If Republicans Wanted to Pass Health Care Reform, They Didn't Show It
Over the past week, or perhaps even the past month, Republicans have been looking quite a bit like the dog that finally caught the bus. It has been said a million times, but after all of the posturing, rallies, promises, obstructionism, one would think that the Republicans might actually have something up their sleeve when it came time to play ball on health care.
Now I do believe that there are a couple of factors which seriously limited their ability to pass legislation. For starters, Republican health care policy has not looked very different from "repeal Obamacare" for about 5 or so years now. There have been conservatives advocating serious cutbacks on medicaid or a complete government withdrawal from health care all together, but the party itself has not put forward its own vision for care in years. This is partly because the Republican vision of health care before the Obama presidency actually looked a lot like Obamacare.
In 2006 when Mitt Romney - heard of him? - was governor of Massachusetts, he signed into law health reform legislation which mandated that all residents obtain a minimum level of health coverage, provided free health insurance to residents earning less than 150% of the federal poverty level, and mandated that employers with more than 10 full time employees provide health insurance. Sound familiar? Well it should, because that's almost exactly what Obama brought to the table after the 2008 election.
It is difficult to quickly come up with something knew when someone steals your idea, but it would be a stretch to say that Romney's health care legislation represented all that the party had to offer (see the McCain plan), and even more so to say that the Republican Party hasn't had enough time to come up with something else.
The second factor that I would blame for the defeat of the BCRA is the President. We've heard a lot about Trump in the past 6 months, often focusing on his unhinged twitter ramblings, false claims, or alleged collusion with Russia, but he has done an abysmal job providing and assisting a legislative agenda for his fellow Republicans.
Barack Obama had a health care plan before he was sworn in, and kept key White House advisers in the room during the entire drafting process. Trump forced Senators to undergo a secretive and embarrassing drafting process, and then watched them struggle under the spotlight of the news media as he his behind his twitter account. It is usually the job of the President to utilize his bully pulpit to assist his party - direct the national attention, influence public opinion, or make necessary the change he seeks. Trump did no such thing, with very little public presence on the health care front, and even failing to learn the basic nuances of the legislation which was to bear his name. It is actually hard to understate just how little Trump did to help his health care bill. He made more news posing in a fire truck than he did rallying republican support.
According to the New York Times, the President was actually "growing bored in selling the bill" and over the course of the health care battle so to speak, Trump likely did more to hinder his party's efforts than anything else. He called the Senate bill mean, made promises contrary to the legislation, and began efforts of revenge against his own party members instead of trying to win support, nearly literally cutting off the nose to spite the face.
But I contend that Trump himself was not the main obstacle of the Republican effort to reform health care, rather it was the Republicans themselves.
If we take Trump out of the equation and look purely at the efforts of Senators themselves to create and promote the legislation, we will find a seriously defunct body of conservative-minded thinkers surrounded by Senators who want the medal but don't want to run the race. The reality is that none of the party leaders wanted to own this bill - not Trump, not Paul Ryan, not Mitch McConnell. Each of them wanted to pass the bill, but didn't care enough about what was in it. Trump had no plan from the beginning, but both Ryan and McConnell had plans designed to appease the concerns of other members, rather than fulfill a health care vision.
The Republican messaging behind the AHCA and the BCRA was simply "not Obamacare," and when the free market, lower tax, lower premium (although that last part isn't true) argument isn't being made, Republican support has no grounds and Democrats get the opportunity to own the narrative.
Republicans had a great opportunity with this legislation to make it about less government, defunding planned parenthood, and eliminating handouts, but because nobody in the party was willing to stick their neck out for the bill, its detractors had field day. On the Sunday shows this week, Rand Paul was the lone Republican talking head, and he was actually against the bill.
Why didn't Mitch McConnell get on CNN and talk about the Senate bill? Why didn't Ted Cruz go out and make his usual anti-abortion argument in favor of his bill, or even explain the changes he installed last minute in the legislation?
In the end getting a caucus together like the Democrats were able to do in 2010 requires popular support, something Republicans didn't want to or didn't try to go out and get. In a congress where everything stems from re-election, the Republican PR plan to win voter support for their promised changes was conspicuously absent. If a Senator believes he will win reelection based on a vote, chances are he will vote the way of the people -- just ask Jerry Moran, one of the two senators who finally sank the Repeal and Replace effort.
If Republicans want to make progress on taxes, education, or every try health care again, they need to have members and a President who are willing to put their seats on the line. Politics is so often a zero-sum game in the sense that half-assing something is the same as no commitment at all. It would appear that Republicans on Capitol Hill and the White House are still unclear on this concept, and one can only wonder if they will figure it out before the mid-terms.