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Republicans On Capitol Hill Admitting Defeat On Health Care Reform

congress-healthcare

Politico reports that Republicans on Capitol Hill are once again admitting defeat on the seven-year-long effort to ‘repeal and replace’ the Affordable Care Act:

For the first time, rank-and-file Republicans are acknowledging Obamacare may never be repealed.

After multiple failures to repeal the law, the White House and many GOP lawmakers are publicly promising to try again in early 2018. But privately, both House and Senate Republicans acknowledge they may never be able to deliver on their seven-year vow to scrap the law.

“Personally, I don’t” see it, Rep. Phil Roe (R-Tenn.) said. “I just don’t know how you can reconcile a bill you’ve taken two whiffs at already and couldn’t get the votes.”

Some sound almost resigned to the new reality. “I’d say it’s 50-50,” Rep. Kevin Cramer (R-N.D.) said of the prospect the law will remain in place.

Republicans are torn between the potency of their longtime rallying cry against Obamacare — so popular with GOP donors and their base that it helped flip both houses of Congress and the White House — and the reality they’ve wasted nine months of what is supposed to be the most productive time of a new administration failing to get it done. With few legislative accomplishments so far to show voters, failure on Obamacare repeal could prove to be a major liability in the 2018 midterm elections.

Even if Republicans try again next year, few House Republicans are confident the Senate would be successful without a change in the GOP lineup or someone flipping their vote.

“Anytime you fumble twice, there’s the anticipation that you’ll fumble for the third time,” said Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. Do Senate Republicans have “credibility? Yes. Believability? Perhaps no.”

Nearly every Republican interviewed for this story insisted they still oppose the health care law and want to see the repeal effort move forward. But the failure to gather 50 Senate votes before the Sept. 30 deadline to pass a bill without the chance of a Democratic filibuster has injected a new dose of realism — and political vulnerability — into their ranks. Once-lofty campaign promises to tear out Obamacare “root and branch,” as Senate Majority Leader Mitch McConnell said throughout his 2014 reelection campaign, are as likely to produce winces as cheers.

All of this comes, of course, as we come close to the end of a year that has seen Republicans come closer than they ever have to following through on their nearly decade-long promise to bring down the Affordable Care Act. For most of that time, of course, the rhetoric on health care was just that, rhetoric. After gaining control of the House in the 2010 elections, Republicans held repeated votes on repealing the Affordable Care Act that amounted to little more than symbolism for the GOP base due to the fact that Democrats controlled the Senate. The only semi-serious effort the GOP made during this whole period was the 2013 government shutdown, which largely ended up blowing up in the faces of those who were its primary architects. When they finally gained control of the Senate in 2014, Republicans did manage to get a bill to the President’s desk but, of course, that measure was vetoed and no real effort was made to override that veto since the GOP clearly didn’t have the votes to do so. Instead, these votes were basically nothing more than red meat for the base and a means to finance fundraising appeals by Republican candidates, political action committees, and Tea Party groups.

All of that changed, of course, after the 2016 election. With the Republican Party in control of the House, Senate, and the White House, there was essentially no excuse for Republicans who ran on the idea of repealing and replacing the Affordable Care Act. Under these circumstances, and thanks to the fact that Senate Republicans could use the reconciliation process to push a repeal and replace bill through without having to worry about the sixty vote threshold usually necessary to invoke cloture, there was seemingly no reason why the GOP shouldn’t have been able to follow through on a promise they had been making to their base for nearly a decade. What they didn’t realize, of course, was that political reality meant that things would be far tougher than they appeared to be.

The fact that things would not be as simple as many expected should have been obvious from the start. The effort in the House nearly failed all on its own before that body passed the American Health Care Act on a party-line vote in early May. That bill, however, never even got considered by the Senate since it was apparent from the start that it had no chance of getting even fifty votes from Senate Republicans. Instead, the Senate GOP came up with its own bill, but that bill ended up facing difficulty before it even made it to the floor thanks in no small part to a devastating score from the Congressional Budget Office. In response,  Senate Republicans put forward a revised plan that also received a bad CBO score and quickly came under fire. When it became obvious that this bill would also fail to get even the fifty votes required to pass the bill under the Senates relaxed reconciliation rules, Majority Leader McConnell proposed yet another plan that would repeal the Affordable Care Act without actually replacing it with anything, but that plan ended up falling apart after only eighteen hours. Undaunted, the Senate still refused to give up and decided to go forward even though it was unclear which direction they were heading. The bill that finally resulted from that process ended up dying in dramatic fashion just before the August recess thanks to late-night thumbs down that sealed the bill’s fate. Finally, the Senate made one last effort last month with the bill proposed by Senators Lindsey Graham and Bill Cassidy that would have turned much of what the PPACA is all about into a huge block grant program that gave money to the states, who could then create whatever version of health care reform they wanted. The effort to pass that bill also proved to be unsuccessful and with it so did the current effort to repeal or replace the PPACA since Senate Republicans can no longer take advantage of reconciliation rules to get around the sixty-vote threshold.

As I noted when the final effort to repeal and replace the PPACA was pulled from the Senate floor in September, the biggest question going forward for Republicans will be what this failure will mean for the GOP going forward. For seven years, Republicans ran on promises to ‘repeal and replace’ the PPACA, using that promise to get donations and votes from a base that had an especially strong hatred for that bill. The fact that they were unable to do so even after having control of all the political branches of government is something that isn’t likely to reverberate well with base voters and is at least part of the motivation behind the war that Steve Bannon has declared against Senate Republicans heading into the 2018 elections.  The fact that repeal and replace has failed, and is unlikely to be revived before the 2018 midterms has the potential to give momentum to this war. The Tea Party movement was largely organized around opposition to the PPACA, and it was in no small part the basis for the energy that led to Republican electoral successes in 2010, 2014, and 2016 that allowed led to the GOP taking control of the House of Representatives, the Senate, the vast majority of state legislatures and Governor’s Mansions, and ultimately the Presidency itself. That last accomplishment occurred notwithstanding the fact that the GOP’s 2016 candidate was seemingly the worst possible choice to lead them to victory. Despite all of this wins, and all of the fundraising and organizing that was done around the whole ‘repeal and replace’ mantra, Republicans have proven unable to come up with the votes needed to accomplish what they promised for nearly a decade. What impact that will have heading into 2018 and beyond is unclear, but, as I’ve said before, it’s unlikely to be pretty.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Argon says:

    They’re going to try killing it with legislative and executive neglect. In the end those efforts are going to needlessly hurt a lot people.

    Like or Dislike: Thumb up 13 Thumb down 0

  2. Daryl's other brother Darryl says:

    Argon is correct…they will destroy it through Executive Orders, de-funding outreach and promotional programs, and neglect.
    The downside is that they will then spin that as a problem with Obamacare, which it isn’t.

    Trump today used Kissinger, a 90 year old man on Medicare, as an example of why Obamacare isn’t working. Comb-over Donnie is a moron, and is unfit for office.

    Like or Dislike: Thumb up 5 Thumb down 0

  3. reid says:

    You’ve focused on the politics of it all, but this is a huge example of how it’s easy to talk about doing something abstract that will hurt a lot of people, but it’s another matter to put it into policy and convince people to support it in a concrete form. Tax “reform” is similar. The Republicans have been trying to sell poop sandwiches for decades, and only their base eats them up. They need to either elect more rightwing extremists (difficult) or tone down the poop they’re shoveling.

    Like or Dislike: Thumb up 5 Thumb down 0

  4. Slugger says:

    I understand that politics is primarily about getting power, but somebody needs to care about using power. There are problems with healthcare in this country. It costs too much while delivering so-so results. This is a great opportunity for a couple of Senators/Representatives to do a real service to their nation. Get some serious people together and study the problem. Find a couple of possible solutions and lead a discussion. Do the work, please.
    I’ll start with an idea to get the ball rolling. Let’s drop the Medicare age to 50 for the next five years. I predict that the 50-65 age demographic has low rate of illness and won’t be that expensive. Put in a five year sunset into the law in case I’m wrong.

    Like or Dislike: Thumb up 4 Thumb down 0

  5. steve says:

    “I predict that the 50-65 age demographic has low rate of illness and won’t be that expensive.”

    You predict wrong. Going to Medicare might still have some merit, but you should go in with correct facts.

    Steve

    Like or Dislike: Thumb up 0 Thumb down 0

  6. michael reynolds says:

    For eight years now I’ve maintained that Obamacare was the best plan that could be managed given the toxicity of US politics. I believed that once in place it would be impossible to kill. Even with an unhinged president and a Republican Party apparently prepared to shove a bill with 20% support down our throats, Obamacare lives.

    It’s clearly not perfect, but we don’t do perfect. We don’t even do great anymore. We are a decaying democracy struggling with the imbecility of our voter base, and we are in deep trouble as a nation. Obamacare was the best we could manage. It still is. Obama worked with what he had to work with. If we can’t do better the fault lies with the American people, who cannot be bothered to pay attention or respond rationally.

    Like or Dislike: Thumb up 9 Thumb down 0

  7. Tyrell says:

    This is interesting: “Health insurance crisis to cripple Hawaii’s financial future”, “Hawaii may have underestimated just how serious the health insurance liability could be” (Forbes)
    So their it is. And this is just the tip of the iceberg. As we see the insurance companies pull out of one state after another. They can’t take the heavy losses. And what is causing this?
    One cause is that all those healthy young people did not sign up and send their money into the insurance market.
    Another is that hospital costs are soaring.
    The American people are, as one doctor put it, “overmedicated, over tested, and over doctored”. And you have the emergency room hassle where people show up for a cold, stubbed toe, or hangnail.*
    Some solutions are there: change the way hospitals and doctors charge for services, and treatments.
    Offer a variety of insurance options; from a lot of options such as cosmetic surgery, orthodontics, and gym memberships, to simple, no-frills hospital plans, including some access to Medicare plans. The federal government could create some sort of loan guarantees to banks to help people pay large medical bills over time. Increase tax credits and deductions for medical expenses, including a straight tax deduction instead of the ridiculous percentage of income.
    Do away with the mandate and absurd tax penalty. Most tax preparers and accountants know several ways to get around that anyway.
    Millions of people are and will see huge increases in the coming months. They can’t afford for half of their annual income to go to health insurance.
    I know people have some criticisms of my ideas, but that is okay. I just wish they would give some of their own ideas.
    The “Affordable Health Act” is collapsing, “it is repealing itself”

    *What ever happened to take some aspirin and go to bed?

    Like or Dislike: Thumb up 0 Thumb down 9

  8. Just 'nutha ig'nint cracker says:

    @Slugger:

    This is a great opportunity for a couple of Senators/Representatives to do a real service to their nation. Get some serious people together and study the problem.

    And that would be a great idea if service to the nation and solving problems with the PPACA had ever been the agenda item. It isn’t and never was. It was always about Obama being black, not knowing his place, being so uppity that he thought that he was good enough to be President (how silly is that–a black man thinks he can be President), and last but not least, transferring all the money that was being wasted on health care for people like me to 1%ers.

    Yes. It would have been a great opportunity. If only…

    Like or Dislike: Thumb up 3 Thumb down 0

  9. Slugger says:

    @steve: You may well be right. I am not a politician, and do not consider myself infallible. That is why I asked for a sunset provision in my proposal.
    Looking at the ACC MI risk calculator we see that a nonsmoking white male with a total cholesterol of 210, an LDL of 140, HDL of 50, and systolic BP of 135 at age 52 has a ten year risk of a heart attack of 4.9. With the same numbers and an age of 72 bumps the risk to 22.8.
    Obviously, health care requires much analysis. I wish our leaders looked beyond the next election.

    Like or Dislike: Thumb up 0 Thumb down 0

  10. Mister Bluster says:

    “Personally, I don’t” see it, Rep. Phil Roe (R-Tenn.) said. “I just don’t know how you can reconcile a bill you’ve taken two whiffs at already and couldn’t get the votes.”

    Forget health care.
    Dear Leader Kim Jong Trump has far more important issues on his populist agenda.

    Donald J. Trump ✔ @realDonaldTrump
    Why Isn’t the Senate Intel Committee looking into the Fake News Networks in OUR country to see why so much of our news is just made up-FAKE!
    5:59 AM – Oct 5, 2017

    And when Trump completes his purge of the press he can carry out his plan to make America a safe place for the good nazi’s and righteous KKK thugs!

    Like or Dislike: Thumb up 0 Thumb down 0

  11. Davebo says:

    @Tyrell:

    The issue isn’t insurance really though that’s part of it. It’s the skyrocketing costs insurance companies have to pay to providers. No other business could survive with the horrific inefficiencies health providers have. Redundant tests often caused by a system of information sharing that comes out of the 1970’s. Faxing those test results? Seriously? Faxing?

    The excuse is often HIPPA but that BS. Banks seem to be really good at sharing information (and credit ratings companies seem really good at sharing information with everyone).

    The question shouldn’t be “do you want to turn over almost twenty percent of our GDP over to the government (as if anyone is suggesting that). The question is how in the hell did we get to the point that health care takes up almost twenty percent of our GDP?? That is the problem.

    Like or Dislike: Thumb up 5 Thumb down 0

  12. Tyrell says:

    @Davebo: Hospital charged near $100 for a styrofoam throw away water pitcher and straws. That’s what we are seeing. It reminds me of the military paying $300 for a hammer years ago.

    Like or Dislike: Thumb up 0 Thumb down 0