It takes an optimist, but I tell myself that
maybe health-care reform isn’t dead.
Republicans began 2017 with impressive advantages. For the first time in a decade, they controlled the White House and both houses of Congress. Republicans had 33 governors to 16 Democrats and one independent, matching a record the GOP set nearly a century ago. With more state legislators than at any time since the 1920s, Republicans controlled both chambers in 32 states while Democrats commanded both in only 13.
The voters who made the GOP America’s dominant party expected it to pursue a robust agenda. Angry and marginalized Democrats would complain and obstruct, but the electorate believed Republicans would deliver on their promises, such as repealing ObamaCare and replacing it with what President Trump promised would be a “terrific” new program.
Yet after this week’s epic failure on health-care reform, the GOP looks like James Cagney in “White Heat,” yelling “Made it, ma. Top of the world!”—just before the oil refinery explodes around him.
Republicans proved incapable of coalescing around any health-care bill. One set of objections was that the proposed legislation would solve only some of ObamaCare’s problems, not all of them. Another was that as a matter of principle not a line of the Affordable Care Act should be left on the statute books.
But dissenting Republican legislators, by opposing either the Senate bill or the House version, would leave all of ObamaCare intact and all of its problems unsolved. The rebels have let the incomplete be the enemy of the good.
Some blame this debacle on ineffective leadership from the White House or Capitol Hill. Others say doing tax reform first would have made health care easier to tackle. Still others say Republicans never had a serious plan, didn’t hold enough hearings, or failed to include the critic’s preferred wing of the party in enough of the negotiations.
These claims may have some truth. But the main reason the GOP failed is that party unity and discipline mean nothing to too many Republicans in Congress. For senators like Rand Paul, Mike Lee and Jerry Moran, it’s their way or the highway. House leadership narrowly overcame this sentiment within the Freedom Caucus. The delay and disarray in the House deliberations, however, dispirited senators. The GOP’s narrow majority in the upper chamber also encouraged defections.
Majority Leader Mitch McConnell is now resorting to extreme measures, bringing up a bill to repeal ObamaCare without replacing it. He’s calling the vote without knowing if it can pass. In fact, three GOP senators have already announced they will vote against this, which would be enough to kill the measure. Although all but two Republican senators voted for a repeal-only bill in 2015, it didn’t matter then: President Barack Obama vetoed the bill as expected.
It is a sign of Republican desperation that some think their best hope is to repeal ObamaCare and then pray something comes together in the next two years to replace it. President Trump even seems to expect that Democrats will help. Good luck with that.
Still, the repeal-only maneuver might provoke a fresh start, perhaps with a new bill drafted by some ad hoc group of legislators. Maybe failing to pass anything now will prompt wavering Republican senators to start supporting incremental, if imperfect, progress. A defeat of repeal on a procedural motion to take up the bill could cause Congress to drop health care now but return to it later, after Republicans make progress on tax reform, infrastructure, the debt ceiling and the budget.
Or maybe this really represents the end of Republican engagement on health care. If so, the GOP will watch as enthusiasm among party activists and donors wanes, prospective candidates decide not to run, and the prospect of holding Congress in the 2018 election dims.
With Republicans in charge of everything in Washington, voters won’t blame Democrats when health-insurance premiums continue to rise, the number of providers further dwindles, and Americans in more counties are left with zero options on the ObamaCare exchanges. The public knows Democrats passed the law, but Republicans are still expected to clean up the mess.
As an optimist—and only an optimist can view the situation this way—I’m hoping this plays out like a made-for-TV drama. The protagonist appears near certain death at the commercial break but is miraculously saved when everyone returns with popcorn after the final Geico ad.
In the wake of this crushing political week, believing that the GOP’s health-care drama has a few more acts left to play is a thin reed of hope. But it’s the only one Republicans have.