The Republican Health-Care Trap
Are congressional Republicans about to walk into a trap of their own making? With a vote coming (perhaps) next week, the strategy they've followed all year is about to drop them unceremoniously on a path to being stuck with an unpopular law few of them appear to even want in the first place.
The big story in health care has appeared to be straightforward: Virtually every Republican member of Congress on both sides of the Hill ran on "repealing and replacing Obamacare," but virtually all them them filled in at least some policy blanks themselves, lacking a party-endorsed plan to guide them. Once in control of the White House and Congress, there was no way to reconcile their various commitments on the campaign trail and other differences into a single "replace" bill.
Consequently, the actions they've taken since then, at least as I see it, have been designed by various groups and individuals as efforts to duck the blame for not following through on their many health-care promises. The result is they wound up passing something in the House that almost no one liked -- including those who voted for it. 1
And now Senate Republicans may be about to do the same thing. They have entirely avoided the committee process, and have even so far left the contents of the bill a secret. (Some secrecy in working out compromises is normal and, I'll argue, healthy. But what Republicans are doing this time is, as Congress scholar Sarah Binder explains, far from normal). And behind the secrecy appears to be close to utter indifference to how the bill would actually work if it became law.
Granted, the very secrecy they are working under makes it difficult to know much for sure. But it seems to me that there's something unusually unmoored about this process. In 2009, Democrats strongly believed (in large part mistakenly) that voters would like the Affordable Care Act once it was fully implemented. If any Republicans believe that now about their American Health Care Act, they certainly aren't saying so. Nor are they acting as if they believe it. Indeed, I suspect Mitch McConnell probably doesn't much care what happens to health care as long as he can wrap up the bill one way or another and move on to taxes. When Vox interviewed several Republican senators, they were barely able to talk about what the bill is supposed to be about.
Parties, after all, don't hold open processes for legislating because of their belief in good government principles. They do so because it helps create laws that actually work reasonably well. On health care, Republicans seem to be more concerned with making the whole legislative problem go away as quickly and quietly as possible. It's almost as though they are more concerned with bad publicity during the weeks the health-care bill grinds through Congress than the blowback in the months and years after it passes.
And, yes, just like Obamacare, the American Health Care Act is likely to be quite unpopular. Even if it works as Republicans hope it does. Just as with Obamacare, it will be blamed for everything that goes wrong with anyone's health care, whether or not there's a legitimate connection. Just as with Obamacare, there will be nothing positive to hang on to; there won't be, say, any "Trumpcare" benefits cards which link good health-care outcomes with the legislation. And, yes millions of people losing their insurance are going to blame Republicans in control of Congress and President Donald Trump, not Barack Obama and the Democrats. 2 The results could easily contribute to electoral disaster for the party in the 2018 and 2020 elections. 3
This isn't to say that Republicans should shrink from bearing the political price of their convictions. If passing the health-care reform bill is a high priority for the party, it should do so without hesitation. Majorities, as the saying goes, are to use. But I'm still very skeptical that very many Republican politicians actually care about any part of what they may be about to do. I'm not even convinced that Republican voters care about repealing and replacing Obamacare beyond the symbolic level.
Perhaps the whole effort will collapse. McConnell may just bring something to the Senate floor, let it fail, and move on; reports that Republicans are close to consensus could very well indicate an effort to steamroll any opposition with an illusion of momentum. But it also seems quite possible that McConnell will find the 50 votes he needs (with the vice president breaking the tie). If so, Republicans in both chambers may find it's too late to back out now. If they balked now, Democrats will slam them for what they already voted for; Republicans will do so for their failure to pass anything.
It's not too late to avoid this trap, or at least the worst of it. Yes, if the bill dies in the Senate, McConnell and some or all Republican senators will take the blame and some Republican activists may hold it against them. But they'll likely move on to different issues (no doubt with some help from whatever craziness Trump stirs up), given that it's mostly just a symbolic issue for them anyway. It's a lot less likely that voters losing their health insurance will be as easily distraced in the months and years ahead.
Republicans couldn't even manage to line up members to speak in favor of the bill on the House floor during the (short) debate time allotted. Conservative health-care experts don't like it either. And it's not just the floor debate; congressional Republicans aren't very interested in going on TV to defend it, either.
Indeed, that would be the case even if Republicans did nothing at all: Outside of extreme partisans, most people blame incumbents for bad things, regardless of whether it makes sense or not. That's why elected officials have strong incentives to produce successful policy, which is one of the reasons democracy works even though voters aren't very attentive.
Estimating exactly how much an unpopular health care bill could contribute to future landslides is impossible. Political scientists did find a fairly large effect in 2010 against Democrats who supported Obamacare (although, to be honest, I have some skepticism about that finding). Would the effect be larger this time? The Republican bill polls quite a bit worse now than the Affordable Care Act polled before it passed, for what it's worth. I'd say it's an unusually large risk, at the very least.
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