Political salesmanship is something of a lost skill these days. Senate Majority Leader Mitch McConnell drafted his Obamacare-replacement legislation behind closed doors, without much public advocacy behind the health care revamp. President Trump hasn’t even tried to convince the public on the merits of the GOP’s proposal—never mind the fact that he hardly seems to know what’s in the bill that he’s championing. Republican senators, many of whom were expected to support the legislation, don’t want to go on television to defend it.
This is the logical conclusion of legislating without working to secure a popular mandate behind your goals. Such anti-democratic tendencies increased during the Obama years, when the former president famously bragged all he needed was “a pen and a phone” to get executive orders done, even while understanding many of his priorities were opposed by a majority of the public. But under Trump, the strategy of playing to one’s base while ignoring the broader public has reached new levels.
It is remarkable that a party with the White House and healthy majorities in Congress is badly struggling to get any legislation passed—no less its signature repeal-and-replace efforts. In fact, the GOP’s health care conundrum is offering a case study of what happens when you draw the voting public entirely out of the picture, ignoring the role that persuasion plays in getting things accomplished.
Public opinion on the original Senate health proposal is abysmal. The most recent round of polling shows anywhere from 12 percent (Suffolk/USA Today) to 27 percent support (Fox News) for the repeal-and-replace legislation. This plan has been so poorly sold that even the normally faithful Republican base isn’t behind it. Rather, a 40 percent plurality of Republican voters said they don’t have any idea of what’s in the legislation, according to this week’s Quinnipiac survey. That’s a few points higher than the number of Republicans who support it.
At a time when the public is so politically polarized, that degree of intraparty defection is hard to achieve.
To be sure, the substance of the policy itself is driving its unpopularity. Taking away entitlements will always be a tough sell regardless of effective spin, and the legitimate voter anxiety over potentially losing health care benefits as a result of the replacement proposal is driving much of the negativity. But those assumptions also undervalue the unpopularity of Obamacare.
In a vacuum, the GOP’s replacement plan is an epic political dud. But when asked if the GOP Congress should continue efforts to “repeal and replace” Obama’s health care law in the most recent NBC/Wall Street Journal survey, 38 percent agreed while 39 percent opposed. That suggests Americans are still deeply divided on Obamacare’s effectiveness, and are open to supporting an alternative that reduces mandates, lowers premiums, and rolls back taxes—even if it limits the scope of coverage.
One major flaw with the politics of Obamacare was that it created winners and losers, redistributing health care benefits to those who had been uninsured while raising rates for the middle class (on the individual exchanges) and ineffectively managing increased demand for overtaxed medical providers. Past entitlement programs conferred an overall benefit to everyone; Obama’s law effectively redistributed benefits from one group to another.
Given that reality, reversing it inevitably will create another set of winners and losers. That doesn’t mean any replacement proposal should be historically unpopular. If Republicans tried to make the case that government spending on health care was crowding out resources for other public priorities, they might have a captive audience. If they made the case that health care outcomes for those on Medicaid aren’t good, and it’s preferable to have more recipients on private insurance, they’d be making a credible case. If they even made the simple argument that the taxes and mandates on businesses from Obamacare are slowing economic growth, they’d have a receptive constituency.
They still could lose the overall argument, but it’s a safe bet that simply by making a positive case for reforms, public support would rise and it would be easier for McConnell to wrangle 50 votes from his caucus. Instead, the bill is being viewed as a heartless hit job that would effectively kill thousands of sick, uninsured Americans. Even the politically cautious Hillary Clinton got in the act, saying Republicans would become the “death party” if the Senate legislation passed.
Trump deserves most of the blame for this debacle, given his administration’s priority on simply getting health care legislation passed—no matter what’s in it. This is the first time in recent memory when the legislative branch is leading the charge on consequential legislation, absent executive guidance of what to prioritize in a replacement plan. Presidents typically are able to utilize political clout to assert their prerogatives and persuade wayward senators to get with the program. With low approval ratings and minimal command of policy, Trump has none of that capability.
So McConnell will keep chugging along, desperately trying to craft some legislative compromise that can satisfy Republican moderates and conservatives alike. Don’t bet on it succeeding. Even the best-laid plans need some public support behind them. And McConnell isn’t getting any help from anyone—whether it’s the president, his own Senate, or even his party’s top communicators—in selling such wide-ranging reforms to an unaware electorate.