Republicans just can’t quit Obamacare repeal.
Even as they face an insanely busy week when a government shutdown will need to be averted and President Trump would also like to unveil a tax overhaul plan, some GOP lawmakers—perhaps at the behest of White House officials seeking to save face ahead of the 100-day mark—are talking up the possibility of a new deal to revive legislation to dismantle the Affordable Care Act.
Even as GOP congressional leaders tamp down expectations of any quick movement to resuscitate the bill, which was pulled from a House floor vote last month due to lack of support, the latest round of hype signals a longer-term problem for the GOP’s approach to governance. As long as Republicans can’t fully move on from Obamacare repeal, it stands to infect the other agenda items they seek to pass while they still have full control of Congress.
“The bills is undead. You can’t kill it, you can’t revive it,’ said Jonathan Oberlander, a professor of social medicine and health policy at the University of North Carolina-Chapel Hill.
This week, for instance, a potential government funding showdown has shaped up around threats from Trump to blow up the ACA’s individual market unless legislators fund his border wall, a political flashpoint that neither Democrats nor many Republicans want to hash out in must-pass spending legislation.
Trump’s apparent logic is that such tactics give him leverage to force Democratic negotiations on repealing Obamacare—a posture that doesn’t really make sense when grounded in both the political realities of who owns health care at this point (Republicans) and the GOP’s own moves to shut Democrats out of their legislative process.
More broadly, Obamacare repeal presents a confluence of conditions that risk trapping Republicans in a “zombie-care” political quagmire. On the one hand, they’ve made Obamacare repeal a central campaign promise for seven years and put it on the top of their legislative agenda. On the other hand, congressional leaders put the repeal effort on an expedited time-line, giving themselves only a few weeks to cobble together a bill and shore up conference-wide support for a quick passage that would make way for tax reform.
Topping it all off, Republicans are being led in this endeavor by a President with little interest in the mechanics of health policy, little knowledge of the sausage-making of the legislative process, and a penchant for a made-for-TV style of negotiating.
“Why they’re saying that they’re going to keep doing it is because it’s incredibly important, because they staked a lot of political capital on repeal and replace during the election,” Caroline Pearson, senior vice president at the health care consultancy Avalere Health, told TPM.
As a GOP leadership aide told Axios recently, “It’s hard to imagine not resolving the health care issue at this point. We are too far along to abandon the effort altogether.”
In reality, they did not actually get very far: Republicans gave themselves only a few weeks between unveiling the legislation and slating it for a floor vote, and in the process, held just a handful of hearings. They have basically no buy-in from outside stakeholders: the reaction to the legislation from major hospital groups, patient advocates and insurers ranged from muted expressions of concern to, more commonly, vehement opposition.
The latest flicker of hope comes from a deal reportedly offered by Rep. Tom MacArthur (R-NJ), who co-chairs the moderate Tuesday Group, to let states waive certain ACA insurer mandates. The rumblings began in the middle of last week, with White House officials optimistic that the bill could be brought up for a vote again this week, despite all the other matters lawmakers have on their plates.
Still, the fundamentals, in terms of counting votes, have yet to visibly shift. Speaker Paul Ryan (R-WI) told GOP lawmakers during an “all-hands” conference call Saturday that no votes would be scheduled until it was clear the bill had the votes to pass, the Washington Examiner reported, and there are no signs yet of an aggressive whip operation.
What Trump has created for congressional Republicans is an atmosphere where moderates are being slammed by their constituents for supporting the failed bill, conservative hardliners are doubling down on their demands for a more sweeping repeal of the law, and no one wants to be the one blamed for its failure.
“They sold the original bill short and now they’re having regrets about that but they’re having trouble coming up with a better deal than they had to begin with,” said Tom Miller, a health care policy expert at the conservative American Enterprise Institute.
Trump, meanwhile has tossed off public threat after public threat, including the elimination of Obamacare subsidies that, if halted, would lead to major chaos to the insurance industry. Funding the payments, known as cost sharing reduction subsidies, has now become a flashpoint for government spending negotiations.
“This works within a 24 hour cable news cycle. It doesn’t play out on the legislative front,” Miller said. “It’s not just a soap opera or a momentary headline. It takes a lot of consistent, determined, planned out work to hold these things together and get majorities in Congress.”
Health care policy experts were skeptical that the policy tweaks to the legislation that have been floated would be enough to change the dynamics around the bill.
“We haven’t really seen the kind of nuanced negotiation on the nuts and bolts of the policy that you need in order to come to some sort of consensus and we haven’t seen the kinds of political organization that is often needed to really line up the votes,” Pearson said. “I think they are trying because it’s politically important, but it doesn’t seem like this round is materially different than what we have seen before.”