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Saved by Obamacare?
The shutdown ended on October 17. But sniping between the two anti-Obamacare camps continued. Norquist gave a series of interviews in which he leveled particularly harsh criticism at Sen. Cruz. "He pushed House Republicans into traffic and wandered away," Norquist told The Washington Post. Cruz responded with several speeches to conservative groups in which he defended the strategy and blamed its failure on the lack of conservative unity and the timidity of establishment Washington.
Meanwhile, Obamacare's exchanges were online. It was hard to imagine that the GOP would be able to start a productive conversation about health policy-what to do about it, and how to talk about it-at a time Obamacare was not only the law of the land but a working policy affecting millions of people's lives. As it turned out, they didn't have to.
Obamacare's glitch-ridden opening day ushered in a disastrous opening month. The federally run exchange system operating in 36 states was practically useless-a catastrophic failure of mismanaged government contracting and technology development. Several of the state-run exchanges experienced serious failures as well.
Suddenly, Republicans had a clear and united path forward: They would intensify their criticism of the law, holding hearings to find out what went wrong while blasting the administration for mismanaging the process. Obamacare's failures had saved Republicans from figuring out what to do about Obamacare.
The exchange mess kept Republicans busy. But the reprieve was almost certainly temporary. The GOP will soon be faced with the same old questions: What does the party stand for when it comes to health care? What, exactly, do Republicans want to do, and what is the method by which they propose to do it?
Some answers to these questions will depend on the outcome of the next several elections. "Given that they don't have majorities to pass legislation, Republicans have to understand the Obamacare fight as a longer-term fight that will require winning elections," Yuval Levin told me in late October. "The fundamental change that has to happen is going to require election victories for people who want to replace this law. And I think that means very different tactics than have been used in the last few weeks."
In the short term, that probably means going small. Big, comprehensive reforms make for big targets and big controversies, so scaled-down ambitions may win the day. "There are smaller pieces that we can break out," Rep. Price says. "We've begun the process of breaking our bill down into smaller pieces of legislation."
In the longer term, it means being patient, and learning to compromise. "Let's get to a free and open market in health care," says Norquist. "How do we get there? Are there baby steps? Maybe. There are some times you have to wait."
To an extent, the Republican Party is hampered by its relative inexperience. With a flood of new members, there has been a concurrent loss of institutional memory as long-time legislators and staffers depart. Republican aides say it's harder than ever to work through major legislative deals simply because so few legislators have a feel for the required compromise. "We don't have a Republican majority that remembers how to govern and understands how to juggle tradeoffs," one health policy aide complains.
Substantial reform would mean sustained work over long periods of time, involving legislators, activists, and the policy community. It requires, in other words, a concerted effort much like the one Democrats and their allies made in the years prior to passing Obamacare.
Or, alternatively, like the one that Republicans have already started with Medicare. A decade ago, Republicans passed a deficit-funded expansion of the law-the prescription drug benefit that became Medicare Part D. But there was no consensus plan to restrain the entitlement's unsustainable long-term spending requirements, and limited-government Republicans pointed to Part D as a damning indictment of Bush-era conservatism. But over the years, Republicans slowly coalesced around a broad plan drawn up by Rep. Paul Ryan (R-Wis.)-a plan that many expect to be a centerpiece policy for any future Republican governing coalition.
Ryan's work on Medicare suggests that it's possible to bring Republicans together on meaningful health and entitlement reforms. His work also suggests the sort of steps that will be necessary for a plan to gain broader acceptance. Ryan offered multiple versions of his plan over the years, persisting even as GOP leadership kept its distance. As the plan caught on, Ryan met with virtually all of his Republican colleagues individually to walk them through the details, ensuring that they both understood and could explain what the plan entailed. And he worked across the aisle, signing on to a compromise with Sen. Ron Wyden (D-Ore.) that would leave traditional Medicare in place, even while expanding its menu of private options. The plan eventually helped earned him a slot as Mitt Romney's running mate in the 2012 presidential campaign.
Yet Ryan's struggle to convince his own presidential ticket-mate about the reform plan also suggest the limits of even the most diligent GOP policy entrepreneurship efforts. Ryan's Medicare reforms wormed their way into the congressional consciousness as part of a larger budget blueprint that was amended and reissued multiple times over the years, and eventually helped inform Mitt Romney's Medicare overhaul proposal in 2012. But despite the plan's influence, and Ryan's own slot on the ticket, Romney failed to explicitly endorse the Ryan blueprint for reforming Medicare, deciding a less detailed plan would be more difficult to attack.
That sort of calculated political timidity is why so few Republicans have reached the first step: simply coming up with a plan and then making it known. "There should be different approaches out there," says Levin. "They should be competing, and there should be a sense that Republicans want to solve the problems in the health care system, that they should have different ways of solving it than Obamacare, and right now they're thinking it through. But that's just not happening."