The American Health Care Act Is Not Just Bad Policy — It’s Bad Politics
On the utter disaster that is the AHCA
It is not a conservative talking point to declare that the Affordable Care Act, popularly known as Obamacare, has consistently failed to achieve its objectives — it’s actually the unavoidable conclusion from looking at the very metrics it set out for itself.
Even if they refuse to admit it, Republicans and Democrats on Capitol Hill know that Obamacare is mathematically insolvent and completely unsustainable.
What is the great solution offered us by a Republican Party endowed with nearly total control of the levers of government and exalted for precisely this hour?
The American Health Care Act — the long promised “repeal and replace” of Obamacare.
There’s just one problem: the AHCA does not actually repeal and replace Obamacare.
Instead, the AHCA opts to “fix” Obamacare, which means that its proposed changes operate within the Obamacare framework and swallow wholesale its guiding assumptions.
As Yuval Levin points out: although AHCA is modeled on some reform conservative ideas, it is also fundamentally different from such ideas “because it functions within the core insurance rules established by Obamacare.” This means that the AHCA draft “can’t really achieve most of the key aims of the conservative reforms it is modeled on.”
Given that Obamacare was pitched in an undeniably unethical manner — Jonathan Gruber; “if you like your health care plan, you can keep it”; “we have to pass the bill so that you can find out what is in it” — and given that it was rammed through Congress on a strict party-line vote, the Democrats have had to shoulder full political responsibility for the law’s disastrous consequences.
They suffered devastating mid-term electoral losses in 2010, when Republicans took the House, and in 2014, when Republicans took the Senate. This electoral wave was a clear indictment of the President’s policies, chief among them his sweeping healthcare legislation.
President Trump and the Republicans also ran strongly against Obamacare in the 2016 election and once again won a mandate to repeal it, this time with control of the Presidency as well as both houses of Congress. So, although Obamacare has been terrible for the country, it has been the gift that keeps on giving for Republicans as a political wedge against the Democrats who created it.
Until now.
The takeaway thus far is that Obamacare is more than a piece of failed legislation in the throes of a death spiral — it is a political hot potato. No one wants to get caught holding the ticking time bomb when it blows up.
Which is another reason why the American Health Care Act — variously referred to as Obamacare 2.0, Obamacare Lite, Trumpcare, Ryancare, RINOcare — is a bad idea for Republicans.
Up to this point, the Democrats have owned the political fallout and backlash for Obamacare. But the AHCA has effectively changed the narrative. As the Democrats look to regain power in Washington in 2018 and beyond, their camp is breathing a collective sigh of relief now that the GOP, fully ensconced as the governing party, has to bear the burden of dealing with the dumpster fire that is Obamacare.
The Republican congressional leadership are hyper-aware of the cognitive dissonance of the American people when it comes to what they want from their healthcare system. They are also intimately aware of the power of political backlash to major changes.
In other words, they are afraid of making the same political mistakes the Democrats made and they are afraid of the Democrats using their same tactics against them to exploit anxiety about changes to the health care system. This is of course completely hypocritical but it is the reality of political warfare. Republicans fear Democratic demagoguery if they push for big, bold, conservative change.
All of this is worth considering when taking into account the political challenges of repealing Obamacare.
The Republicans have allowed these considerations to override their own repeated promises on the campaign trail to pursue true conservative reforms. This is worse than a case of failing to deliver on major campaign promises – they are lying about the fact that they are breaking these promises and they are doing so in favor of a strategy that is politically suicidal.
By merely tinkering around the edges, by trying to “fix” Obamacare while retaining its core, Republicans are actually exacerbating the death spiral.
By passing new legislation that does not truly repeal Obamacare, the Republicans get the worst of both worlds: Republicans will fail to pass conservative health care reform and they will get blamed for the inevitable failure of Obamacare.
Conservative Review’s Daniel Horowitz is correct to observe that there is no political benefit for the Republicans to pursue a half measure by merely tinkering with Obamacare:
This is one of the rare instances when it’s better to do nothing if they don’t want to do the right thing. There is no upside for a conservative to sign onto this, and only downside.
The combination of using “repeal and replace” rhetoric without actually repealing and replacing Obamacare is both incredibly disingenuous and politically incompetent. Using rhetoric of bold change without actually implementing bold change gives you much of the political drawbacks of bold change with none of the benefits.
Such a tactic moves you from being viewed as the firefighter attempting to put out the political dumpster fire to the arsonist who started the fire in the first place.
What are the political prospects of the ACHA? For the GOP, both parties sharing the blame would be their best case scenario while Republicans taking the brunt of the blame is the most likely scenario. That is worse than the current scenario in which Democrats own all of the damage for their own failed policy.
If Republicans will not genuinely repeal and replace Obamacare for the sake of keeping their promises and finally passing conservative healthcare reform, then they should at least do it for the sake of avoiding the political backlash from their own supporters and the political albatross of responsibility for Obamacare’s insolvency. If Republican leadership does not think that true conservative reforms can pass a Senate filibuster, then they should force the Democrats to actually filibuster a good plan. If the filibuster fails, you get the good plan. If the filibuster succeeds, you can blame the Democrats for obstructing meaningful reforms in favor of their failed legislation and perhaps win some of their seats in the upcoming midterm election.
President Trump needs to use the bully pulpit of the Presidency to make the case for a real repeal of Obamacare and for real conservative healthcare reform. Right now, we just have Congress and the White House playing politics, and playing badly.
