Off to the Races

The GOP’s Health Care Dilemma

Republicans can either pass an unpopular bill or betray a core promise.

Senate Majority Leader Mitch McConnell of Ky., listens to a question while speaking with the media after he and other Senate Republicans had a meeting with President Donald Trump at the White House, Tuesday, June 27, 2017, in Washington.
AP Photo/Alex Brandon
Charlie Cook
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Charlie Cook
June 29, 2017, 8 p.m.

There are di­lem­mas and then there are real di­lem­mas. On health care, Re­pub­lic­ans are in a real di­lemma.

Con­gres­sion­al Re­pub­lic­ans prom­ised their base a mil­lion times that they would re­peal and re­place the much-des­pised (by the GOP base) Af­ford­able Care Act. No am­bi­gu­ity what­so­ever. In the House, they voted over 60 times to re­peal the ACA, though the re­place part was a little vague. Now that Re­pub­lic­ans oc­cupy the White House and hold ma­jor­it­ies in the House and Sen­ate, the Re­pub­lic­an base would be re­war­ded with re­peal of Obama­care, right?

But here comes the di­lemma. While Amer­ic­ans are not ex­actly de­li­ri­ously happy with Demo­crats’ health blue­print, they like it a lot bet­ter than the Re­pub­lic­an House-passed Amer­ic­an Health Care Act. It’s un­likely that Sen­ate Re­pub­lic­ans will come up with something any­time soon that will be much more pop­u­lar than the ver­sion passed by their House col­leagues.

So, do Hill Re­pub­lic­ans be­tray all of those prom­ises to their base to re­peal and re­place Obama­care, or do they pass something that people will hate even more? That’s what you call a di­lemma.

Obam­care has had a rocky ride. You can have a spir­ited ar­gu­ment over just how hard Demo­crats tried in 2009 and 2010 to get Re­pub­lic­an sup­port for the con­tro­ver­sial bill, but ba­sic­ally Demo­crats took ad­vant­age of very large ma­jor­it­ies in the House and Sen­ate to jam the ACA through Con­gress in early 2010—and paid the price for it by los­ing 63 seats and their House ma­jor­ity, along with six Sen­ate seats, in that Novem­ber’s gen­er­al elec­tion. The af­ter­shocks con­tin­ued four years later, as Demo­crats lost nine Sen­ate seats and their Sen­ate ma­jor­ity (along with 13 more House seats) in 2014. The ACA was a Pyrrhic vic­tory for Demo­crats, at least elect­or­ally.

When it was first en­acted, the ACA ap­peared to get a pos­it­ive re­sponse; the non­par­tis­an Kais­er Fam­ily Found­a­tion monthly health care polls showed 50 per­cent of Amer­ic­ans in Ju­ly 2010 had a fa­vor­able opin­ion of the ACA, and 35 per­cent saw it un­fa­vor­ably. But soon Obama­care’s poll num­bers turned south, with un­fa­vor­able num­bers ex­ceed­ing fa­vor­able for much of the next six years—fa­vor­ables gen­er­ally run­ning in the mid-30s and 40s, un­fa­vor­able in the 40s and low 50s. But that was among all Amer­ic­ans; the ACA was seen very fa­vor­ably by Demo­crats and some­what un­fa­vor­ably by in­de­pend­ents. Re­pub­lic­ans, mean­while, de­tested the law.

But start­ing soon after last Novem­ber’s elec­tion, the pro­spect of the ACA ac­tu­ally be­ing re­pealed began to sink in, and its pop­ular­ity in­creased. In the June 14-19 Kais­er poll of 1,208 adults na­tion­wide, 51 per­cent had a fa­vor­able view, 41 per­cent un­fa­vor­able; 29 per­cent had a very fa­vor­able view, and 27 per­cent a very un­fa­vor­able opin­ion. Con­trast that with the Ju­ly 2014 Kais­er poll that showed 37 per­cent fa­vor­able, 53 per­cent un­fa­vor­able, with just 15 per­cent see­ing it very fa­vor­ably, 35 per­cent very un­fa­vor­ably.

In con­trast with Obama­care’s gradu­al des­cent, pub­lic opin­ion on the Re­pub­lic­an House-passed AHCA sunk like a lead bal­loon. The new Kais­er poll showed just 30 per­cent had a fa­vor­able view, 55 per­cent un­fa­vor­able. The Kais­er num­bers are backed up by plenty of oth­er data. The June 17-20 NBC News/Wall Street Journ­al poll by GOP poll­ster Bill McIn­turff of Pub­lic Opin­ion Strategies and Demo­crat­ic poll­ster Fred Yang, two of the best in the busi­ness, had 41 per­cent say­ing Obam­care was a good idea, 38 per­cent that it was a bad idea.

That’s hardly any­thing for Demo­crats to write home about. But for the AHCA, just 16 per­cent said it was good idea, 48 per­cent a bad one. With­in those num­bers, 34 per­cent of Re­pub­lic­ans thought it a good idea, 17 per­cent bad idea, and 47 per­cent had no opin­ion. Among in­de­pend­ents, it was 16 per­cent good idea, 48 per­cent bad idea, 36 per­cent no opin­ion, while among Demo­crats it was 4 per­cent good idea, 73 per­cent bad idea, 22 per­cent no opin­ion.

Polling this month by McIn­turff and POS for the Amer­ic­an Med­ic­al As­so­ci­ation in six states shows the ACA had net good-idea num­bers of 11 per­cent in Col­or­ado and Ohio, 8 per­cent in Nevada, 1 per­cent in Alaska, minus-6 per­cent in Arkan­sas, and minus-12 per­cent in Ten­ness­ee. For the GOP House-passed le­gis­la­tion, it was minus-14 in Arkan­sas, minus-20 in Ten­ness­ee, minus-33 per­cent in Alaska, minus-34 in Nevada, minus-40 per­cent in Ohio and minus-41 in Col­or­ado.

Simply put, on health care, con­gres­sion­al Re­pub­lic­ans are damned if they do and damned if they don’t. The fact that the ini­tial plan from Sen­ate Ma­jor­ity Lead­er Mitch Mc­Con­nell’s (a pretty smart guy) had at least four Re­pub­lic­ans (Ted Cruz, Mike Lee, Rand Paul, and Ron John­son) who thought it didn’t go far enough in elim­in­at­ing Obama­care, and at least five (Susan Collins, Lisa Murkowski, Shel­ley Moore Capito, Dean Heller, and Rob Port­man) that wor­ried it went too far showed that this was a mat­ter of split­ting the baby.

If I were a Sen­ate Re­pub­lic­an, I would sup­port the bill, know­ing that it would prob­ably fail any­way, then tell my base that ‘I tried,’ then move quickly on to oth­er is­sues. People take health care very per­son­ally; passing something this hated by voters would be even worse than break­ing their re­peal prom­ise. As Sen. Joe Manchin said of West Vir­gini­ans and health in­sur­ance last month, “They’ve got something they nev­er had be­fore. They don’t know how they got it, they don’t know who gave it to them. … They’re go­ing to know who took it away from them.”

This is le­gis­la­tion that would be bet­ter handled next year, in a back room, with prag­mat­ic House and Sen­ate mem­bers from both parties try­ing to fig­ure out what is work­ing, what isn’t work­ing, and how to make it work bet­ter.

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