Health Care

The Demise of an Unwanted, Unloved Health-Care Bill

It's astonishing how unliked the Republicans' legislation was.

Collins and McCain, mavericks.

Photographer: Andrew Burton/Getty Images

We've never had anything like the Republican health-care bill, which fell just one vote short of passage in the Senate -- in the dead of night, of course, because Republicans appear absolutely dedicated to fulfilling in fact every fiction they told about the Affordable Care Act back in 2009-2010. 

But that's not what made any version of the Republican bill -- including the pared-back "skinny repeal" edition -- so special. Nor am I talking about the secretive procedures under which the bill was considered, including all of two hours -- two hours! -- between making the final Senate bill public and voting. The process was awful, and hardly any way to design such an important law. However, while this is an extreme case, we've had bills considered and even pass under terrible procedures before.

No, the most astonishing thing about this bill, from when the first version was introduced in the House right until what appears to have been the bitter end, was that hardly anyone was willing to actually say they liked it. That's extraordinary. And I suspect at the end of the day that's what killed it. 

Health-care workers and organizations didn't like it -- the doctors, the nurses, the hospitals, the insurance industry and more. Patient organizations hated it. Other organized groups (AARP, for one) targeted it. 

I'm always very skeptical of policy polling, but for whatever it's worth, voters had been telling pollsters they hated it. No one can recall the last major bill that passed with such awful polling numbers.

The bill never appeared to generate any real party enthusiasm, either. If Republican activists rallied to it, they did so very quietly. Quite a few Republican health-care experts either opposed various versions of the bill or supported them without real conviction. Republican-aligned media seemed more interested in chasing rumors about Hillary Clinton than in building support for legislation. Some of this has to do with the post-policy Republican Party, which just doesn't consider public policy as important as symbolic actions, but I suspect the tax bill, if we get one, will generate at least some interest.

The president never bothered learning anything about the bill, and at least publicly did very little for it. He did mention it from time to time, but there was no high-profile speech dedicated to it, no Oval Office address, and I believe just a single event dedicated to pitching it. And of course his dysfunctional White House hardly was in a position to lobby effectively for it. It's quite possible the lack of a strong signal from the White House might have been responsible for Republican voters failing to rally to the bill in the polls. 

Even the people voting for the bill didn't like it. Republicans had an hour to advocate for the bill, and Senate Budget Committee Chairman Mike Enzi spent that time rambling on a wide variety of topics, almost none of which had anything to do with the bill under consideration. 

The same thing had happened in the House. When that chamber considered the Affordable Care Act, members lined up in the aisle to praise the virtues of that legislation, and Republicans lined up to oppose it. This time, Republicans must have been off at dentist appointments or something.

In his postmortem speech, Majority Leader Mitch McConnell did get some digs in at Obamacare, but his remarks lacked references to what would have been the case if the bill had passed. 

The story the news media is going to tell will be about the three Republicans who split with their party on what turned out to be the big vote: Susan Collins, Lisa Murkowski and John McCain. And each of them had reasons for doing so. But the truth is that jiggering the bill this way or that way would have produced a different group of three, or a group of five or nine or 15. That McConnell eventually chose the path he did makes it look like those three defeated the bill, but that's mostly an illusion. Its odds have been very low since January, with the real question being who would get caught without a chair when the music died. 

And I suspect the bigger story was really the House than the Senate. Yes, Speaker Paul Ryan managed to get something through his chamber. But it arrived in the Senate with no enthusiasm, no strong support and way too many enemies. Perhaps a better legislator than McConnell could have managed to save it, but his task was always going to be very difficult. 

At any rate: I don't think the core problem was with Ryan, or McConnell, or even Donald Trump. I think the core problem was a bill no one but its opponents cared about. It's awfully hard to pass something like that.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

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    Jonathan Bernstein at

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