WASHINGTON ― Republicans could have run on preserving employer-based health insurance. They could have run against Democratic plans to enact “Medicare for all” and moved beyond the GOP’s doomed efforts in 2017 to repeal Obamacare and replace it with an unpopular bill that would have undermined protections for people with pre-existing conditions.
Instead, thanks to President Donald Trump, the GOP is gearing up for 2020 races centered on many of the same health care issues that plagued them in 2018 ― and congressional Republicans don’t even seem upset.
“One way or the other, you’re going to talk about them,” Rep. Rob Bishop (R-Utah) told HuffPost on Tuesday. “Obamacare basically is structurally unsound. It’s going to have to be fixed at some time. Whether it’s sooner or later, you’re going to have to talk about it.”
He said it “doesn’t hurt” that Trump has brought repealing the Affordable Care Act back to the forefront, with the Department of Justice now taking the position that the courts should strike down the entire law. And most Republicans HuffPost talked to Tuesday agreed.
“It’s certainly not hurtful,” said Rep. Ted Budd (R-N.C.), who represents a Republican-leaning district that Democrats are targeting in 2020.
He said it was “always great” to be talking about “market-based solutions” to health care, and while he said it was also politically helpful to be contrasting the Republican plan with Democratic proposals that would end employer-provided insurance, he said he didn’t have a problem with GOP efforts to kill Obamacare suddenly dominating the discussion.
“That was something President Trump was discussing, and you know he processes stuff out loud. And that’s fine,” Budd said.
Like many other Republicans HuffPost talked to, Budd seemed to take more issue with the GOP’s inability to repeal Obamacare than he did with the bill Republicans offered up as a replacement.
“What was unpopular is that we didn’t get it done, and that’s one person in the United States Senate,” Rep. Tom Cole (R-Okla.) said, referring to the late Sen. John McCain (R-Ariz.).
Cole said he didn’t believe the renewed focus on Republican efforts to repeal the Affordable Care Act would make much of a difference in the long term ― “It’s going to be a blip on the political radar,” he said ― but he certainly didn’t appear afraid of another fight over Obamacare or the House GOP health care bill, the American Health Care Act.
Democrats seemed ready to tear one another apart in 2020 over “Medicare for all,” and Republicans seemed eager to make political hay over those Democratic efforts to end employer-based health insurance. But Trump’s threats to dismantle Obamacare through the courts has united Democrats, with even the most progressive lawmakers saying Democrats should first shore up the Affordable Care Act.
Trump has backtracked somewhat from his earlier calls for Republicans to begin working on health care now. With the House under Democratic control, he tweeted Tuesday that Republicans could wait until after the 2020 elections to get going on health care again.
But such a statement preserves health care as a political issue, and a lawsuit making its way through the courts adds urgency. Voters are likely to know exactly what’s at stake in November 2020.
If you needed an example of how damaging the AHCA was to Republican re-election efforts, look no further than the 2018 midterms. Republicans lost 41 seats in the House, and health care was the top issue on the minds of voters, according to exit polls. Even more troubling for the GOP, 58 percent of voters said Democrats would better protect people with pre-existing conditions, compared with 34 percent who said Republicans.
Much of that is due to the GOP health care bill drastically undermining those protections.
The AHCA would have allowed states to waive those protections if they set up “high-risk pools” for the sick to get coverage. The big problem with such a plan, however, was that the Republican bill drastically underfunded those high-risk pools.
By one estimate, Republicans had designated only about one-third of the money required to adequately fund these pools, meaning states would have to come up with the money themselves or, more likely, come up with a slew of regulations to limit the number of people who could get access to the high-risk pools.
The Congressional Budget Office concluded in its summary of the legislation that those with pre-existing conditions “would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”
But if you talk to Republicans, you’re bound to find some lawmakers who insist the AHCA would have protected the less than healthy. Rep. Rodney Davis (R-Ill.) repeatedly ― and spiritedly ― claimed as much. “That’s the craziest thing. It’s English in there, buddy. Read it,” he told HuffPost.
(PolitiFact rated the claim that the AHCA would not eliminate protections for people with pre-existing conditions as “mostly false.”)
And vulnerable Rep. Will Hurd (R-Texas) claimed, “Republicans and Democrats agree that we should protect pre-existing conditions.”
But when challenged that the AHCA would have undermined those protections and that the GOP-backed lawsuit to strike down Obamacare would gut them, he said that that implied those were the only two ways to address health care.
And when HuffPost noted that there wasn’t an alternative GOP plan, Hurd responded, “Um, there’s some piece of legislation, and we can point you to it. Thanks, my man.”
Rep. Elise Stefanik (R-N.Y.) told HuffPost that some Republicans were working on an alternative health care bill that would protect people with pre-existing conditions, though she admitted one didn’t exist yet.
But if the AHCA fight proved anything among House Republicans, it’s that the only bill that can pass with votes in just their conference is one that undermines protections for the sick in exchange for lower premiums for everybody else.
That was what caused a handful of moderates to vote against the proposal ― moderates like Rep. Brian Fitzpatrick (R-Pa.).
Fitzpatrick, who eked out re-election by 2.5 percentage points, said that he voted against the bill because it didn’t protect people with pre-existing conditions and that Republicans were wrong that a renewed focus on health care would help them politically.
“Of course we have to talk about health care, but it’s got to be health care that the American people want. The American people don’t want a pure repeal of the ACA. They want to keep what works, fix what’s broken,” he said.
“Politically, it makes sense to give solutions that make sense,” Fitzpatrick said, mentioning better interstate competition and medical liability reform.
The only other Republican HuffPost talked to on Tuesday who agreed that Trump’s reinsertion of health care into the conversation was unhelpful was Rep. Justin Amash (R-Mich.).
Amash said he could hardly believe other Republicans thought Trump was doing them a favor. (“They think it’s helpful?!” he asked in amazement.) And he suggested Trump was doing this only to change the conversation, possibly away from special counsel Robert Mueller’s report.
“The president often has his own reasons for bringing up certain topics, sometimes it’s to distract from something else or change the subject. I don’t know,” Amash said.