The Thinker

Republicans fall into their own health care trap

House Speaker Paul Ryan’s laughably named American Health Care Act bill went down in defeat yesterday. It was abruptly withdrawn before yet another planned vote Friday afternoon. Millions of Americans, particularly those who stood to lose under the law, breathed a sigh of relief. I was not surprised by its defeat. It was inevitable.

Without complete Republican control of government, it was an impossible needle to thread. Republicans don’t have total control in the Senate, although they do have a majority of its members. Thus the only way to “kill” Obamacare was to gravely wound it. It would have to be done using the Senate’s budget reconciliation process, which would leave in place the structure of the Affordable Care Act so as to avoid a filibuster. Consequently a House bill (where all financial legislation must emerge) must have met the constraints of this Senate rule to have a chance of passage. In essence that was what killed it.

House Democrats would not vote for it, which left Ryan to persuade all but twenty-two Republicans to vote for something that would meet the Senate’s budget reconciliation criteria. For members of the Freedom Caucus in the House then a vote for the bill would amount to a tacit endorsement of the ACA, the exact thing they ran against to win their seats. Attempts to make the bill more punitive were not enough because the ACA’s basic structure would still be in place. It was doomed.

Why it was doomed though is interesting and part of a larger story about the challenges of governing and points to a fatal flaw in the Republicans’ governing structure. It was doomed because the Republican Party, like all parties, is full of factions. These factions could not come together and find consensus. It was the same problem that drove former Speaker John Boehner into an early retirement. It’s okay to be true to your principles as long as you know doing so won’t affect anything. Republicans could to this during the Obama Administration, passing more than fifty votes to wholly repeal the ACA. These were acts of symbolism and statement, not actual legislating. When you control Congress but you still can’t move legislation for the same reasons, these principled but unmoving factions become self-defeating.

If they compromised, the Freedom Caucus effectively continued the health care legislation they so revile, albeit in a crippled form. Yet by not compromising they undermine their own cause. It’s like being in a battle and wounding your opponent instead of killing him. In their eyes, the only option is to kill. They ran not on a “no Obama” platform but a “never Obama” platform. This left them no place to go toward, at least not without embracing hypocrisy.

Much has been written about the polarization of Congress on both sides of the aisle. Right now with Republicans controlling Congress this polarization affects the whole Republican agenda. The only legislation that can go forward will be bills that have general Republican consensus and can survive Senate filibusters or can be narrowly written to pass the Senate’s budget reconciliation rules. Republicans are going to find more success in these areas like tax cuts. Where factions inside a party don’t agree and won’t compromise, progress is impossible.

What fascinated me was how big the explosion was yesterday. It tarred the whole Republican brand. It showed that Trump’s claims of being a master negotiator were simply bluster. He could not deliver on this promise that he said would be easy. It proved that Paul Ryan couldn’t govern using the normal legislative process. His only hope was to draft something in secret and try to rush it through the House. It was a very long pass indeed. Given a lack of an offensive coordinator it’s no surprise that he didn’t have a player in the far end of the field to catch the ball.

The Affordable Care Act, as imperfect as it was, was at least a process of a lot of open discussion and back and forth negotiating. Republicans were offered a seat at the table but refused to sit down, leaving it to Democrats to write the bill. Even that turned out to be long and tortuous and resulted in many of the flaws that affect the ACA today, principally the lack of a public option. But at least Democrats were able to get the ball somewhat down the field. In doing so Americans got a taste of what affordable health insurance was like. The nearly visceral reaction to Ryan’s bill, approved by only 17% of Americans based on a recent Quinnipiac poll, demonstrates that what was proposed was deeply reviled.

Withdrawing the bill was a bad option but the best available. Had it gone to a vote a whole lot more House and Senate seats would be in jeopardy in 2018. As it is though it left a bad taste in Americans’ mouths. It demonstrated that Republicans largely have forgotten how to govern and this is a problem they own by empowering the far right to gain the majority. Trump was elected based on his so-called “talent” to get things done. Expect few things to change in government in the years ahead and that due to this disillusionment and being in charge that Republicans will be paying a heavy price.


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