Congressional Republicans have now positioned themselves firmly between a rock and a hard place on healthcare reform. This would be highly amusing if it weren’t for the seriousness of the subject matter, which could accurately be described as a life-or-death subject for millions. Republicans now have the choice of voting for a bill which is massively unpopular with the public (increasingly so, as a matter of fact), or admitting to their own voting base that they’ve been flat-out lying about the evils of Obamacare for the past eight years. That’s a tough choice, because no matter what route they take, it is bound to cause anger among the voters ― at this point, it’s just a question of which particular voters (and how many of them) will be massively disappointed.
At the heart of the Republicans’ problem is the simple fact that they’re rushing headlong towards passing some bill ― any bill ― without even bothering to give lip service to “regular order” (which Paul Ryan and other Republicans used to profess to hold dear, it’s worth pointing out). The Obamacare bill took 14 months to pass. It had dozens upon dozens of hearings, committee meetings, efforts to reach out to the other side of the aisle, and amendments, as well as ample discussion and debate in Congress. At each and every stage along the way, the bill was sent to the Congressional Budget Office for “scoring.” Compare that to the two efforts that Paul Ryan has so far made towards their “repeal and replace” bill. No hearings, no committee meetings, no efforts whatsoever to reach out to the other side of the aisle, amendments solely designed to make the bill worse, and the only discussion and debate taking place is in the back rooms, far from the eyes of the public. Their first effort went down in flames after only 18 days. They allowed a C.B.O. score to be released during this brief period, but the score was devastatingly bad. The second go-round is being hustled through the House with similar haste, and this time they’re trying to avoid the C.B.O. altogether. And please remember, they’ve had seven full years after Obamacare passed to get their act together. During much of this time, they held control in the House of Representatives ― meaning there was nothing to stop them from taking their time and using regular order to put together a well-thought-out bill. They did not avail themselves of this opportunity, preferring instead to pass bills they knew full well would either die in the Senate or get vetoed by President Obama.
When either party tries to pass a major bill this quickly, the obvious question is: What are they trying to hide? Why are they trampling all over their own committee chairmen and refusing to allow the C.B.O. to score the bill before the vote? Where are the hearings with expert testimony about the affected industries? Why are the drafts of the bill held in secret rather than publicly posted? The obvious answer is: They’re definitely trying to hide something (or several things), because they know the public won’t approve.
The biggest secret ― and the real reason why there’s a lot of pressure to move hastily ― is that this entire effort is nothing short of a massive tax cut for the wealthy masquerading as healthcare reform. If Republicans can pass this bill before they tackle tax reform, then their “baseline” shifts, which will allow them to pass even bigger tax breaks for millionaires later (so their thinking goes). This is truly all Paul Ryan cares about ― it doesn’t really matter to him what’s in the bill itself, as long as the bottom line remains close to the same. Donald Trump, on the other hand, really doesn’t care what’s in the bill, he just wants a political victory to brag about. As long as he can stand up and claim “I repealed and replaced Obamacare,” nothing else matters. The urge to spike the political football is of far greater importance to Trump than how the bill will affect any of his voters, that’s for sure.
The big problem for Republicans is that they have now achieved something even Obama could not ― now that people are finally understanding exactly what Obamacare contains, it is becoming more and more popular. For the first time, a majority of the public approves of Obamacare ― something that had never been true before Trump was elected. All the news on the GOP efforts to repeal Obamacare has been about what guarantees the public is about to lose, which explains Obamacare’s new popularity. At the same time, the Republican efforts are not popular at all. Only 17 percent approved of the initial bill. The second iteration will likely be even less popular, once the public finds out what’s in it.
Which leaves Republicans betwixt a hard place and a rock. At this point, all their options look pretty bad, politically. Their best realistic option now would be to just table the entire bill and not hold a vote on it in the House. That way, at least, individual members wouldn’t face a slew of election ads from Democrats about all the various awful consequences of the bill: “Congressman Jones voted to let this retired woman choose between buying health care and eating.” With over 80 percent of the public disapproving of the bill, these ads will just about write themselves, really. In fact, Democrats would be guilty of political malpractice if they didn’t run such ads.
Republicans’ second option is to offer various deals and kickbacks to individual House members to get their vote count over the finish line. This is what is currently being attempted by Ryan. House Republicans may decide to pass the bill in the sincere hopes that the Senate saves them from their own political folly. This would allow them (so their thinking goes) to campaign on: “Don’t blame us, we tried ― but the Senate failed to repeal and replace Obamacare.” They could chalk up what would (for them) be a political victory, knowing that it would never actually become law. This worked wonders for them while Obama was still in office, but it’s dubious that it would work so well again with a Republican Senate and a Republican president.
Even if this did come to pass, the battle in the Senate is going to be a lot harder within the Republican caucus. The margin is thin ― only three GOP defections would mean the bill would go down. This would make exactly the same battle that’s playing out in the House ― Tea Partiers versus moderates ― even tougher. For some Republicans, even the bill the House is putting together simply isn’t ideologically pure enough, because it retains major portions of Obamacare. For the moderates, however, the results of the bill are so sobering (tens of millions thrown off health insurance) that they worry for their own political future if the bill actually becomes law.
The big focal point currently is on what Donald Trump calls “the pre-existing.” He swore, in a recent interview, that he’d “take care of the pre-existing,” which only served to shine a spotlight on the fact that the current Republican bill does no such thing. Republicans are now squirming after the revelation that they want to turn the guarantee that people with pre-existing conditions get affordable health insurance into a guarantee that people with pre-existing conditions will definitely be charged a whole lot more money, be forced into a doomed-to-fail high-risk pool, or be priced out of the market entirely. Ryan is trying to dance around this reality, but it’s catching up to him ― especially after Jimmy Kimmel’s on-air plea to Republicans not to kill the pre-existing condition guarantee. It’s pretty hard to argue that a newborn baby deserves to be denied health insurance because of “bad lifestyle choices,” after all. The pre-existing conditions debate, it should be mentioned, is just one awful part of the bill. There are plenty of others to spotlight, as well.
Which leaves Republicans in their tight spot. They’ve been promising ― and winning elections on ― the whole “repeal and replace” mantra for years. But the public’s mood is shifting in a big way. Now that average people are being educated about what Obamacare actually contains (instead of the fear-mongering lies Republicans have been spewing about it for eight years), Obamacare is suddenly popular. And taking things away from people is always a heavy lift for politicians. Republicans had hoped this would all happen so quickly that the public wouldn’t even have time to react, but that doesn’t appear possible anymore. To gain Tea Party votes, they’ve been trying to make their bill even worse, which certainly doesn’t help matters (outside of the floor of the House of Representatives, at any rate). They now are left with the choice of passing a massively-unpopular bill and then suffering the slings and arrows of the inevitable Democratic campaign ads, or admitting that their bill is too awful to pass and risking their own base voters becoming disgusted with being lied to for so long about how easy it would be for a conservative alternative that would achieve the same (or better) results as Obamacare. This has led to the amusing spectacle of Republican lawmakers now sheepishly admitting that Obamacare actually does a lot of good, in some cases. If it didn’t, why would they be concerned about getting rid of it all?
Republicans have only themselves to blame for their current lose-lose situation. Obamacare was, in reality, a very conservative way to address many of the problems in the healthcare industry. The idea was initially proposed by a conservative think tank, then was adopted by Mitt Romney in Massachusetts, and Democrats bent over backwards to allow all sorts of Republican ideas into the final bill. It is a free-market solution to what was becoming an untenable problem with the health insurance marketplace. It demanded something that conservatives used to love ― “personal responsibility” ― in mandating that everyone purchase health insurance. It’s almost quaint nowadays, but conservatives used to decry poor people using emergency rooms for free and demanded that they put “some skin in the game” and buy their own health insurance. To top it all off, the Blue Dog Democrats killed any hint of a “public option” or “Medicare for all.”
Because Obamacare was built on such a conservative framework, it left Republicans with very little wiggle room in replacing it with something supposedly more ideologically pure. This is what they are now painfully figuring out. There is one obvious way out, but it’s a mighty stupid one. Politically, however, it just might work, because it would allow them to save face while still following the medical tenet of “first, do no harm.”
Republicans should get together and write up a list of all the lies they’ve been telling about Obamacare for so long. Then they should craft a piece of legislation that “repeals” all of these myths. Since none of these things ever actually existed, it wouldn’t change anybody’s healthcare at all. Start with Sarah Palin’s infamous complaint: “This bill will hereby ban all ‘death panels,’ because any baby born is a precious life and no government board should ever have the power to decide which babies are worthy to live and which will die. The penalty for any member of such a board making such a decision will be death by drawing and quartering.” This would also, conveniently, address Jimmy Kimmel’s heartfelt plea (at least rhetorically). From there, work down the list of all the mythological evils of Obamacare, and boldly ban each one. As icing on this cake, end with: “Any and all references to ‘Obamacare’ will be changed to refer to ‘Trumpcare,’ in all official documents.” That’ll guarantee a presidential signature. And since, like all the other myths on the list, it wouldn’t change a single thing (the official name is still the “Patient Protection and Affordable Care Act,” and never has been “Obamacare”), it could cap off the list of meaningless changes with a Trumpian flourish.
Such legislation would sail through the House. Democratic senators would likely not stand in the way of such idiocy, and allow Republicans to pass it through the Senate as well. In fact, Democrats would be doing well not to break out in gut-bursting laughter during these debates. Then Trump could triumphantly sign it, proclaim Trumpcare has replaced the evil Obamacare, and nobody in the real world would be affected in any way.
Rather than being trapped between a rock and a hard place, Republicans could claim they’d gotten something done and fulfilled their campaign promise in full. Sure, it’d be a monumentally stupid thing to do, but at least it wouldn’t harm anyone. That is the only reasonable way out of the conundrum for Republicans, since all their other attempts have been stupid things to do which would harm millions of Americans. Republicans should learn from Trump’s electoral victory ― style is much more important to Republicans these days than substance. Pass a stylistically-helpful bill that doesn’t actually harm anyone, and everyone from Trump on down to the Tea Partiers in the House can claim a big political victory. Even Sarah Palin would be happy!
Follow Chris on Twitter: @ChrisWeigant