Congressional Republicans failed to unite around a passable health care bill, and must now brace for the political consequences.
The preponderance of that burden falls on the House, where the more moderate and wonky leadership has to recognize that the conservative caucus is not going away, and substantive reforms will have to involve real trade-offs.
The problem began when Speaker Paul Ryan and company put forward a bad bill undeserving of support. A period of debate and tweaking is a natural part of any typical legislative process, but the rush toward passage that the House leadership pushed for belied the extraordinary character of this particular bill. Rather than just another routine piece of legislation, it was emblematic of the whole GOP’s standing vow to repeal and replace Obamacare, a malfunctioning and cronyistic law with shaky constitutionality that didn’t deliver on its basic promises.
Yet instead of a bold alternative, or even just an effort to reset the clock, the House bill offered what many perceived as the worst of both worlds: watered-down Obamacare with an added layer of complexity. Such a bill could not be tweaked and debated without embarrassment.
But this is President Donald Trump’s failure as much as Ryan’s. The president’s seemingly halfhearted argument to secure votes boiled down to a harsh judgment of the House. Ryan is your leader, the White House suggested; let him lead. But repeal and replace was a promise that helped get Trump elected, too. A president known for his deal making surely could have mustered a better defense for a cornerstone piece of legislation of his administration. Instead, he shrunk from battle, preferring to “let Obamacare explode.”
Fear of being punished at the ballot box was partly reasonable, too. But if a few voters might have lost out on entitlements under the new system, lots of Republicans now see their representatives as having betrayed them.
To be sure, some aspects of Obamacare are almost universally supported, such as rules on preexisting conditions, but that one positive does not in any way diminish the damage this bill has otherwise done. It’s difficult to imagine how the GOP could have taken control of the legislative and executive branches without Obamacare to run against. And now, it’s difficult to see how congressional Republicans can survive the next election cycle undiminished.
The president and GOP lawmakers must craft a new bill. Obamacare has driven up premiums too frequently. From 2013 to 2015, monthly costs per member jumped 70 percent, according to the S&P Global Institute. Middle-class families are now more apt to pay more and get less than before. As a Kaiser study determined, in 2015, 46 percent of uninsured couldn’t find an affordable plan.
The solution is an entitlement for catastrophic injury and pre-existing conditions, a hold on Medicare expansion, and a repeal of what’s left of the Affordable Care Act. This is a plan that could even attract some support from Democrats, especially if it included some cost controls. After all, about half of health care in the United States is now paid with public dollars.
The biggest beneficiaries of Obamacare have been the biggest insurance companies and hospital systems. But Republicans need to do more than run against that kind of state-managed crony capitalism.