House Republicans are rattled and confused after their rapid, frustrating, angry failure to pass a healthcare reform bill. Leaders don’t know which way to go next, and rank-and-file members have no idea what to expect.
Here, and it’s not a new idea, is what they should do: Repeal and replace Obamacare.
Obamacare is a bad system, and the notion that mid-March 2017 was the not just the first but also the last opportunity to replace it was ridiculous.
When House Speaker Paul Ryan said congressmen had a “binary choice,” to vote for the American Health Care Act or to live with Obamacare, it wasn’t true, even though he perhaps really believed it was. President Trump made the same claim, that if that bill didn’t pass, the White House would move on.
Whether or not this was a bluff that got called, it was a massive miscalculation. So now it’s time to deal another hand. The defeat last week of the AHCA in no way prevents Republicans from returning to this issue. No deadline has been missed.
Democrats passed Obamacare into law in March, but it was March of Obama’s second year, not his first. From inauguration to signing was more than 13 months. Repeatedly, the bill seemed dead. It seemed dead when Democratic members faced a firestorm in summer town halls. It seemed very dead when Republican Scott Brown won a special election, destroying the Democratic supermajority.
Sharp disagreements arose and persisted between the committees, between chambers, between wings of the parties. Democrats persisted, hashed out differences, and eventually passed the bill into law.
Republicans need to emulate that persistence and learn from the mistakes of their recent furtive effort.
The second time around, leaders shouldn’t just craft a bill and hand it to the House. Let congressional committees do their work to shape the legislation. Let dissidents and supporters all have a seat at the table. This will win some buy-in even from members who don’t get their way in shaping the bill. At least they will have been listened to and will have some sort of a vote. A participatory, open process, might achieve a deal within the governing party.
There’s something else we know now that we didn’t know at the beginning of March. A bill that kills Obamacare’s regulations may still be eligible for budget reconciliation treatment, which makes it immune to a filibuster in the Senate.
The Senate parliamentarian has told senators that if the legislative language is written correctly, a reconciliation bill could repeal regulations. This is so far from shocking as to be fairly obvious. Obamacare’s regulations drive up the cost of health insurance, and the government subsidizes insurance premiums. That means deregulation to lower insurance premiums can reduce the deficit.
The AHCA didn’t include any deregulation, and Republican leaders pointed to reconciliation rules to justify the omission. Then they added a provision altering some regulations, but in a jury-rigged way that was also so sudden that it drove some centrists away.
The next repeal and replacement should include repeal of the regulations from the outset. If there are parliamentary problems, address them when they come up in the upper chamber rather than trying to read the Senate parliamentarian’s mind from the House side of the Capitol.
Leaving Obamacare in place is not a responsible course of action. The exchanges are sclerotic in much of the country, with little or no competition. A web of mandates and regulations leaves insurers as unprofitable monopolies in many markets. The law wasn’t merely objectionable on ideological grounds, it was poorly built.
Keeping the country on Obamacare is asking for a broken insurance market, and eventually more government control, even a single-payer system, which is what many on the left wanted all along. Obamacare needs to go. Having failed once at repealing and replacing it is not excuse for leaving it in place. It’s an argument to come up with a better plan of attack.
