With the failure of the American Health Care Act, President Donald Trump and Republican lawmakers now have to come to grips with the fact that their first big legislative initiative has come to naught. They also have to face the reality that, for the moment, Obamacare will persist as the law of the land.
So what is the next move that the GOP should make? Well, it’s time for a modest proposal: They should fix Obamacare, declare their promises fulfilled, spike the football and move on.
I know, I know, there’s no evidence that Republicans would even countenance this idea. But I think it’s the only way they get out of this with something that could be called a win. Besides, did you guys see what went down last week with that American Health Care Act nonsense? That failure was the culmination of eight years of fulminating against Obamacare and extravagant, unkeepable promises. If that’s the best they’ve got, then it’s not going to hurt anybody to just hear me out on this.
Right now, the failure to pass a replacement bill creates two immediate dilemmas for Republicans. First, they’ve made eight years of promises to repeal the Affordable Care Act and replace it with something better ― but whenever their efforts encounter daylight, their would-be replacement bills fall apart. A big reason why is that they are constitutionally averse to actually fulfill any promise to improve upon Obamacare’s status quo. The American Health Care Act, itself, wasn’t so much as “health care bill” as it was the opening salvo in a multi-part revenue baseline manipulation scheme that was supposed to pave the way for a massive tax cut for the wealthy. Chances are, if they continue to try to go back to the drawing board, they’re not going to come up with anything that gets them any closer to a true Obamacare “replacement.”
The second dilemma is that right now, the Affordable Care Act can really stand to be shored up with some legislative tinkering so that it will yield optimal outcomes. Republicans recognize that existing law has some flaws ― to a certain extent, they are responsible for this. But Trump has signaled that his preference is to let the Affordable Care Act “explode” (or “implode”), in the hopes that Democrats can be forced into participating in Obamacare’s further undoing.
There are some obvious flaws in Republican logic. Trump may be hopeful that he’ll be able to pin Obamacare’s problems on Democrats, but this is a risky gamble. Voters tend to pin the blame for lousy outcomes on the party in charge, and the Democrats hold none of the levers of power. It’s a bit of a long walk in the park to explain to voters how Obamacare’s collapse is the fault of President Barack Obama and the remnants of his Democratic legislative caucuses ― especially when the Republicans have been talking about undermining the bill for eight years.
If Democrats are smart (an open question!) they could act now to fill the vacuum left by the American Health Care Act with their own ideas of how to fix Obamacare. A united front around necessary legislative fixes would compare favorably to GOP infighting and ineffectiveness. Democrats could compete on fixing Obamacare, and could do so knowing that the law now enjoys the kind of public approval ratings that eluded it during Obama’s tenure.
When you consider the situation, it seems to me that there is a clear solution to the GOP problem: co-opt the Democrats on fixing Obamacare. And here’s some good news to start with ― a lot of the work has already been done. The Huffington Post’s Jeff Young explains in pretty great detail how Obamacare could be made better. He’s not alone ― economist Austin Frakt laid out a plan to fix Obamacare’s weaknesses in a November 2016 New York Times editorial.
Everywhere you look, the hard work of determining what needs to be done has been done by others. Congressional Republicans should find the experience familiar, only instead of corporate lobbyists explaining what to do, it’s health care economists doing all the heavy lifting.
Of course, at this point you’re probably wondering, “Sure, the GOP could do this, but what do they get out of it?” Well, I should concede up front that one thing the GOP won’t get out of this is total ideological satisfaction. Republicans hate Obamacare mainly for its redistributive effects. The money of wealthy people is taxed and put to the task of paying for the health care of poorer people. In this sense, what Obamacare does is anathema. The problem the GOP faces is that without some kind of redistribution in this vein, they can’t improve upon Obamacare. And, in fact, their efforts don’t improve upon it ― the American Health Care Act would have thrown millions of people off their insurance.
But if my plan won’t help Republicans get all of their ideological jollies, it still offers them something that’s almost as good: Credit. Sweet, sweet credit. If the party in power takes most of the stick for bad outcomes, the flip side is that they get most of the rewards for good outcomes. And if the GOP just strengthens the law, shores up the marketplaces, and gets more people signed up for insurance ― then they get the credit for that.
If the uninsured rate continues to drop, if the cost curve continues to bend downward, if more people ― freed from the need to take employer-offered insurance ― take the opportunity to leave jobs they don’t like and start their own businesses, then Republicans get to high-five each other, all day, everyday. And why not? If they fix the Affordable Care Act, it would be their doing. You can even slap Trump’s name on it if you want, cut him in on the action.
But is this “repealing and replacing Obamacare?” Well, if you want to get super-technical, no, it isn’t. But who’s stopping Republicans from just saying they repealed and replaced it? Sure, it’s not, strictly speaking, true. But we’re talking about a party that last week was selling a bill that would throw millions of people off their insurance and create a new market for terrible, skimpy, high-deductible plans as an “improvement” on Obamacare. This isn’t a party that’s super-tetchy about honesty.
Passing the American Health Care Act bill would have been a huge electoral gamble ― and if the fallout from Obama’s famous “if you like your plan, you can keep it” line is any guide, it wouldn’t have worked. The pure toxicity of story after story about people being forced off their insurance when Obamacare was passed cost Democrats dearly in the midterm elections ― and the universe of people who would have been similarly affected with the passage of Trumpcare would have been several orders of magnitude larger. Republican voters in particular would have had the most to lose.
And the “let Obamacare ex/implode” plan Trump favors could come with the same risk that Republican voters would bear the brunt of the adverse effects. So, if there is an electoral cost that comes with not truly fulfilling the “repeal and replace” promise, it’s important to understand that the GOP was always flirting with significant electoral risks. In fact, it’s not at all clear that Trump’s “pin the blame for Obamacare’s failings on Democrats” plan is going to work if the bill’s collapse was always going to fall heaviest on people who weren’t voting for Democrats anyway.
Over the long term, Republicans may get a few ideological gains from simply fixing the Affordable Care Act. If they manage to facilitate increasingly better outcomes, it’s going to blunt any call for a further expansion of Medicare in the short term, and probably set back the movement to institute nationwide single-payer for decades. In the meantime, we’ll have a healthier and more productive workforce with fewer people going into massive debt because of health care costs. There’s no reason that Republicans can’t be glad about these things.
Right now, the alternatives to simply fixing the Affordable Care Act range from spending another few years trying to come up with a replacement plan that won’t pass the House, to allowing harm come to millions of people because Obamacare collapsed. And while Republicans stay trapped within this line of thinking, they could compound these risks by touching off an insurance market meltdown or shutting down the government. None of this makes any sense from a standpoint of policy or electoral strategy. While my “just fix the damn Affordable Care Act” plan doesn’t allow for a total ideological victory, it’s the only plan out there that allows everybody to “win.”
Let’s face it: I have always thought that two-thirds of the hostility that GOP lawmakers have shown the Affordable Care Act over the years simply stems from the fact that Obama essentially stole the entire idea for the law from Republicans in the first place. Well, here’s their chance to steal it back.
Jason Linkins edits “Eat The Press” for The Huffington Post and co-hosts the HuffPost Politics podcast “So, That Happened.” Subscribe here, and listen to the latest episode below.