GOP out of options on health care

Published on Friday, 14 July 2017 14:22
Written by Jonathan Bernstein

Senate Majority Leader Mitch McConnell’s new plan is to ask Republicans to suspend reality until after casting their vote: Regardless of what the bill actually says, it means whatever they want it to mean. To state the obvious, this is not exactly a strong position. Conservatives will believe they are being betrayed, while Republicans (and everyone else) who want to preserve Medicaid won’t believe the reassurances.

McConnell, whether his reputation as a master legislative technician is deserved or not, is no fool. He simply has only a few choices remaining at this point in the game. Playing pretend is one of the last tools left at his disposal.

The bottom line remains where it’s been since January: Very few congressional Republicans want to be responsible for the changes that repeal-and-replace would produce - including, of course, taking health insurance away from millions of Americans. Even fewer want to be responsible for killing the item at the top of the Republican rhetorical agenda since spring 2010. And at the same time, there’s a group of very conservative members who want to take advantage of a rare unified government opportunity to roll back major parts of the Great Society.

There’s just no way to square that circle.

And House Speaker Paul Ryan, for better or worse, has done an excellent job of boxing McConnell in. Ryan was able to get something through the House by basically using the same logic McConnell is attempting now: Secure the support of various factions by promising that their objections would be dealt with later on in the other chamber. That was sufficient for those who were unhappy with the House bill but didn’t want the blame for defeating it. And then Ryan has made it clear (or at least effectively bluffed) that the House will accept intact whatever the Senate will do, making it harder for McConnell to do the same thing - senators believe that anything that they pass will wind up as law, and they’ll be liable for the effects.

Republicans have become increasingly desperate over the last few months to find a way to fulfill their campaign pledge to repeal and replace Obamacare. But their streak of mistakes began years earlier. There were many, many off-ramps available since the Affordable Care Act was signed - well, really, since the original bill first hit Congress. Republicans had plenty of chances to either shift to “fixing” the health care system instead of claiming they were able to fully replace the status quo. Or they could have defined “repeal and replace” as something that they really could have accomplished. Or they simply could have declared victory and moved on to something that was more promising for them, such as taxes - in other words, they could have gone with a “pretend and rename” version of repeal and replace.

It’s still not clear what the fate of this legislation might be. The surface problem remains the same: It’s hard to satisfy the very conservative demands of Rand Paul, Mike Lee, and Ted Cruz without losing the votes of the least conservative Republican senators such as Dean Heller, Lisa Murkowski and Susan Collins - and vice versa.

But I think the underlying question remains a more basic one: Do Republicans really want to pass a bill? Not just if they’re willing to vote for it, but do they really care about getting this done?

If they do, it’s likely that compromises will eventually be found. If they either don’t want to pass anything or, more likely, just don’t feel all that strongly about it, then they probably won’t.

What goes into the answer to that question are several things. Basic political calculations - is it worse to break their promise on repealing Obamacare, and responsibility for managing a law they never supported in the first place - or is it worse to be stuck with responsibility for the replacement? Policy considerations - they may really care about the effects of the status quo compared to the replacement bill in their districts and across the nation. And who knows what other considerations any of the 52 Republicans might have.

It’s anyone’s guess what that adds up to. But I certainly don’t hear very much enthusiasm about the bill from any congressional Republicans so far. That might (might!) be the most important hint about what is about to happen.

Bernstein is a Bloomberg View columnist. He taught political science at the University of Texas at San Antonio and DePauw.



Posted in The Bristol Press, Editorials on Friday, 14 July 2017 14:22. Updated: Friday, 14 July 2017 14:25.