In many ways, the challenge facing Republicans in enacting their American Health Care Act looks pretty close to insurmountable. The most conservative members of the House Republican Conference, as well as allied groups such as the Club for Growth, FreedomWorks, the Heritage Foundation, and Breitbart News, are deriding it as “Obamacare Lite” and a betrayal of promises to scrap the Affordable Care Act. Moderates and lawmakers from swing districts are nervous that the bill goes too far, and could result in many people losing insurance, cutbacks in state Medicaid programs, and a paring of public-health programs. Even lawmakers who didn’t hold town meetings during the recent recess saw what happened to those who did, and they’re feeling the heat.
Key provider groups such as the American Medical Association, the American, Catholic and Children’s Hospital Associations, and the American Nursing Association, along with consumer groups including the AARP, have come out against the plan. House Speaker Paul Ryan and other proponents of the bill must feel a little like General George Armstrong Custer at Little Big Horn.
The best and perhaps only compelling reason why this bill might pass is that Republicans don’t have another obvious choice. As Ryan put it earlier this week, “We as Republicans have been waiting seven years to do this. We as Republicans, who fought the creation of [Obamacare], and accurately predicted it would not work, ran for office in 2010, in 2012, in 2014, in 2016, on a promise that if given the ability we would repeal and replace this law.”
Ryan continued, “This is the closest we will ever get to repealing and replacing Obamacare. The time is here; the time is now. This is the moment.” He called it a “binary choice”: kill Obamacare or keep it. If the GOP fails at what has been its key organizing principle for the past eight years, the party will look weak and ineffectual, jeopardizing the rest of the Republican and President Trump’s agenda.
The truth is that many newly elected presidents have had key agenda items defeated early in their first terms. After House passage, President Obama’s Clean Energy and Security Act of 2009 was never really even considered, let alone voted on by the Senate. President Clinton’s Health Security Act, aka Hillarycare, died in his second year in office. In the first year of a presidency, everything looks like a life-or-death matter, but few actually end up that way. That could be the outcome here.
In a different era, after the first effort went down to defeat, both parties might come together in a more accommodating spirit, with neither side able to get its own way. But that’s when the system actually worked, before compromise became a four-letter word, before “my way or the highway” became a way of life in Washington.
The sad thing is that the Affordable Care Act, pushed through by Obama and Democrats with the best of intentions, was a deeply flawed law, one that desperately needed to be fine-tuned before it passed. It’s possible that a huge and complicated bill could be enacted with no need for modification, but it would be extremely rare. Big legislation is almost always a work in progress. It needs constant tinkering, undertaken in good faith, to make it better, not kill it. But if one party sees a law as of an immaculate conception, not to be changed in any way, and the other party views it as the most horrible piece of legislation ever enacted, it’s hard to make constructive changes. That’s what happened with Obamacare.
It’s interesting how much President Trump is trying to push the bill without actually owning it. He makes no pretense of having had a hand in writing it, thus leaving defeat as more a problem for Ryan than for the White House. Similarly, Senate Majority Leader Mitch McConnell has no ownership stake either. This is a House Republican thing, through and through. While the Trump White House can make promises and threats behind the scenes to lawmakers, they may be more responsive to one of his barbed tweets or, worse yet, a presidential visit to their home districts where he scorches them as preventing America from becoming great again.
Congressional Republicans are keenly aware that Trump has an 86 percent approval rating among Republicans in the latest NBC News/Wall Street Journal poll, so they’re likely to think carefully before crossing him. While the vast majority of GOP incumbents are unlikely to lose a primary, most really don’t even want to have an opponent, let alone spend money and time on a contested intraparty race.
But to the average Republican voters, all of this is behind-the-scenes stuff. A typical Trump supporter doesn’t think it’s his bill. This is the House Republicans’ bill, it’s Ryan’s bill. It’s not hard to see Trump saying, “Well, it’s too bad they failed. They just couldn’t get it passed.”