After days of trying to thread the needle between two rival House Republican factions - the moderates (“Tuesday Group”) and the hard right wing (“Freedom Caucus”), Speaker Paul Ryan was forced to pull his party’s Obamacare replacement from the House floor. The stunning move came after days of negotiation and horse wrangling in which Republicans attempted to add enticements to appease moderates and deep cuts to placate conservatives. Still, it was not enough. And in a stunning defeat without even a vote cast, the now-majority Republican House was unable to achieve something they had done countless times before: pass a bill repealing Fmr. President Obama’s signature health care law.
There were many ironies evident in the legislative events of this week, but my favorite was the lack of any Republican policy alternative to that grand health care question. If you remember, achieving universal healthcare (or at least a broad overhaul that covered most Americans) was a major campaign issue in the 2008 presidential election. The massive shortcomings in America’s healthcare system had long been recognized by both sides of the country’s political spectrum. Upon taking control of the White House and both chambers of Congress, an internal debate brewed within the Democratic Party about how to fix the healthcare system. There were many who sought some version of a single-payer system - one in which the government directly provides medical services to citizens, either in total or as a supplement or alternative to a private system. However, seeking to achieve some measure of bipartisan support, Pres. Obama pushed for a market-based solution along the lines of the one originally proposed by the Republican Heritage Foundation and enacted in Massachusetts by then-Governor Mitt Romney.
Pres. Obama no doubt thought this concession would win him some portion of Republican support, since the idea itself encouraged a market-based competition for coverage. Republicans, however, had a different strategy in mind: unwavering and universal opposition. Ultimately, the Democrats passed the Affordable Care Act, later dubbed “Obamacare” by Republicans, on a party-line vote without even a single Republican. While many on the left have argued that this was a huge missed opportunity for Democrats to pass a plan more in line with their liberal sentiments, such as single-payer, ultimately this was a monumental error for Republicans.
Fast forward to this week. Having categorically opposed “Obamacare” for years - campaigned and railed against it, and promised immediate repeal - the Republicans finally found themselves in the drivers seat. There was just one problem - there were no policy options left on the table that would both be palatable to Republicans and also achieve that goal of providing coverage to a majority of Americans. Having railed against and derided as “socialism” the previously enacted market-based compromise solution (“Obamacare”), Republicans lacked any viable alternative plan. This became increasingly evident throughout the week as, at each attempt to placate their right flank, the leadership lost more and more moderates. With a small margin over Democrats of only 18 votes, the task proved too hard.
It's hard to imagine any Republican-led healthcare reform package being passed with large Republican support in this Congress. President Trump has already indicated that he may work with Democrats on an attempt to fix the "exploding Obamacare," and, in all fairness, this might be the approach most likely to succeed. Moderate Republicans are not able to swallow a plan that removes all the so-called "essential benefits," and Freedom Caucus members barely want a replacement plan at all (repeal, by itself, is really what they seek).
This is one of those times when you have to laugh at politics. Having passed Obamacare "repeals" tons of times throughout Obama's presidency, Republicans, now in charge, couldn't muster the support for even one bill. Maybe they shouldn't have categorically opposed the market-based solution that Obama proposed back in 2009 and 2010, because that was probably the most passable solution to America's healthcare ills that we are likely to see in this political climate.