On Health Care, Republicans Lack a Leader

Neither Trump nor Hill GOP leaders have charted a clear course for what to do next on Obamacare.

Sens. Bill Cassidy and Lindsey Graham fist-bump each other during a news conference on Wednesday to unveil legislation to reform health care.
AP Photo/Andrew Harnik
Alex Rogers
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Alex Rogers
Sept. 13, 2017, 8 p.m.

After promising for seven years to repeal and replace the Affordable Care Act, Republicans gained all levers of federal power in 2016, and named health care reform their top priority in Congress. But since the Senate failed to pass a repeal bill in July, Republicans have turned on each other.

The woeful state of the intraparty debate was apparent Wednesday, when Sen. Lindsey Graham of South Carolina implored the president and his leaders in Congress to pass his health care reform bill, perhaps the last-ditch effort for a broad conservative overhaul of the 2010 law.

“Here’s my challenge to the Republican leadership: Act like this matters, because it does,” said Graham at a press conference on Capitol Hill. “I’m not ready to move on. Are y’all ready to move on?”

The answer from the White House appeared to be: Yes. In a statement, President Trump did not announce his support of the bill put forward by Graham and Sen. Bill Cassidy of Louisiana.

“Inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis,” wrote Trump.

The president’s hope is not enough for change.

Congress members have blamed Trump for the government’s inaction during his first year, when presidents usually capitalize on the popularity of their campaigns to enact an ambitious agenda. But Trump’s popularity has fallen to record levels, as he has taken on members of his own party and continued to make controversial statements.

And by all accounts, the Republican leadership has moved on to the immediate tasks of passing the National Defense Authorization Act, extending some federal programs by the end of the month, and then passing tax reform by the end of the year. They’ve kept at bay two efforts to reform the ACA: Graham’s bill and a bipartisan effort from Sens. Lamar Alexander and Patty Murray to stabilize the insurance exchanges, which some senior Republicans consider a “bailout.”

There is little sign that Trump or Senate GOP leaders will back a bill to either repeal or fix the law, as they repair the relationships frayed in the summer’s health care debacle.

During that health care debate on Capitol Hill, Republican Congress members criticized the president when he turned his back on their proposal, calling it “mean” after having invited them to the White House to celebrate its passage through the House in May. When the debate turned to the Senate, enough Republican senators bristled at Trump’s heavy-handed tactics to kill the bill. Meanwhile, support for Obamacare actually grew to its highest levels recorded this year, according to the Kaiser Family Foundation.

Graham’s attack was just the latest example of the party’s lack of leadership on the issue, which had united Republicans during the Obama administration, when they ran on “repeal and replace” on their way to capturing the House in 2010, the Senate in 2014, and the White House in 2016. Now, the failure to deliver on that promise has deeply disappointed Republicans, putting at risk their control of Congress, and turned the president against his party.

In August, Senate Majority Leader Mitch McConnell said Trump had “excessive expectations” in passing complex legislation. On Twitter, Trump responded with a personal message to perhaps his most important ally on Capitol Hill. “Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn’t get it done,” the president tweeted. “Must Repeal & Replace ObamaCare!”

Current and former senior White House officials recently echoed Trump’s criticism, hitting House Speaker Paul Ryan for setting unrealistic deadlines and Republicans in the Senate for being unreliable.

When asked by Charlie Rose on 60 Minutes if the choice now came down to how to fix the ACA, former White House strategist Steve Bannon responded, “I think their choice is going to be you’re not going to be able to totally repeal it.” This week, White House legislative director Marc Short said in a breakfast meeting with reporters that the president is searching for Democratic votes to get tax reform done, because they were unable to pass health care with only Republicans.

“Despite promises of commitments that they made to voters since 2010, we don’t feel like we can assume we can [get] tax reform done strictly on a partisan basis,” said Short.

Some Republican senators are still keen on reforming Obamacare, but they’re running out of time.

“My sense is it won’t be anytime soon,” Sen. John Kennedy of Louisiana said of the Graham-Cassidy bill’s prospects for passage.

Still, Graham and Cassidy introduced their bill, saying it would provide block grants to the states so they could reform their health care systems without some federal mandates or regulations.

“The idea that the Republican Party has done its best to repeal and replace Obamacare is a joke,” said Graham. “The idea that we can do this by ourselves is unreasonable.”

In an interview, Sen. John Cornyn, the Republican whip, responded to Graham’s critique, pledging to work with him to “get a sense of where the votes are.” But he made the point that the bill had just been introduced, and the full extent of the bill had not been analyzed by the nonpartisan Congressional Budget Office. “I think it’s only fair to say people ought to be able to read it and know what the score is,” he said.

At a White House meeting with members of Congress, Trump reiterated his overarching goal.

“We do want to do something very, very powerful with respect to Obamacare,” he said.

Erin Durkin contributed to this article.
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