President Donald Trump sounded weary when he stepped in front of the press to announce that the GOP’s Obamacare repeal had failed to rally enough votes to clear the House Friday. It was the President’s first real lesson in the hard realities of governing. On social media, Trump’s extensive back catalog of bravado about his dealmaking prowess fueled a merciless Twitter at its snarky worst. The truth is that the GOP Obamacare repeal bill was doomed from the start.
The demise of the American Health Care Act (AHCA) was as much a failure of vision as a failure of dealmaking. It took a year to pass Obamacare. The idea that the AHCA was going to get through in a month was dubious. It led House Speaker Paul Ryan, eager to score a quick win, to design a bill mostly to meet the demands of a fast-track legislative procedure called budget reconciliation. This would allow it to pass the Senate with a simple majority rather than the 60 votes normally required to break a filibuster. But, there is a catch. Reconciliation is limited to budget-related matters. This severely limiting the scope of what the bill could actually do. In the end, it was crippling.
By design, AHCA was a half measure — neither full repeal nor sweeping reform. It was a bill with a few things to like and something in it for everyone to hate. Conservatives saw it as little more than a defanged version of Obamacare. It replaced Obamacare’s premium subsidies with tax credits — which are essentially the same thing, just smaller and called by a different name. More modest premium subsidies, which were based on age rather than income, would hit older, poorer people hardest, turning off moderates. It gave new flexibility to governors in running state Medicaid programs, but reduced federal funding. Flexibility is nice, but governors would rather have the money.
It also ended the individual mandate, a win for the free market that came at the expense of an unhelpful Congressional Budget Office estimate that 24 million people would choose to drop health care coverage when AHCA gave them the option to do so. No House member relished the idea of facing reelection amid headlines of an explosion in uninsured.
President Trump threw himself into selling the bill, but never mastered its tedious details. He cajoled some, threatened others. But, ultimately the art of this deal eluded him.
AHCA was to be the first in a three stage process. Its passage was to be followed by regulatory modifications and then a second bill that would perform the remaining heavy lifting of reform. Few believed that second bill would ever happen. Judging from the ignominious fate of this one, they believed so with good reason. Without the broader market-based reforms planned in the second bill, it is hard to see how AHCA would have been much better than what it replaced. Trump was like a car salesman pitching a model that he was never quite sure would actually run, reluctant especially at first, to fully embrace it. He resisted the moniker “Trumpcare.” Trump withheld his name. Members of Congress withheld their vote.
Republicans have ideas about health care. Good ideas. Ideas that would actually work. Yes, a more full-throated reform might not qualify for the budget reconciliation process, but it might have the virtue of actually improving the health care of Americans. While it would surely face opposition in the Senate, at least Republicans would have the opportunity to lay out a complete vision for health care reform that could form the basis for a public debate — and in some parallel universe — perhaps even bipartisan consensus. In the current environment of partisan animosity and warring Republican factions, a more substantial reform probably would have died in the Senate too. But, it would have been an honorable death at least. AHCA couldn’t even pass the House. Governing is not as easy as it looks.
Our elected leaders are sent to Washington to govern on behalf of the American people and enact policy solutions that improve their lives. The AHCA is a stark example of the extent to which our Representative democracy has instead become about putting political points on the board.
In their zeal to score an easy win, Speaker Ryan and the President seemed to forget altogether that governing was actually their job. Rather that propose a meaningful, comprehensive and workable replacement for Obamacare, they chose to settle for what they thought would be an easy layup. They missed.
Before we sneer in disgust, we should look in the mirror too. We’ve cheered political blood sport and yawned at serious policy for years. We should not be surprised when the leaders we elected do the same. They learned it by watching us. When we don’t put our time in as citizens to understand the issues our nation faces and to vote thoughtfully, we get the government we deserve. This is that government.
Politicians have promised Obamacare repeal for years. They said it was simple. It isn’t. The lesson here is that there is no such thing as a free lunch — and reforming health care is hard. The only thing harder than health care might be tax reform. Word is, that’s up next. Oh boy.