaders looking to round up enough votes to be able to pass the measure as soon as this week. Long was not on the radar as a possible no vote.

This confirms a few observations, none of which bodes well for House Republicans.

First, the decision to allow states to opt out of the community rating provision (in effect, allowing insurers to charge people with preexisting conditions more) is a big deal that unnerved many House members. For moderates, the change made the bill worse. And, as Long suggests, it may not have helped keep mainstream Republicans together. The way these things work is that a prominent defection usually spurs a flood more.

Second, President Trump couldn’t get the ball across the end line last time on Trumpcare and instead wound up alienating some key Republicans. This time around, Trump insisted that the bill was still changing (so why agree to the current version?) and would guarantee coverage for those with preexisting conditions. He demonstrated that at any moment he can undercut whatever compromise Republicans are considering. The president has no bottom line or ideological compass; that leaves members unable to figure out where he is going to wind up. Imagine if President Barack Obama had given Democrats the idea that he might not like their end product. They’d never have passed a bill. After getting burned once or twice, GOP lawmakers will become gun-shy about taking votes on anything controversial.

Third, Long’s “surprise” suggests that the House leadership doesn’t really know how many votes it has. That’s peculiar for legislation so important for the GOP. It reminds us how grievous an error it was not to build support patiently through a legislative process, as Democrats did for Obamacare over 11 months. Had they gone the long, patient route, Republicans would have resolved objections and gotten lawmakers to buy in as the process went along. Instead, they now are compelled to present one ultimatum after another to members. Having refused to include everyone in the crafting of legislation, GOP leaders are left to guess how each iteration will go down. Apparently, their guesses are not all that accurate.

Fourth, each time the Republicans suggest they have the votes and then back away, they rack up another loss. (They’re up to two.) It’s bad enough to fail on your No. 1 policy objective; it’s quite another to lose over and over on the same priority. With each failure, it becomes that much harder to pick up the pieces and try again.

Fifth, Trump’s (and some Republicans’) insistence on doing health-care reform before tax reform made sense initially. GOP leaders wanted the revenue generated from repeal of Obamacare to help make up the shortfall that they’d create in tax reform. Now, however, they’ve demonstrated no appetite for any other fiscal restraint or concern about revenue neutrality in their tax plan. So why are they still hung up on health care? Most likely, Trump’s ego cannot accept a humiliating loss. He repeatedly goes back to the well with, so far, little to show for it. At some point, he’ll get tired of losing so much, one expects.

And finally, the president’s insistence that the bill does protect people with preexisting condition by virtue of high-risk pools has called attention to the pools’ track record and considerable defects. Grouping people with potentially expensive health-care costs into one pool makes coverage, well, really expensive for those in the pool. States using pools in the past had to restrict coverage, create waiting lists (which grew longer and longer) and/or charge high premiums. Republicans have thrown out “high-risk pools” as an all-purpose alternative to Obamacare’s protections without examining their efficacy. (“State high-risk pools are a smarter way of guaranteeing coverage for people with preexisting conditions,” House Speaker Paul Ryan (R-Wis.) has often said.)

In fact, they are no panacea, as McClatchy reported earlier in the year: “Most experts agree that the state-run pools were largely a failure, suffering from poor funding, which led to restrictions on enrollment and benefits along with higher premiums. Pool coverage costs were typically 50 to 100 percent above private market rates.” It’s estimated that $30 billion to $50 billion would be needed to fund the pools each year, a sum the GOP will never guarantee. Had the House gone through a careful policy process with complete hearings, perhaps Republicans might have learned that their “solution” to covering people with preexisting conditions was really no solution at all.