President Trump promised again on Tuesday night that Republicans would repeal and replace Obamacare. It was good to hear this expression of resolve, for achieving the desirable goal will require persistence and follow through.
Trump has been consistent in calling for repeal and replace, as he has on other policies such as trade protectionism and a border wall. But his debating and other rhetoric does not evince purposeful, clear, step-by-step thinking. So turning the huge policy goal into legislative reality is likely to present a challenge to the president orders of magnitude greater than he yet realizes.
The White House doesn’t need to dictate the specifics of replacement, but it does need to ride Congress to make sure it happens. Some observers have expected Trump simply to give Speaker Paul Ryan the “go” signal on all wonky policy matters and then turn his attention to Making America Great Again. That won’t work on healthcare.
Congressional Republicans are divided on what needs to be in a repeal bill, and the divisions on replacement are deeper and more numerous. If Trump leaves Congress alone, repeal and replace will stall.
Even if Trump, Ryan and Senate Majority Leader Mitch McConnell play their cards expertly, repeal and replace will be no easy lift and will hit serious snags. It will perhaps often look dead. But as long as Republicans control both chambers and the White House, it won’t be dead.
President Barack Obama understood this eight years ago. When lawmakers went home for recess in August 2009 they were soaked in a massive flood of opposition to Obamacare. They returned to Washington scared. Obama persisted, though. He rallied industry lobbyists who were beginning to worry, and he called a joint session of Congress to buck up his party’s lawmakers.
When a handful of members looked likely to torpedo the House bill, Obama gave Democratic leaders the go-ahead to cut deals. To win over wavering senators, the White House persuaded drug makers to promise support in the mid-terms.
Then Republican Scott Brown won the special election to replace Sen. Ted Kennedy, and Democrats lost their supermajority. Conventional wisdom suggested Obamacare was dead. But Obama kept hammering. He called a healthcare summit in February to keep the issue alive.
A month later, he signed the bill into law.
The president was willing to spend political capital, and, more importantly, he never let himself be distracted. His eyes stayed on the prize. Plenty else was going on, but he focused, paid attention and followed through until he was done.
Trump’s address to Congress on Tuesday was uncharacteristically steady and on message. This is the virtue he will need to show if he’s going to get serious policy wins, especially the repeal and replacement of Obamacare.
Dropping the ball and leaving Obamacare intact would be disastrous, politically and for the healthcare of the nation.
Repealing Obamacare isn’t merely a Trump promise. It has been the central political promise of the GOP since 2010. In 2010, Republicans ran on repeal and took the House. In 2012, the top of the GOP ticket was Mitt Romney, author of Obamacare’s first draft in Massachusetts, and Republicans lost. In 2014, Republicans ran against Obamacare and won the Senate. In 2016, Trump pledged to repeal Obamacare and won.
Voters expect politicians to break some promises, but breaking the promise to replace Obamacare would tell voters that Republican candidates are fundamentally unreliable.
Obamacare is a Trojan Horse for a steady government takeover of the health sector. That’s been obvious since before it was passed. These days, rickety exchanges threaten to destroy the heavily subsidized-and-regulated private markets the law set up, and the Left is using this danger to call for a more direct government role.
A federal takeover of health insurance would be a deadly blow to liberty. Once everyone is paying for everyone else medical problems, you can expect nanny-statism to soar. Rationing will follow. When the government controls 18 percent of the economy — that portion will grow — the economy will increasingly become dependent on Uncle Sam. This is a recipe for inefficiency, cronyism, and a Leviathan State.
The legislative process is difficult, and lawmakers can be fickle and unpredictable. Trump will need to persist through frustrations, twists and downturns. If the White House lets up the pressure, the risk is high that Congress will fumble the issue.
Then Obamacare will win. The party and the country can’t afford that.
