Dozens of conservative congressmen will vote against the American Health Care Act, in part because they don’t trust the promises from their party’s leadership. And that skepticism is well founded.
The Republican majority in both chambers is built largely of men and women elected by a party base angry that the GOP hasn’t delivered its promises. Republicans over the past two decades ran on spending cuts but then exploded the budget. They ran on small government, and then created a new entitlement and bailed out Wall Street.
The Tea Party was partly a revolt against those broken promises. Eric Cantor and John Boehner lost their jobs because of disillusionment among a conservative base that felt it was lied to. Republican voters picked Donald Trump, an outsider, because they didn’t trust the insiders.
Against this backdrop, Republican leaders are playing with fire in their approach to Obamacare repeal.
Donald Trump promised to “fully repeal” Obamacare. Voters handed unified government to the party that promised ceaselessly to repeal the bill. But the new bill, the AHCA, doesn’t do that. It leaves in place much of Obamacare, specifically the regulations that make insurance more expensive and insulate the industry from competition.
Republicans have insisted that they cannot repeal Obamacare’s regulations now because that would require 60 votes in the Senate. The House bill, leadership has argued, contains only those measures that it is sure can pass the Senate through the budget reconciliation process, which is exempt from filibusters and thus requires only 51 votes.
This is standard fare in fights between conservatives and party leaders. Conservatives demand the party deliver what it promised and leaders respond that it is delivering the best bill that can pass.
But there’s plenty of reason to doubt that this partial repeal — the bill repeals all of Obamacare’s tax hikes but not its regulations — is “the best bill that can pass.” For one thing, it’s unclear that partial repeal will get more Republican votes than full repeal would. Second, we don’t know whether Republicans can repeal the bill through budget reconciliation because Republicans haven’t tried to do it.
Sen. Mike Lee, R-Utah, asked the Senate parliamentarian this week, and the parliamentarian indicated that repealing the regulation may be kosher in a reconciliation bill.
This isn’t far-fetched at all. Cato Institute healthcare expert Michael Cannon laid out the case in detail on the pages of the Washington Examiner. In short, Obamacare’s regulations are the terms and conditions for Obamacare’s spending. A budget reconciliation should be able to repeal these regulations, which drive federal spending levels.
This suggests to us and to congressional conservatives that Republicans should fix the House bill before Thursday’s vote and include repeal of the regulations.
Leaders in recent days have made a counter-argument that the House bill needs to be limited to taxes and spending so that it doesn’t get stopped at the Senate door by the parliamentarian. The claim is that if the parliamentarian rejects the argument, it would be better to see a regulation-gutting Senate amendment blocked than to see the whole bill blocked because it contained regulatory provisions.
This is what Republican leaders are telling wary House conservatives now. It is, once again, “trust us.”
Republican leaders will invite an avalanche of distrust and disillusionment if they don’t try to make this argument, openly, on the Senate floor. There’s no guarantee that the parliamentarian will agree, but this effort shouldn’t happen behind closed doors. It won’t satisfy anyone for Majority Leader Mitch McConnell, R-Ky., to explain, in a disappointed tone of voice, that he did what he could but the regulatory reform has to wait while the tax cuts for the medical-device industry get to sail through.
The party leadership can only redeem that trust if they fight openly, vigorously and effectively, to get their deregulating amendments in the reconciliation bill. Anything less will be a breach of trust.
