On Friday, Speaker of the House Paul Ryan’s crumbling halfway house — known officially as the American Health Care Act — definitively collapsed.
So far, the standard tactic among Republican leadership and the mainstream media has been to point fingers at the House Freedom Caucus and blame them for obstinately blocking the bill. But this is laughable and untrue. The repeal and replace movement didn’t have to wind up in the mess it did on Friday, and pundits and politicians alike need to take a long, hard look at the facts.
In the 114th Congress, Republicans passed the Restoring Americans’ Health Care Freedom Act, which repealed much of Obamacare. The bill delivered on most fronts: It gutted most of Obamacare’s taxes, it erased its tax and cost-sharing subsidies, it blocked Medicaid’s two-year window for expansion, and it cancelled the individual and employer mandates.
At the time, Ryan praised the bill in a press release: “We have shown now that there is a clear path to repealing Obamacare without 60 votes in the Senate,” he said. “So next year, if we’re sending this bill to a Republican president, it will get signed into law.”
But this bill didn’t wind up making it to President Trump’s desk. What Republicans tried to send him instead was a new version of the Affordable Care Act, with an ‘H’ added to the acronym.
The bill established what is essentially a new entitlement program through the use of refundable tax credits. It retained, though delayed, Obamacare’s “Cadillac tax.” It replaced one individual mandate with another. And it allowed the states to keep enrolling people in Medicaid until Dec. 31, 2019 — by which time, presidential election season will have rolled around again and Democrats will have made reinstating Medicaid expansion a major campaign issue.
The bill also fell far short of repealing Obamacare’s regulatory structure in Title I of the law. The Heritage Foundation has noted that these regulations are responsible for 44 percent to 68 percent of premium increases. While House Republican leadership did eventually include the so-called “essential health benefits” in the bill, they refused to repeal Obamacare’s community rating provision, which is a major cost-driver for premiums.
Conservatives put Republicans in the House in 2010, the Senate in 2014 and the White House in 2016 — all on the understanding that Republicans would keep their promises to really repeal Obamacare. As late as January of this year, congressional Republicans continued to reiterate these promises. But Ryan’s bill tried to do Obamacare better than the Democrats did — it was more big government.
It should surprise no one, then, that the House Freedom Caucus opposed the bill as it was written. They are not simply being intransigent or obstinate. The American Health Care Act is a complete betrayal of everything that Republicans said they could deliver in 2016. It ignores the frustration of millions of Americans tired of mounting premiums, closing co-ops and broken promises. The Freedom Caucus is simply holding the rest of the party to their words.
All Ryan needed to do was follow through, perhaps add Title I to the bill and elements of the replace plan that conservatives support, and spearhead the Restoring Americans’ Health Care Freedom Act, as he said his plan was under a Republican president — but that was when most people thought Hillary Clinton would win. Sticking to the plan would have paved the way for Republicans to tackle tax reform and other key policy issues. It would have increased trust in their leadership and shown the country that they knew how to govern.
But instead of choosing to stay the course and use members’ votes for the bill under President Barack Obama, he tried to twist the arms of the Freedom Caucus to support an Obamacare-like bill.
The week prior to the vote, 1,000 conservative grassroots activists stormed Congress to make it clear that they would accept no less than a full repeal. House Republicans ignored them — and Friday we saw the result. Representatives must do what the people hired them to do and actually represent their constituents. Failure to do so not only means failure politically, it means failure as a leader.
As Ryan and House Republican leadership struggle to regroup over the weeks to come, they must learn from their massive mistake.
Adam Brandon (@adam_brandon) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is president and CEO of FreedomWorks.
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