“We’re going to deliver real change … That begins with immediately repealing and replacing the disaster known as Obamacare … You’re going to have such great health care, at a tiny fraction of the cost – and it’s going to be so easy.” Donald Trump, October 25, 2016
“Nobody knew that health care could be so complicated.” Donald Trump, February 27, 2017
“Doing big things is hard.” Paul Ryan, March 24, 2017
For the past seven years, Republicans in Congress and most recently the White House have railed and wailed against the Affordable Care Act, known as Obamacare. Sixty times the House passed bills repealing the law. The House and Senate both passed a repealer two years ago, which was vetoed by President Obama. The party made the 2016 campaign a referendum of sorts on the law.
And then this past Friday, seven years of BS came crashing down upon House Republicans and Donald Trump. Speaker Paul Ryan showed his ultimate weakness by pleading with a president, who really knew nothing about the subject, to pull the bill. Ryan apparently was not able to make that decision himself. The bill was pulled. After seven years, it was an incredible defeat for Trump, Ryan and the entire party.
This was a defeat for the man who wrote “The Art of the Deal.” This was a defeat for the man who told us only he could solve all our problems. This was a defeat for a man who fancied himself as “the closer” who could wrap up a big deal. He failed miserably.
Trump complained that Democrats offered no help. Really, he said that. He said that while the world knew that he made no effort whatsoever to ask for Democratic Party help. Not one of the 120 House members he spoke to was a Democrat. The Republicans, after all, have a nearly 50 vote majority in the House. The need for 60 votes in the Senate was removed by use of reconciliation legislation, so the Senate did not need Democratic votes. But he says Democrats let him down.
My blog post of January 3rd laid out how this might unfold. I suggested that in the end, which may be two or three years from now, the Affordable Care Act will be amended, not repealed. I still feel comfortable with that prediction.
The failure-to-launch event last Friday highlighted the fact that there are three wings to today’s Republican Party: the far-right wing occupied by the House Freedom Caucus and a handful of Senate rabble-rousers; the not-quite-far-right wing consisting of the so-called Republican Study Group, which previously was considered far-right; and the pseudo-intellectual, establishment wing who are Ryan’s inner circle. The non-vote on the most important piece of legislation that the Republicans promoted exposed once again the impossibility of getting the three wings in harmony on anything. Somewhere in Florida John Boehner must be sipping his red wine and saying, “told you so.”
The non-vote clearly identified the Freedom Caucus as the most powerful part of the party. There are only about forty members, but they are enough to control the caucus. They just faced down the President of the United States and the Speaker of the House, and they won. They will now be insufferable. Poor Donny. Poor Paul.
The American Health Care Act that was slapped together over the past month or so was a joke. It would have removed medical insurance coverage for 24 million people and raised premiums and deductibles for those who still had coverage. What would be covered would be diminished. Chris Collins’ attempt to blackmail the State of New York through his New York-only Medicaid scheme became derided nationally as the “Buffalo Buyout” and the “Buffalo Bribe.” Maybe the reason the plan was New York-only was that of the other 17 states that require their counties to contribute for Medicaid, 11 of those states have Republican governors.
Going forward, it is likely that the repeal and replace fiasco will make it much more difficult for the Republicans to enact anything major, even with their control of Congress and the White House. The Treasury Secretary’s predictions about tax reform legislation by August are silly. The wall, immigration issues, and the infrastructure dreams are even less likely to proceed quickly or to the desired conclusion.
What will really be dicey for Republicans, however, are the “must-dos,” such as increasing the debt limit and passing a budget. The Freedom Caucus is going to have a field day with those issues.
As for health care, Trump can and likely will do more than simply hope that Obamacare will implode on its own. The Secretary of Health and Human Services, Tom Price, can do real damage to the law through administrative regulations and waivers to the states to do whatever they want. He can also make enrolling in coverage difficult. There are serious issues about rising rates and limited insurance company choices in some parts of the country that will get worse if not addressed. Insurance companies will bail out, which will eliminate coverage in some areas, including many represented by Republicans in Congress.
There is also the problem of the lawsuit that House Republicans began which challenges the appropriation of money for the subsidies that are a key part of the ACA. If the Trump administration chooses not to contest the suit any longer, the loss of subsidies in 2017 will create major financial issues for insurance companies that are forced to cover the lost revenue. They will then pull out of coverage.
So letting the law implode can be hastened and will create big league medical insurance problems for millions of people throughout the country. The Trump administration is probably not above encouraging such a meltdown and has demonstrated that it is not prepared to deal with such a calamity.
There will be political consequences for all this that can greatly impact the 2018 mid-term elections. In the meantime, a weak, unfocused, unintelligent and ignorant president will also be dealing with the fallout from the Russian-influence scandal, immigration issues and the conflict of interest problems that are just under the surface at the moment.
Paul Ryan, despite having been exposed as a weak and ineffective Speaker, will stay in that position for a very simple reason – nobody else will want the job.
The Freedom Caucus will have the run of the House unless Trump and Ryan choose to abandon the Caucus and revert to the Boehner era style of seeking Democratic votes to approve things that need approving. The Freedom Caucus has its following in the party, and ignoring them will only escalate the Republican civil war.
For the good of the country I hope people come to their senses. I’m not holding my breath on that. I’m trying really hard to fight a very heavy dose of schadenfreude. Things will get much crazier before they get better.