The Falling Apart Of The Deal: GOP Disunity Delays American Health Care Act Indefinitely

“It’s gonna pass. And that’s it.”

Those words coming today at 2:08 p.m. EST from the White House Press Secretary when asked if there might be a rescheduling of the House vote on the American Health Care Act (AHCA) if the GOP couldn’t muster enough votes. Sean Spicer channels his boss more and more every day.

The truth, of course, is that Spicer didn’t know. Nor did Speaker Ryan. Nor President Trump. That’s why representatives actually vote. Same reason marathoners run the race. Drop the puck. Deal the cards. You get the point. Or at least, that’s why they schedule the vote.

Predictions have abounded for days. To the extent that “experts” still exist within the political world after the last two years, I did ask one of them for a prediction. Mark McKinnon, former adviser President George W. Bush and Senator John McCain, did an interview with me yesterday. When I pressed him for a “yes” or “no” on whether the AHCA will ultimately be passed by both chambers into law, Mark begrudgingly flashed a green light:

“I’m not very good at handicapping legislative battles. But I think that ultimately, it’s such an existential issue for the Republicans. I mean, they ran on repealing and replacing this thing, and if they don’t do it, they’re cooked It seems to me that ultimately they’ve got to find some way to get it done.”

I was a little surprised by Mark’s prediction, mostly because it’s felt all along like Republicans have lost the messaging war on this legislation. But also because the whole thing seems to get messier every day. Of course, we must not forget just how messy it was for the Democrats to pass the Affordable Care Act. It was a long battle even when the Dems possessed a filibuster-proof 60 vote majority in the Senate. And once Senator Ted Kennedy had died and Scott Brown (R-MA) shocked the world in replacing him, it got even messier. But what we’ve been watching play out in recent day is a whole different brand of messy.

The GOP has been at war with itself in recent years. And just before it won the White House and barely held on in the Senate on November 8th, it looked like Donald Trump’s upending of the party was going to force an even more public struggle for its future. But he did win. So that philosophical battle all of a sudden became very real. Governing. Organizing a “unity government.” The one big, public thing that did unite congressional Republicans for nearly a decade was that phrase “repeal and replace.” I remember when I first heard it. My immediate thought was how brilliant and tight those three words were as a marketing slogan. It was alliterative. It was assonant. It also seemed asinine. And the former Speaker of the House, John Boehner (R-OH), knew it. He made that point very clear just a few weeks ago:

“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once. And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we’ll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it.”

In the preamble I wrote two years ago in Unlock Congress, I likened the freedom with which former members of Congress speak their minds to suspects given immunity in a criminal investigation. They can easily tell the truth, as there’s no personal consequence for them anymore (elections). If you’ve watched or listened to Boehner say these things since his 2015 retirement, he seems positively gleeful to share his thoughts. Governing is hard. Opposing or commenting is easy.

So today, on the seventh anniversary of the day that Obamacare was signed into law, you had a whole lot of people who were very annoyed.

Speaker Ryan was annoyed that he couldn’t just get to a vote on the original bill that he laid out for the president and for the press in a lovely Power Point presentation last week.

The 29 members of the House Freedom Caucus (HFC) ― the conservative wing of the GOP majority ― were annoyed that the bill was not “free-market”-oriented enough (Republicans could only afford 21 “no” votes to pass the AHCA though the House).

The White House was annoyed with the members of the HFC, so it negotiated with them.

When the president agreed to give them concessions last night, without first telling Speaker Ryan, Ryan and the moderates in the House then got annoyed.

Meanwhile, Republicans in the Senate have been annoyed for weeks that their colleagues in the House have been trying to pass the bill in any form. So annoyed, in fact, that they’ve been warning about its imminent failure in the Senate, and begging the House to drop the dud altogether. One of the bill’s opponents, Senator Susan Collins (R-ME), boiled it down:

“My goal is to expand access to health care and have more individuals covered than in the ACA, and prevent the collapse of the ACA marketplace.”

Collins, and some of her other GOP colleagues, almost sound like Democrats. Congressman Eric Swalwell (D-CA) has become one of the best when it comes to distilling his own party’s talking points on AHCA:

“This bill is bad and it’s going to make people sicker and poorer ... There’s ways to improve the Affordable Care Act. He hasn’t come to Democrats yet. He promised that he’d be this great negotiator businessman, and we’re still waiting.”

But here’s the part that’s deliciously ironic for many on the left yet very troubling for the country at large: The conservative HFC members who have been negotiating concessions with the president are not requesting things that will cover more people (reports the Congressional Budget Office). The HFC got Trump to give in and agree to get rid of the Obamacare mandates which require insurance companies to provide a floor of “essential benefits.” But that still didn’t go far enough. And at this point it seems like nothing may end up being enough for those who oppose. Last night, Congressman Thomas Massie (R-KY) of the HFC was asked by CNN’s Kate Bolduan if he believed that President Trump was right that their House majority was at risk if they didn’t pass the bill. Massie flipped the script entirely, explaining that the president didn’t understand just how awful the proposed legislation is:

“We’re afraid he’s a one term president if this passes. We are trying to save him. The phone calls to my office are running 275 against vs. only four votes from my constituents are in favor of this. So electorally, voting for this is bad today, and it’s gonna be really bad in two or three years when the changes start kicking in, and health insurance prices start going through the roof.”

Massie didn’t detail precisely why his constituents were against the ACHA. Might many or most of them been voters who benefited from Obamacare? Were they all objecting for the same complaints that HFC members have with the bill? Were they worried that health care premiums would go up, as Massie and other have been warning? Or were they worried that they were going to be among the 24 million Americans that the CBO estimates will lose their coverage over the next several years?

Meanwhile, back in Washington, House Minority Leader Nancy Pelosi (D-CA), the person who lead the effort to get the Affordable Care Act passed when she was Speaker of the House, called Speaker Ryan’s scheduling of an uncertain vote a “rookie error.” Pelosi was right. In the 4:00 hour this afternoon, the House Republican Leadership cancelled the vote. Thirty GOP members were No’s ― and not just HFC members. Rep. Charlie Dent (R-PA), known as one of the more pragmatic moderates in his party, said the following:

“I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”

You could almost hear Democrats all over the country celebrating when the announcement was made. Or at least breathing a yuge sigh of relief. Senate Republicans, too. But nobody should be too thrilled, because the less talked about headline today is that the U.S. Congress and the president of the United States aren’t just failing to pass Trumpcare ― they’re failing to improve the overall system. When you set aside all of the partisanship, we still have a healthcare system in this country that I have described more than once as a “non-system.”

In the quote above from Rep. Swalwell, he zings President Trump for not taking even the first step to negotiate with Democrats. It’s not really a surprise that he hasn’t, of course. Trump will need Democrats in the Senate at some point on healthcare, if his party is able to spiff up this stinker enough to pass the House. The president isn’t exactly someone who plans ahead. But there are real effects and consequences of the president doing this in isolation. In that same interview with Mark McKinnon, he told me that he’d never seen a president be successful by governing exclusively to his base.

In the election campaign, Donald Trump did something historic. He exploded traditional political voting blocks in the country, and in a way this set him up to do very big things in the presidency if he actually stood up to buck his party once in power. A big problem for him is that his math never made sense. On most things, including healthcare. Keeping his twin promises of repealing Obamacare, while providing universal coverage for all Americans, is not possible. But Trump doesn’t care about moving off things he’s said. In fact, it’s a uniquely personal character he carries.

The truth is that as much good as the Affordable Care Act has done for people in recent years, which President Obama reminded everyone of today on its seventh anniversary, it needs plenty of fixes. McKinnon elaborates:

“I don’t think there’s a Democratic Senator or House member out there that would say that Obamacare is perfect and doesn’t need changes. So you have a strong majority on both sides of the aisle that believe it needs to be amended, needs to be improved. And yet what we’re going to end up with if it does pass is a bill with 100% Republican votes and zero Democratic votes which was the problem with the earlier bill. And either way that’s a problem.”

In theory, President Trump could still change all that. Theoretically, he could change the trajectory of these efforts at healthcare legislation. If he really wanted to display some of that “art of the deal” stuff he constantly boasts about, he could reach out to Democrats, get into the details of the current healthcare landscape, and improve upon the historic legislation that was passed in 2010. Sadly, this is theoretical. Because the GOP is still at war with itself about just how conservative a party it is going to be. Not just in elections, but now with actual power. Meanwhile, the status quo of our healthcare non-system survives. Ridiculously high drug costs. Higher prices for medical procedures. Too many hard-working people who are still paying too much for coverage. And worse health outcomes than we see in so many other advanced democracies.

The GOP may still get to a vote on Friday, or at some point in the future. Even if it passes, it’s a failure. And as with all failures, it will have plenty of fathers. It won’t be just Donald Trump’s. It is also the failure of a defective and polarized U.S. Congress. There are reasons why ― you could fill a book with ‘em.