OFF TO THE RACES

Trump Pushes Health Bill, But Ryan Owns It

Republican lawmakers don’t want to cross the President, especially since he could walk away and leave the House holding the bag.

House Speaker Paul Ryan of Wis. uses charts and graphs to make his case for the GOP's long-awaited plan to repeal and replace the Affordable Care Act, Thursday, March 9, 2017, during a news conference on Capitol Hill in Washington.
AP Photo/J. Scott Applewhite
Charlie Cook
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Charlie Cook
March 9, 2017, 8 p.m.

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.”

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