House Speaker Paul Ryan says the nation has just two options. It can accept his repeal and replace bill or it can keep the mess it already has. “It really comes down to a binary choice,” he said, trying to whip recalcitrant conservatives into line behind the American Health Care Act. “This is the closest we will ever get to repealing and replacing Obamacare.”
Many House Republicans are persuaded. So are some conservative commentators and activists. But they are mistaken because Ryan’s logic is faulty.
Our friends at the Wall Street Journal editorial page endorsed the AHCA on Wednesday, focusing mostly on the tax cuts in the bill. Tax cuts are indeed an attractive feature of the legislation, but voters delivered neither House and Senate majorities to the GOP nor President Trump’s stunning victory so that united government could deliver a narrow victory of lower tax rates for big corporations. Nor were lower taxes on capital gains and medical devices what ignited voters’ support for Republicans. They wanted something bigger and more sweeping than that.
The journal argued that conservative critics of the House repeal and replace bill are “missing the larger and rarer opportunity,” and added, “ObamaCare was designed to expand over time … If conservatives fumble this repeal-and-replace moment, they won’t get another chance.”
This is true as far as it goes, but just because the time is right to repeal and replace does not mean Ryan’s bill is the right way to do it. His premise of “a binary choice” is not true.
There’s another option. Republicans could pass a better Obamacare replacement, one that doesn’t preserve costly regulations or create a brand new entitlement.
The current bill was drafted in the dark without debate. It wasn’t a collaborative or a transparent process. And now Ryan talks and behaves as though it’s a done deal.
The bill has already passed through both the Ways and Means panel and the Energy and Commerce committee. The panel meetings that passed the legislation are called “markups” because they usually mark up bills by adding amendments, deleting provisions, and appending whole sections. Nothing like that happened this time. Party leaders made sure every amendment was killed and that the committees passed the bill unaltered.
It’s hard to understand Ryan’s antagonism towards debate. Why the rush?
A comparison with the passage of Obamacare itself is telling. It is true that Obamacare passed through parliamentary shenanigans shoved forward by heavy-handed leadership tactics. But the process wasn’t a sprint of a few weeks. Obama and the Democratic Congress started shaping the bill right after the 2008 election, and it didn’t become law until March 2010. From inauguration to passage took 14 months.
There’s no rush now. Republicans will control Congress at least through January 2, 2019, and have the White House, at a minimum, for two years longer than that.
There’s also no reason to believe the current bill has a better chance of passing than a genuinely conservative alternative. Centrist Republicans are abandoning Ryan’s bill after the Congressional Budget Office predicted that it would leave millions more people without insurance.
Rep. Ileana Ros-Lehtinen, R-Fla., declared Wednesday “I plan to vote NO on the current #AHCA bill.” Rep. Leonard Lance (R-N.J.) said he wants leadership to drop the bill. Enough moderate, conservative, and Trumpish Republicans have expressed concern that it’s not clear the bill could pass either chamber.
A true debate, and maybe even competing replacement bills, are called for. A good replacement would repeal Obamacare’s regulations that make insurance plans so costly. Could this get Susan Collins’ vote, or Justin Amash’s? Would repealing the regulations fit within a bill considered under the budget reconciliation process (and thus immune from a Democratic filibuster)? It’s possible and certainly arguable. But under the current plan of action we will never know, because the “binary” doesn’t allow other reform plans to be considered.
The “binary choice” is a false premise and thus a bad argument. It’s also bad politics that will yield bad policy. Republicans and conservatives who want real healthcare reform (not merely tax cuts) should withhold support at least until their leaders agree to consider other possible roads out of Obamacare.
