Obamacare

On Health Care, Republicans Are Only Negotiating With Themselves

The GOP's Obamacare repeal is stalled because Republicans haven't made a case for its merits.

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Cheriss May/TNS/Newscom

From a certain perspective, the Republican effort to repeal (or at least rewrite) Obamacare made slow progress this week. The Freedom Caucus, one of the main sources of GOP opposition to the bill, endorsed an amended version. Republicans seem to have settled on state opt-out waivers, which, as Yuval Levin writes at National Review, could allow the party to navigate its internal political and policy differences. Key outside groups such as Heritage Action have dropped their strong objections to the bill.

And yet it's far from clear that the bill will actually move forward, because for all the progress Republicans appear to have made, the bill is still stalled. Despite multiple reports that the House would proceed with a vote on a bill to partially repeal Obamacare, another week has gone by with no actual vote. There has been no vote for the simple reason that the bill lacks the support to pass. Still.

For now, at least, the American Health Care Act (AHCA), remains dead. And if you want to understand why, it helps to compare the Republican effort to repeal Obamacare with the process by which Democrats put together the bill in the first place.

In some ways, the movement we have seen so far on the AHCA resembles the drawn-out process by which Democrats drew up and passed Obamacare in the first place. When Democrats put together the health care law in 2009, they were aiming to have the entire process completed by early or mid-summer. Instead, the process stretched out for more than a year, as holdouts negotiated tweaks and carve-outs. Then, as now, the process moved in in fits and starts, with various versions floated and then discarded, and congressional support levels hovering at some difficult-to-determine level below the threshold for passage.

But the GOP process this time around is distinct in at least one important way: Unlike Democrats, Republicans are only negotiating with themselves.

Democrats spent much of the summer of 2009 letting Senator Max Baucus, who oversaw the bill-writing process, negotiate with Senate Republicans, in hopes of picking up a veneer of bipartisan support. At the same time, the White House and Senate Democrats negotiated various deals with major players in the health care industry, including drug makers and trade groups representing hospitals and doctors. As a result of those deals, the industry groups helped sell the bill to both the general public and skeptical legislators, promising air cover in exchange for certain carve outs. Finally, President Obama used the bully pulpit to make the case for the law to both congress and the public. All of this followed years of discussions amongst liberal wonks and activist groups.

There was the usual internal wrangling as well, of course, with Democrats cutting deals with their members in exchange for support. But part of the reason that Democrats could make those deals was that they had gathered backers from other quarters, and had created a sense that passage was inevitable. External support created internal support. The process was self-reinforcing.

Republicans, in contrast, are negotiating entirely within their own congressional ranks—and really only within a small subset of House Republicans. The amendment released this week was written by Rep. Tom MacArthur (R-New Jersey), a leader of the moderate Tuesday Group, but it is designed almost entirely to appeal to members of the House Freedom Caucus. It's not clear that Senate Republicans want anything to do with this bill. "The Freedom Caucus has done a good job of trying to make the bill less bad," said Sen. Rand Paul (R-Kentucky) this week–not exactly a ringing endorsement.

And outside of Congress, there appears to be little or no effort at all. When the initial draft of the bill was released, conservative activist groups were widely opposed, and many complained that they had not been consulted at all. Health care industry groups, many of which oppose the current bill, have been left out of discussions entirely. ("[Republicans are] not interested in how health policy actually works," one insurance company official told The Los Angeles Times.) And President Trump has made no more than a cursory effort to sell the bill to the public; he has never delivered an extended speech devoted to the bill, and has never made any attempt to explain its virtues.

It's true that there are reasons—even some good reasons—why Republicans might want to avoid the sort of politicking and dealmaking that Democrats engaged in to sell Obamacare. Industry groups are likely to be hostile to many GOP aims, especially where reductions or shifts in government funding are concerned. Republicans are probably right to assume that, short of nationwide single-payer, there is no compromise measure that Democrats would join with Republicans to support. Trump, who does not appear to understand even the most basic policy elements of the GOP health care bill, is probably not the best messenger to make the public case that it improves on Obamacare.

But right now, no one is making that case. The Republican case for the AHCA rarely goes further than the declaration that it repeals Obamacare, which is bad. Many Republicans appear to believe that its main virtue is as a setup for tax reform.

The process by which Democrats sold Obamacare may have been long and unseemly, and may have resulted in an ungainly law that is often frustrating even to many of its supporters. But it also resulted in a bill that clearly advanced Democratic goals—and could pass.

One reason, of course, why Republicans are talking only to themselves about health care is that they had adamantly refused to do so during the Obama years. Despite promises to repeal and replace the health care law, the specifics were always to-be-determined. But so far, Republicans haven't even convinced themselves of what should be done. If anything, as Byron York writes, they seem to have decided that, contrary to what they promised, they did not really want to repeal Obamacare.

The GOP's failure to make the case for the AHCA to either the public or themselves is why the bill has an approval rating below 20 percent—far worse than even Obamacare, which was consistently unpopular under Obama. It's why there hasn't yet been a vote, and even if there is one, the bill, in its current form, still faces an uphill climb in the Senate. It's why even though we've seen signs of progress on the bill, we have yet to see the real thing.

And it's probably why the GOP's biggest achievement so far has been to finally push Obamacare into popularity, with poll after poll showing support for the health law on the rise. By not making the case for its current legislation—or, for that matter, any coherent alternative at all–Republicans have implicitly made the case for Obamacare instead.

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26 responses to “On Health Care, Republicans Are Only Negotiating With Themselves

  1. … the White House and Senate Democrats negotiated various deals with major players in the health care industry, including drug makers and trade groups representing hospitals and doctors. As a result of those deals, the industry groups helped sell the bill to both the general public and skeptical legislators, promising air cover in exchange for certain carve outs. Finally, President Obama used the bully pulpit to make the case for the law to both congress and the public.

    And how did all of that work out for them in 2010?

    1. Well, they’ll always have their legacy.

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  2. It also helped that people were able to keep their health insurance if they liked it. Democrats had that going for them in their plan.

    1. And the fact that it didn’t require tortured judicial reasoning in order to be declared legal.

  3. “Trump, who does not appear to understand even the most basic policy elements of the GOP health care bill, is probably not the best messenger to make the public case that it improves on Obamacare. But right now, no one is making that case”

    I would consider that a lesson-learned. The democrats put a shitload of effort into convincing the public that Obamacare would be awesome. They failed; miserably. So, they said “fuck it” and passed it anyways. The Republicans are just skipping that entire charade because they know they’ll fail even worse.

    As you mention, dems would never cheer for anything other than single-payer. But the larger public will never cheer for anything… period. The concept of a healthcare bill that would win the public’s support is pure fantasy. That’s not a reason to keep Obamacare. But, it should be a reason to try an approach other than Obamacare-lite.

    1. The thing that improved public opinion of Obamacare wasn’t so much the Republican attempts to kill it. It was mostly the fact that it became the status quo. No one has any reason to believe that Republicans will offer a better alternative. So, all they’ll do is mess up the status quo. That disrupts life for people and they won’t enthusiastically support that.

    2. The democrats put a shitload of effort into convincing the public that Obamacare would be awesome. They failed; miserably.

      No, they succeeded which is why they passed it. The GOP then spent a huuuuuuuge shitload (as big as Drumpf himself) of efforts denigrating it which convinced the public that Obamacare was bad, but the elements of it without the label were still very popular.

      And now the cat’s out of the bag when the same public has figured out that ending Obamacare would end the elements they like in it.

      So today, it is as popular as it has ever been.

      Gawd I hope the GOP repeals it. All of it. And then tells the public that they are better off.

      1. Anyone who understands the scope of federal authority hopes Obamacare is repealed, since Congress has never been granted the authority to spend money on health insurance or delivery of medicine. The problem is that the Republicans in Congress agree with the Democrats. Both political parties support a larger national government with increasing control of Americans. Neither supports individual liberty. Sad reality.

  4. Shorter Suderman:

    Republicans are evil for not lying to the American people and for not giving as nice of a hand job to special interests.

    He’s engaging in a whole lot of revisionist history here and giving the Democrats every benefit of a doubt, while not giving the Republicans the same. Hardly surprising though, coming from him.


    The process by which Democrats sold Obamacare may have been long and unseemly, and may have resulted in an ungainly law that is often frustrating even to many of its supporters. But it also resulted in a bill that clearly advanced Democratic goals?and could pass.

    Yeah, it passed because the Democrats had a super majority and the Republicans do not and it’s ungainly because it was a wish list for various special interests and the Democrats had absolutely no idea what was in the bill. And also, what is meant here by ‘Democratic Goals’ exactly?

    If Republicans had a super majority would Suderman suddenly say that the Republicans are doing the right thing in doing a straight party-line vote for whatever they want? Seems doubtful.

    1. “If Republicans had a super majority would Suderman suddenly say that the Republicans are doing the right thing in doing a straight party-line vote for whatever they want? Seems doubtful.”

      Where in this article are you reading Suderman as being complimentary of the Democrats? Where do you think he is suggesting that the Democrats did the right thing with the party-line vote for Obamacare?

      His comments about the Democrats are negative throughout the entire article. They’re just a little less thoroughly negative then his comments about the current efforts. And that’s because the focus of the article is the current efforts.

    2. The closest he is to being complimentary to democrats is the line that you quoted. “But it also resulted in a bill that clearly advanced Democratic goals?and could pass.” And, calling that complimentary is a stretch.

      “advanced Democratic goals” – yes, it got us closer to the democrats goals of socialized healthcare. You could hardly say the current and previous versions of the Republican bill “advances Republican goals” unless the republicans are officially on-board with socialized healthcare now.

      “and could pass” – yep… it was a shit law and it passed because of the super majority. The current stuff from republicans won’t pass. Not gonna happen.

      Just because Suderman is pointing out how shit the current efforts are from republicans doesn’t mean that he supports the previous efforts from democrats. He criticizes them throughout.

  5. The GOP is debating with itself because the only debate about this issue in Washington that any good* will come from takes place within the GOP. So that’s actually a good thing.

    *From a libertarian perspective.

    1. If it were a debate, and not horse trading.

      a. They do not have a repeal, just what clauses to add so that they call it a repeal and replacement
      b. They do not have a bill, just proposals which could be amendments
      c. They do not care for a score on the bill, which is irresponsible

      Right now the debate is how to get a bill passed that says “Repeal” and not get pounded in the 2018 midterms when the people find out.

      Best thing to do? Wait till late 2017, announce a bill that will become effective from 2019 onwards, and call it a day

  6. Trump has Wall Street and business people all over his cabinet. There’s no reason why the insurance industry wouldn’t or shouldn’t have a place in this discussion. I think they’ll be keenly interested in tax cuts and reduction to mandatory essential benefits that are driving up the cost. Not to mention a whole lot of other things.

    The law simply cannot work without handouts from the government. The best argument for the rise in premium is that “it’s insulated by subsidies”. The cadillac tax and some other things have been delayed, thanks to lobbying by the insurance industries. They already got a lot of what they wanted under Obama and they’re probably hedging the next move given that Trump is simultaneously more friendly to business yet deeply unpopular among left leaning corporate players.

  7. What a bunch of pussies.

    They don’t even need Democrats screaming about pushing grandma off a cliff anymore. The voices in their heads tell them to do what the Democrats want.

  8. Gawd, this is such a mess. The only way GOP can sell this is if they approach it as an effort to deregulate and simplify a monstrosity. Instead, like every government kool-aid drinker, the GOP cannot help but see it as their mission to tweak every undesirable cost of healthcare with government tools that represent a leviathan-sized swiss-army knife designed by Kafka and Mussolini’s love child.

    I get that the public isn’t going to support SOME level of safety net and relief for people with pre-existing conditions. But until people become price sensitive to their health care, we are never going to dig our way out. So:

    1) Blow up the tax-favored system of employer-based coverage. Give the tax-deduction to people, not corporations.
    2) Give everyone Health Savings Accounts where they can put before-tax dollars.
    3) Remove mandated coverage, and restrictions on buying across state lines. Let people choose the coverage options they want.
    4) For the truly needy, the government can deposit money into the HSA.
    5) Set a minimum period (6 months to a year) where insurance companies don’t have to cover pre-existing conditions unless the patient can show proof of continuous coverage for the condition.

    Done. Yes, there are all sorts of things like Tort reform that could be added later. But at the end of the day, we need people to start shopping for health insurance and for their health care itself. That won’t happen until they control the money.

  9. But…that’s a good thing (at least a good sign), isn’t it? If these H.R. members are confident that whatever they come up with will have a good chance of passing, the fact that they can achieve this w/o need of further compromise says good things to me. They’re not doing it for p.r., because they’re doing it secretly, so it looks like they’re sincere in their belief.

  10. Losing bigly.

    In December 2015, they passed a bill repealing Obamacare. Drumpf could demand that same bill, but he won’t.

    Eventually, the AHCA will pass, and will cost a lot of Republican voters a LOT more than it does today to get healthcare.

    It’ll look a lot like Obamacare, but with lesser coverage and fewer people covered. It’ll cost the same or more, but not less.

    Good.

  11. I’m looking at the take over of healthcare in California for a single payer plan which will steal Medicare from seniors, and money from those paying for their healthcare. For years Democrats have scared seniors saying Republicans would take their Medicare and they just got caught with their hands in the cookie jar. Single Payer will supposedly cover everyone for the same amount, but NHS hasn’t ever been able to pull that one off in 70 years. They kill more people than Kaiser, which is for profit medicine. Democrat California Senator Kevin De leon wants everyone else to pay for his admitted Illegal Alien relatives. Another California Senator Richard, Lara says Taiwan’s nanny state proves single payer works. Healthcare in Taiwan isn’t the rosy picture he presents. Taiwan’s Kuomintang government who ran Taiwan for over 70 years has made it a basket case for its current president. She has her hands full cutting unsustainable government pensions. Most of my wife’s family came from Taiwan, and am much more than Lara does.

    Whats going to happen is these La Raza Racists like Lara and De leon are going to kill my 91 year old Taiwanese mother in law to fund care for Illegal Aliens. Other than UK, there isn’t any other European country with single payer healthcare. France doesn’t have it, Germany doesn’t have it and Switzerland doesn’t have it. Japan doesn’t have it either, and my nephew living in Japan says it’s as good as what he had working for UCSF medical center.

  12. If this class of republicans can’t return sanity to the nation’s Doctor / Patient relationship we’re finished. The collectivist have the K – 12 system, the Universities, the unions that serve state, local and federal agencies and the gigantic mess of our bureaucracies. When new citizens are sworn in they first take a test that asserts that the US is a Capitalist political / economic nation. Hogwash!! We are just another Euro- Welfare State drifting along on the inertia of our former glory.

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