Sunday, 26 March 2017

House Leaders Pull Doomed ObamaCare Replacement Bill. What Now?

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Republican leaders in the House of Representatives withdrew their ObamaCare replacement bill Friday afternoon when it became clear that the bill would fail if brought to a vote, a significant defeat for both House Speaker Paul Ryan (R-Wis.; shown) and President Donald Trump.

The bill, known as the American Health Care Act (AHCA), was introduced on March 6 following days of closed-door committee sessions spent crafting the legislation. The bill was assailed from the Left for daring to touch ObamaCare at all and from the Right for doing too little to repeal the 2010 law.

The New American reported at the time: “The bill does repeal the individual and employer mandates, along with many of the Affordable Care Act’s (ACA) taxes, and it attempts to repeal the ACA’s Medicaid expansion and reform the program. However, it makes repeal effective years from now, retains most of the ACA’s regulations, imposes its own mandates, and is likely to exacerbate the very problems that Republicans have spent seven years rightly blaming on ObamaCare.”

The House Freedom Caucus, a group of conservative congressmen, was particularly outspoken in its opposition to the AHCA. Although the House leadership did make some changes to the bill to address the concerns of the caucus, this proved insufficient to overcome many members’ objections. The concessions also frightened off less-conservative congressmen such as House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.), who said the changes “raise[d] serious coverage and cost issues.”

The Trump administration lobbied hard for the bill, with the president personally contacting 120 congressmen, White House Press Secretary Sean Spicer told reporters Friday. Trump cut off negotiations with recalcitrant lawmakers late Thursday and demanded a vote on the bill Friday regardless of the outcome. Nevertheless, “Vice President [Mike] Pence, White House Chief of Staff Reince Priebus and Health and Human Services Secretary Tom Price also engaged in last-ditch attempts to win over members Friday — including a midday huddle with Freedom Caucus members,” according to the Washington Post.

All of it was to no avail. By Friday afternoon, both Ryan and Trump had become convinced that the bill would not receive the 216 votes needed for passage — Trump would later say they were “10 to 15 votes short” — and decided to pull the bill rather than see it go down to defeat. Half an hour later, “Ryan called Republicans into a closed-door meeting to deliver the news that the bill would be withdrawn, with no plans to try again,” reported the New York Times. “The meeting lasted five minutes.”

And with that, congressional Republicans’ and Trump’s promises to repeal and replace ObamaCare apparently went up in smoke.

“It’s done, DOA,” declared Energy and Commerce Committee Chairman Greg Walden (R-Ore.). “This bill is dead.”

Trump himself, according to the Times, “expressed weariness with the effort” to pass the bill, saying, “It’s enough already.” Reuters wrote that the president “said he would turn his attention to getting ‘big tax cuts’ through Congress.”

The average American could be forgiven for thinking that the whole effort had been a charade, with Congress and Trump just going through the motions of attempting to repeal ObamaCare so they could say they’d tried and then move on to things they really wanted to do. From 2010 to 2016, under a president who could be counted on to veto every attempt to roll back his signature achievement, the House passed a variety of bills that would have scotched significant parts of ObamaCare, and just last year the entire Congress approved one completely repealing the law. This year, with a Republican in the White House, GOP leaders tried to ram through a bill that would have accomplished far less. Why?

“Sometimes you’re playing fantasy football,” Representative Joe Barton (R-Texas) told reporters, “and sometimes you’re in the real game.”

Despite seven years in which to prepare for the “real game,” when it came time to go out on the field, Coach Ryan couldn’t even find his playbook. Then, when his team lost, he implied that the some of the players are to blame for not being ready to govern.

In fact, observed ForbesAvik Roy, the bill’s defeat should be blamed on the leaders, not the rank-and-file:

First, leadership failed to build an intra-Republican consensus on how to replace Obamacare. While this was admittedly a challenging task, it was a central one. Instead, they simply assumed that they had developed the most plausible path forward, and plowed ahead.

Second, leadership established a timeline under which House members literally had sixteen days — nine with a [Congressional Budget Office] score of any kind — to consider a bill that would make major changes to one-sixth of the economy.

Third, leadership took a “my way or the highway” approach to members’ concerns about the bill, begrudgingly buying off votes here and there only when it became clear that they were short of a majority.

Fourth, Senate Majority Leader Mitch McConnell informed his colleagues that once the House passed the bill, the Senate would take it up with a direct floor vote, so as to give senators precious little opportunity to amend the bill or think it further through.

Fifth, after failing to achieve a consensus around leadership’s plan during the artificial 16-day timeline, leadership picked up their marbles and went home, giving up on future attempts at reform. “Obamacare is the law of the land,” said Ryan, “for the foreseeable future.”

The defeat of the AHCA doesn’t have to be the end of the line for ObamaCare repeal. As Roy’s colleague Robert Book pointed out, the final ObamaCare legislation didn’t become law overnight but was the culmination of months of wrangling over various proposals in both houses of Congress. Furthermore, as Roy noted, Democrats had spent years laying the groundwork for ObamaCare. Had they just brought one bill up for a vote in a hurry without preparing people for it, it too would probably have failed, and Americans would never have been saddled with the ACA in the first place.

If — and this is becoming a bigger if all the time — Republicans are really serious about repealing ObamaCare and replacing it with something genuinely better (not to mention constitutional), they need to start preparing the public for what their plan will look like and how it will affect them. Then they need to be open to multiple proposals, some of which have already been submitted, such as Senator Rand Paul’s (R-Ky.) ObamaCare Replacement Act. And they certainly ought to take time to build consensus within their own party and perhaps even attract some votes from conservative Democrats rather than engaging in arm-twisting and ultimatums.

President Trump tried to spin the AHCA’s failure as a victory, saying it was “the best thing that could happen” because it would allow ObamaCare to “explode,” at which point Democrats would come begging for Republicans’ help in fixing it. But given most voters’ short attention spans, such an explosion could just as easily sweep Democrats back into power, at which point the long-feared endgame of ObamaCare, single-payer nationalized healthcare, might well be enacted. Is it worth taking that chance just to move on to Trump’s real agenda — or is that his real agenda?

Photo of Speaker of the House Paul Ryan: AP Images

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