There’s plenty of room to argue over who was primarily responsible for the implosion of the House Republican leadership’s Obamacare-partial-repeal bill last week. No less than fourteen lessons are drawn by my Washington Examiner colleague Byron York.
Many blame those purist members of the House Freedom Caucus who refused to accept anything less than a complete Obamacare repeal or, when one demand was met, suddenly made another. Many blame Speaker Paul Ryan and/or the Trump White House for insisting on bringing a complex bill forward in an unusually short period of time; it will be interesting to learn who insisted on such a tight schedule (the Democrats took 14 months to pass Obamacare in 2009-10). Many blame so-called moderate Republicans who moved to opposition in the closing days.
One thing that’s clear is that different groups of Republicans made various demands on the assumption that Ryan and Trump had no option but to accede to them. But on this and other issues Trump has other options, as White House Chief of Staff Reince Priebus was at pains to point out on the Sunday shows. Ryan is a principled conservative, who has sought reform of entitlement programs which in his view (and mine) are on an unsustainable trajectory; that’s why he included a provision in the healthcare bill setting a long-term limit on federal Medicaid funding.
Trump has made it clear that he opposes entitlement reforms. In effect he’s taken Social Security reform, of the sort George W. Bush sought in 2005, off the table, and has shown no interest in the Medicare reform Ryan has championed as Ways and Means Committee chairman and speaker.
In contrast, Trump praised the Canadian healthcare system during the campaign. A lifelong resident of New York City, he has shown little discomfort with its big government institutions, seeking to manipulate rather than abolish them. After the Ryan bill was pulled from the floor, Trump made remarks suggesting he could work with Democrats on healthcare and other issues; infrastructure is one obvious possibility, but there are others, including taxes.
If Freedom Caucus purism keeps Ryan from amassing a Republican majority in the House, Trump could seek different majorities there and in the Senate. The result could be to push public policy to the left rather than the right. How many congressional Republicans want that?
