The American Health Care Act, a.k.a. the House Republicans' plan to repeal and replace Obamacare, thudded to earth on Friday afternoon after Paul Ryan concluded that he lacked the votes to pass it and pulled the bill from the floor of the House. It's always big news when the ruling party fails to enact a major legislative initiative, and even more so just two months into a new presidency. Yet the ensuing media coverage, though extensive, nevertheless gives an incomplete—and perhaps even misleading—picture of how and why the AHCA imploded so quickly and spectacularly.
Most of the stories I've seen—especially on cable news—focus their attention on Donald Trump, portraying the bill's demise as primarily a failure of the president. This is hardly a surprise. Media coverage of American politics often revolves around the presidency while giving much less attention to other relevant institutions and actors, to the extent that citizens tend to overestimate the president's responsibility for outcomes and conditions.
Trump had also set himself up for a splash in the media dunk tank by spending the past year promising voters a health care plan that simultaneously expanded coverage and reduced costs, and by bragging that his unmatched skill at negotiation would easily overcome any remaining policy disagreements. Now that events have confirmed the widespread suspicion that both claims were pure fiction, journalists will not be shy about pinning the AHCA's failure on a president whom they already view as having a big problem telling the truth.
Over the past 24 hours, several inside accounts have been published that portray Trump as having blundered through meetings with congressional Republicans, exposing a lack of policy command and an empty desire to achieve an easy legislative "win" for its own sake rather than a demonstrated commitment to a particular set of substantive goals. Trump and his advisor Steve Bannon also apparently lectured and threatened Republican holdouts in ways that ultimately backfired in attracting support.
Those not inclined to solely blame Trump for the demise of repeal-and-replace—including the White House itself—have mostly aimed their shots at Ryan instead. Liberals who have rolled their eyes for years at Ryan's boy-genius reputation in Washington claim righteous vindication from this week's events, while some conservatives sympathetic to Trump have sought to shift responsibility to the speaker for drafting an unpopular and politically risky bill that could not make it through his own House.
While it's certainly true that both the president and the speaker made mistakes in handling the health care issue, it's inaccurate to portray the demise of the AHCA as primarily a consequence of individual failures of leadership or strategy. Replace Trump and Ryan with Marco Rubio and John Boehner, or Jeb Bush and Kevin McCarthy, and the results would almost certainly be more or less the same. The bill died so quickly, and was so far away from success when it did fail (remember, the House was by all accounts the easier lift of the two chambers), that the specific day-to-day behavior of the principal actors seems inadequate to account for the result.
The real obstacle to the passage of health care reform is the Republican Party itself, and any full reckoning with what just happened has to grapple with that fact. Nearly eight years of attacks on the ACA as a "government takeover" of health care, along with repeated promises to replace the hated Obamacare with an unspecified superior alternative, paid considerable electoral dividends but left the party committed to an unachievable policy goal. Republican leaders desperately sought to placate conservatives calling for a broad rollback of federal responsibilities and expenditures, but they simultaneously refused to acknowledge that satisfying these demands in practice would result in a reduction of coverage and a relaxation of popular regulations—which in turn would alienate swing voters and mobilize political opponents.
The national party has also become increasingly influenced, if not controlled outright, by unelected activists and news media personalities who gained considerable internal power during the Obama years by constantly criticizing Republican officeholders for insufficient ideological loyalty. This dynamic has, perhaps inevitably, resulted in the formation of a faction within the congressional GOP that plays to this constituency, even when doing so is counterproductive to legislative productivity or concrete policy achievement. From the Freedom Caucus in the House to the Ted Cruz-Mike Lee axis in the Senate, the existence of these self-appointed keepers of the purist conservative flame deprives the Republican leadership of a functional partisan majority on major legislation, and this obstacle has not been removed with the election of a Republican president.
Mainstream Republicans, Trump included, have viewed the entire health care policy domain most of all as a useful club with which to beat Democrats, while hard-line conservatives have likewise viewed it as a useful club with which to beat mainstream Republicans. The various partisan and electoral motives at play have often governed Republican behavior to politically successful ends, but few within the party have concentrated on the more difficult and less immediately rewarding task of first developing workable policy alternatives to the ACA and then investing substantial energy in building support for them among their colleagues.
Some critics have argued that the AHCA, a bill that was transparently pulled together in a matter of weeks with little expert input or elite support, ultimately failed because it was bad policy. Maybe so. But we should be wary of the ensuing implication that a "better" bill would have stood a stronger chance of passage in the House. It's fair to criticize Ryan for the legislation that he drafted and promoted, but he presumably believed its provisions would best reconcile the conflicting demands of swing-seat moderates and conservative purists. The revisions made in the final hours in a futile effort to attract greater support on the right suggest that opponents of the bill would not have been easy to satisfy even with a more thorough policy-making process.
Congressional Republicans' increasingly apparent challenges in reaching internal agreement on policy—which even Ryan was forced to publicly acknowledge yesterday—do not bode well for the rest of the party's legislative agenda, from tax reform to appropriations to the looming federal debt ceiling. Nor does the current chaotic state of the Trump administration, which will hardly be in the position to deliver much assistance to Ryan and Mitch McConnell in the exercise of their leadership responsibilities over the coming months.
Up to now, the news media and Washington community have treated Trump's shocking ascension within the GOP as a more-or-less random event—the hostile takeover of an otherwise sound party apparatus. But it's time to devote much more serious consideration to the question of whether its existing internal dysfunction left the contemporary Republican Party uniquely vulnerable to a Trump-led ambush. As any health care expert knows, an effective remedy for one's ills first requires a correct diagnosis.
Saturday, March 25, 2017
Wednesday, March 22, 2017
What's a President Gotta Do to Be Called a Conservative These Days?
Donald Trump's conservative credentials have been disputed by all sides from the moment that he emerged as a leading contender for the Republican presidential nomination in the summer of 2015. The editors of the National Review denounced him as a "philosophically unmoored political opportunist" in a special anti-Trump issue early last year, while both Hillary Clinton and Barack Obama characterized Trump as unfaithful to conservative principles during the 2016 general election. Trump's success in capturing the Republican nomination and then the White House prompted some observant analysts on both the left and the right to conclude that the Republican Party is no longer the party of conservatism and that a realignment of the entire American party system is now underway.
We are now two months past the presidential inauguration—and while there have been a number of surprises and unprecedented acts both large and small, the actual policies and personnel of the Trump administration have emerged with some clarity. What they add up to, at least so far, is as conservative a presidency as any in modern history. Trump has endorsed an orthodox conservative legislative agenda on taxes, regulation, and health care (including a major cut to Medicaid)—and has even apparently pressured Paul Ryan to revise the House health care bill in order to address objections from hard-line conservatives. His budget proposal calls for shifting billions of dollars from domestic discretionary programs to national defense, prompting opposition even from some conservative members of Congress. On foreign policy and immigration, Trump only differs from other Republicans to the extent that he has staked out positions further to their ideological right.
Trump's hiring and appointment record tells a similar story. His cabinet is filled with conservative stalwarts like Jeff Sessions, Tom Price, Ben Carson, and Betsy DeVos. Prior to his selection as Trump's budget director, Mick Mulvaney helped to depose John Boehner as Speaker of the House because he viewed Boehner as insufficiently devoted to conservatism. Neil Gorsuch, Trump's nominee for the Supreme Court, is a Federalist Society-style conservative jurist. Top Trump aides Steve Bannon and Stephen Miller are likewise firmly on the right end of the ideological spectrum, and palace-intrigue accounts of the Trump White House indicate that Bannon, Miller, and their allies nearly always prevail in internal disputes.
One reason for the strong right-wing character of the Trump administration is that a party, and even a presidency, is much bigger than one person. The Republican Party is increasingly controlled by ideologically-oriented politicians, activists, and media outlets, and Trump needs to work with, and maintain support from, his fellow partisans in order to govern. During the 2016 campaign, Trump sometimes promised to address policy goals that didn't fit within conservative doctrine—increasing public infrastructure spending, renegotiating trade deals, providing childcare assistance, lowering prescription drug costs—but few other Republicans, in Congress or elsewhere, share these priorities. Declining either to pressure his fellow partisans to modify their views or to build a bipartisan coalition with Democrats, Trump has yet to emphasize any of these issues since taking office.
Another explanation lies with Trump himself. There is little reason to believe that Trump is unshakably devoted to the tenets of conservative political philosophy as a personal value system. But Trump demonstrates two other characteristics that attract him to the pursuit of ambitious conservative policies: (1) a desire to project strength, decisiveness, and success by achieving large-scale—one might say "big-league"—political change; and (2) an eight-year-long resentful preoccupation with Barack Obama that has continued without abatement into the new administration, perhaps suggesting to the current president that any dramatic reversal of a policy supported by his predecessor is by definition a worthy and politically advisable act.
The gap between Trump's own public statements and his administration's actual issue positions is sufficiently large that some people are starting to wonder if Trump even understands the content of the legislation that he has endorsed and is pushing through Congress. Reporters are fanning out to the hamlets and hollows of Middle America to find Trump supporters of modest means who would be disadvantaged by the president's budget and health care proposals. How, wonders the Washington pundit class, can Trump possibly reconcile his populist appeal with his efforts to simultaneously enact a upper-income tax cut and revoke health insurance from millions of less fortunate Americans?
Trump might bet that voters will reward bold policy change for its own sake, regardless of its specific consequences. Or, perhaps, he retains confidence in his ability to successfully sell anything he does to a segment of the electorate that he once claimed was so loyal that it would still support him even if he shot somebody in the middle of Fifth Avenue. It's also quite possible that he will deny responsibility for any unpopular provisions of the policies that he endorses, instructing voters to direct their blame toward Congress, the courts, or the federal bureaucracy.
Trump may be trapped between campaign rhetoric on one side and political realities on the other, but the entire Republican Party is in a similar predicament. The congressional GOP has also been forced to grapple with the challenge of suddenly fulfilling years of breezy promises to repeal the Affordable Care Act (and to replace it with an unspecified better, cheaper alternative) without spurring a popular backlash that could endanger its control of the legislative branch in next year's midterm elections. Today's health care debate is merely one example of a larger political problem that Republican leaders have faced for the better part of a century. Perennial conservative pledges to implement significant reductions in the scope of federal power are often frustrated by the inconvenient complication that even voters who say they don't like the government do like most of the specific things that the government actually does.
Trump the candidate was shrewd enough to recognize this fact, which is why he committed himself to maintaining current Social Security and Medicare spending levels while guaranteeing all sorts of other government-provided goodies to his supporters. But Trump the president will need to be even shrewder in order to escape voter anger for seeking to cut popular federal programs and benefits in contravention of his campaign-trail promises. The current occupant of the White House may be a newcomer to the conservative cause, but he has adopted its central ambitions as his own. Now he must reckon with the most formidable obstacles to its success.
We are now two months past the presidential inauguration—and while there have been a number of surprises and unprecedented acts both large and small, the actual policies and personnel of the Trump administration have emerged with some clarity. What they add up to, at least so far, is as conservative a presidency as any in modern history. Trump has endorsed an orthodox conservative legislative agenda on taxes, regulation, and health care (including a major cut to Medicaid)—and has even apparently pressured Paul Ryan to revise the House health care bill in order to address objections from hard-line conservatives. His budget proposal calls for shifting billions of dollars from domestic discretionary programs to national defense, prompting opposition even from some conservative members of Congress. On foreign policy and immigration, Trump only differs from other Republicans to the extent that he has staked out positions further to their ideological right.
Trump's hiring and appointment record tells a similar story. His cabinet is filled with conservative stalwarts like Jeff Sessions, Tom Price, Ben Carson, and Betsy DeVos. Prior to his selection as Trump's budget director, Mick Mulvaney helped to depose John Boehner as Speaker of the House because he viewed Boehner as insufficiently devoted to conservatism. Neil Gorsuch, Trump's nominee for the Supreme Court, is a Federalist Society-style conservative jurist. Top Trump aides Steve Bannon and Stephen Miller are likewise firmly on the right end of the ideological spectrum, and palace-intrigue accounts of the Trump White House indicate that Bannon, Miller, and their allies nearly always prevail in internal disputes.
One reason for the strong right-wing character of the Trump administration is that a party, and even a presidency, is much bigger than one person. The Republican Party is increasingly controlled by ideologically-oriented politicians, activists, and media outlets, and Trump needs to work with, and maintain support from, his fellow partisans in order to govern. During the 2016 campaign, Trump sometimes promised to address policy goals that didn't fit within conservative doctrine—increasing public infrastructure spending, renegotiating trade deals, providing childcare assistance, lowering prescription drug costs—but few other Republicans, in Congress or elsewhere, share these priorities. Declining either to pressure his fellow partisans to modify their views or to build a bipartisan coalition with Democrats, Trump has yet to emphasize any of these issues since taking office.
Another explanation lies with Trump himself. There is little reason to believe that Trump is unshakably devoted to the tenets of conservative political philosophy as a personal value system. But Trump demonstrates two other characteristics that attract him to the pursuit of ambitious conservative policies: (1) a desire to project strength, decisiveness, and success by achieving large-scale—one might say "big-league"—political change; and (2) an eight-year-long resentful preoccupation with Barack Obama that has continued without abatement into the new administration, perhaps suggesting to the current president that any dramatic reversal of a policy supported by his predecessor is by definition a worthy and politically advisable act.
The gap between Trump's own public statements and his administration's actual issue positions is sufficiently large that some people are starting to wonder if Trump even understands the content of the legislation that he has endorsed and is pushing through Congress. Reporters are fanning out to the hamlets and hollows of Middle America to find Trump supporters of modest means who would be disadvantaged by the president's budget and health care proposals. How, wonders the Washington pundit class, can Trump possibly reconcile his populist appeal with his efforts to simultaneously enact a upper-income tax cut and revoke health insurance from millions of less fortunate Americans?
Trump might bet that voters will reward bold policy change for its own sake, regardless of its specific consequences. Or, perhaps, he retains confidence in his ability to successfully sell anything he does to a segment of the electorate that he once claimed was so loyal that it would still support him even if he shot somebody in the middle of Fifth Avenue. It's also quite possible that he will deny responsibility for any unpopular provisions of the policies that he endorses, instructing voters to direct their blame toward Congress, the courts, or the federal bureaucracy.
Trump may be trapped between campaign rhetoric on one side and political realities on the other, but the entire Republican Party is in a similar predicament. The congressional GOP has also been forced to grapple with the challenge of suddenly fulfilling years of breezy promises to repeal the Affordable Care Act (and to replace it with an unspecified better, cheaper alternative) without spurring a popular backlash that could endanger its control of the legislative branch in next year's midterm elections. Today's health care debate is merely one example of a larger political problem that Republican leaders have faced for the better part of a century. Perennial conservative pledges to implement significant reductions in the scope of federal power are often frustrated by the inconvenient complication that even voters who say they don't like the government do like most of the specific things that the government actually does.
Trump the candidate was shrewd enough to recognize this fact, which is why he committed himself to maintaining current Social Security and Medicare spending levels while guaranteeing all sorts of other government-provided goodies to his supporters. But Trump the president will need to be even shrewder in order to escape voter anger for seeking to cut popular federal programs and benefits in contravention of his campaign-trail promises. The current occupant of the White House may be a newcomer to the conservative cause, but he has adopted its central ambitions as his own. Now he must reckon with the most formidable obstacles to its success.
Tuesday, March 07, 2017
How the New Health Care Bill Confirms the Asymmetry of the Parties
Matt Grossmann and I write a fair amount about health care in our book Asymmetric Politics because it's a political issue that represents a particularly effective example of our main thesis: that the Democratic Party is organized as a coalition of social groups while the Republican Party is controlled by an ideological movement. Now that the House Republican leadership has released its health care reform proposal—the long-promised plan to "repeal and replace" the Affordable Care Act—it is clearer than ever that the two parties are fundamentally different in character.
The Democratic Party is composed of a number of discrete social groups, each of which pressures party leaders to support and enact policies designed to ameliorate specific perceived problems faced by the group. For decades, Democratic constituencies have demanded that their party act to provide health care benefits to vulnerable populations—a goal that was addressed by the creation of Medicare and Medicaid in the 1960s, the Children's Health Insurance Program in the 1990s, and the Affordable Care Act in 2009–2010.
By and large, Democrats are less concerned about the mechanics by which a policy is implemented than they are about the real-world effects of that policy. For example, the Affordable Care Act did not reflect an overarching ideological vision for the nation's health care sector, but instead was designed to minimize disruption to the existing system (in order to increase its chances of passage through Congress) while extending insurance and other benefits to a greater proportion of the public.
Democratic leaders worked for years to negotiate compromises with a range of powerful stake-holders in order to develop a bill that had a chance of passing into law, in order to achieve at least a degree of policy-making success. Pragmatism, not purity, is the dominant style of governing among Democratic politicians, and even liberals within the party who preferred a single-payer system to the relatively inelegant Obamacare apparatus supported the legislation as a partial victory and the best realistic option available to address the practical concerns of their constituents—rather than torpedoing the entire effort in the name of ideological principle.
The Republicans, as one might observe these days, work differently. The bill that Paul Ryan and his congressional allies have released is not the product of extensive deliberation among interest groups, health care providers, or policy experts. Nor is it designed to achieve a particular outcome with respect to the quantity or quality of coverage available to the public. Instead, the legislation is primarily motivated by the goal of reducing federal involvement in the provision of health care to the extent that is politically possible, repealing the individual mandate (deemed unconstitutionally coercive by contemporary conservative ideology) and imposing significant cuts to the federal Medicaid program.
Much has been made of the fact that the House plans to begin legislative action on the Ryan bill without a score from the Congressional Budget Office estimating its total cost and projected effect on the number of Americans with health insurance. This decision supposedly reflects the desperation felt by Republican leaders to push the bill through the committee process as quickly as possible, as well as an expectation that the CBO's numbers, when they come, will indicate that the bill would cause a sizable rise in the proportion of uninsured citizens.
But the lack of interest in the CBO score also demonstrates what the central purpose of the bill actually is. For Democrats, the point of enacting the ACA was to increase the number of Americans who had health insurance, and any legislation that failed to significantly reduce the ranks of the uninsured was, by that standard, not worth passing. Validation from outside experts that the ACA would indeed fulfill the goal of coverage expansion was thus necessary in order to maintain party support.
Republicans, in contrast, are much more indifferent to the question of what effect their own replacement bill will have on the number of insured Americans. An unfavorable CBO score will be politically damaging, to be sure, but is less likely to influence their evaluation of the inherent merits of the legislation. (Reducing the size of the Medicaid program is fully consistent with the ideological objectives of the party—a feature, not a bug.)
Some liberals have responded to our characterization of the Republican Party as fundamentally ideological by arguing that Republicans don't really adhere to a coherent value system but rather merely do the bidding of wealthy citizens and big corporations. But the Ryan bill can't really be explained on that basis. The rich do benefit by receiving a large tax cut, but if Republicans only cared about that issue they would have chosen to pursue a politically easier path of merely cutting taxes on the wealthy while leaving health care alone. Similarly, it's far from clear that insurance companies are getting much out of the Ryan bill; in fact, the repeal of the individual mandate might well lead to a market "death spiral" that would raise insurance premiums and reduce the number of customers.
But perhaps the strongest current evidence in favor of our argument about the differences between the parties is the unique power of ideologically purist activists and pressure groups within the GOP. In what is surely the biggest political news of the day, one conservative organization after another—the Club for Growth, Heritage Action, FreedomWorks, the Koch-funded Americans for Prosperity—has announced its opposition to the Ryan bill, claiming that it doesn't go far enough in repealing the ACA and reducing the government's role in the provision of health care.
Of course, these groups' criticisms only make it more likely that Ryan's reform bill will fail and the ACA will remain in place, squandering a potential opportunity to move federal health care policy further to the ideological right. As we argue in Asymmetric Politics, it is time to devote more serious attention to the fact that the increasing power of the conservative movement and growing electoral success of the Republican Party over the past few decades have not yet come close to achieving the major retrenchment in domestic policy that the American right has been nominally dedicated to pursuing for most of the last century.
When Republican officeholders repeatedly shrink from risking the popular backlash that would naturally arise from large-scale implementation of their ideological commitments—note how the House GOP has acknowledged that simply repealing the ACA without replacement would invite electoral disaster—the unelected elements of the right respond by attacking them for betraying the Republican Party's conservative principles, threatening their defeat in primary elections and forcing them to make increasingly ambitious future promises that in turn are even more difficult to satisfy in practice. Regardless of where one's own sympathies might lie, observers across the political spectrum should be able to agree that this is not a fertile political environment for the prolific enactment of sound public policy.
The Democratic Party is composed of a number of discrete social groups, each of which pressures party leaders to support and enact policies designed to ameliorate specific perceived problems faced by the group. For decades, Democratic constituencies have demanded that their party act to provide health care benefits to vulnerable populations—a goal that was addressed by the creation of Medicare and Medicaid in the 1960s, the Children's Health Insurance Program in the 1990s, and the Affordable Care Act in 2009–2010.
By and large, Democrats are less concerned about the mechanics by which a policy is implemented than they are about the real-world effects of that policy. For example, the Affordable Care Act did not reflect an overarching ideological vision for the nation's health care sector, but instead was designed to minimize disruption to the existing system (in order to increase its chances of passage through Congress) while extending insurance and other benefits to a greater proportion of the public.
Democratic leaders worked for years to negotiate compromises with a range of powerful stake-holders in order to develop a bill that had a chance of passing into law, in order to achieve at least a degree of policy-making success. Pragmatism, not purity, is the dominant style of governing among Democratic politicians, and even liberals within the party who preferred a single-payer system to the relatively inelegant Obamacare apparatus supported the legislation as a partial victory and the best realistic option available to address the practical concerns of their constituents—rather than torpedoing the entire effort in the name of ideological principle.
The Republicans, as one might observe these days, work differently. The bill that Paul Ryan and his congressional allies have released is not the product of extensive deliberation among interest groups, health care providers, or policy experts. Nor is it designed to achieve a particular outcome with respect to the quantity or quality of coverage available to the public. Instead, the legislation is primarily motivated by the goal of reducing federal involvement in the provision of health care to the extent that is politically possible, repealing the individual mandate (deemed unconstitutionally coercive by contemporary conservative ideology) and imposing significant cuts to the federal Medicaid program.
Much has been made of the fact that the House plans to begin legislative action on the Ryan bill without a score from the Congressional Budget Office estimating its total cost and projected effect on the number of Americans with health insurance. This decision supposedly reflects the desperation felt by Republican leaders to push the bill through the committee process as quickly as possible, as well as an expectation that the CBO's numbers, when they come, will indicate that the bill would cause a sizable rise in the proportion of uninsured citizens.
But the lack of interest in the CBO score also demonstrates what the central purpose of the bill actually is. For Democrats, the point of enacting the ACA was to increase the number of Americans who had health insurance, and any legislation that failed to significantly reduce the ranks of the uninsured was, by that standard, not worth passing. Validation from outside experts that the ACA would indeed fulfill the goal of coverage expansion was thus necessary in order to maintain party support.
Republicans, in contrast, are much more indifferent to the question of what effect their own replacement bill will have on the number of insured Americans. An unfavorable CBO score will be politically damaging, to be sure, but is less likely to influence their evaluation of the inherent merits of the legislation. (Reducing the size of the Medicaid program is fully consistent with the ideological objectives of the party—a feature, not a bug.)
Some liberals have responded to our characterization of the Republican Party as fundamentally ideological by arguing that Republicans don't really adhere to a coherent value system but rather merely do the bidding of wealthy citizens and big corporations. But the Ryan bill can't really be explained on that basis. The rich do benefit by receiving a large tax cut, but if Republicans only cared about that issue they would have chosen to pursue a politically easier path of merely cutting taxes on the wealthy while leaving health care alone. Similarly, it's far from clear that insurance companies are getting much out of the Ryan bill; in fact, the repeal of the individual mandate might well lead to a market "death spiral" that would raise insurance premiums and reduce the number of customers.
But perhaps the strongest current evidence in favor of our argument about the differences between the parties is the unique power of ideologically purist activists and pressure groups within the GOP. In what is surely the biggest political news of the day, one conservative organization after another—the Club for Growth, Heritage Action, FreedomWorks, the Koch-funded Americans for Prosperity—has announced its opposition to the Ryan bill, claiming that it doesn't go far enough in repealing the ACA and reducing the government's role in the provision of health care.
Of course, these groups' criticisms only make it more likely that Ryan's reform bill will fail and the ACA will remain in place, squandering a potential opportunity to move federal health care policy further to the ideological right. As we argue in Asymmetric Politics, it is time to devote more serious attention to the fact that the increasing power of the conservative movement and growing electoral success of the Republican Party over the past few decades have not yet come close to achieving the major retrenchment in domestic policy that the American right has been nominally dedicated to pursuing for most of the last century.
When Republican officeholders repeatedly shrink from risking the popular backlash that would naturally arise from large-scale implementation of their ideological commitments—note how the House GOP has acknowledged that simply repealing the ACA without replacement would invite electoral disaster—the unelected elements of the right respond by attacking them for betraying the Republican Party's conservative principles, threatening their defeat in primary elections and forcing them to make increasingly ambitious future promises that in turn are even more difficult to satisfy in practice. Regardless of where one's own sympathies might lie, observers across the political spectrum should be able to agree that this is not a fertile political environment for the prolific enactment of sound public policy.
Thursday, March 02, 2017
Rand Paul Is Busy Blowing Up ACA Repeal. Is the White House Even Trying to Stop Him?
The election of Donald Trump may have been a game-changer in presidential politics, but on Capitol Hill things really don't look all that different. As the immediate euphoria inspired by the prospect of unified party government has started to wear off, congressional Republicans have gamely returned their attention to a problem that has vexed them for decades and especially for the past seven years: what do they do about health care? Existing confusion is mixed with new urgency, with the repeal and replacement of the Affordable Care Act representing the party's first legislative priority and, according to its own strategic plan, a necessary step before Congress considers tax reform later in the year.
Republican plans to propose a detailed replacement for the ACA have always faced two major problems. The first is that it doesn't appear possible to develop an alternative policy framework that doesn't result in higher government costs, higher consumer costs, a reduction in the quality and quantity of care provided, or a combination thereof. As a party committed, at least in principle, to shrinking the size and scope of the federal government, Republicans understandably don't want to raise public expenditures above where they already are—but the alternative reform options would produce higher premiums and deductibles, less generous subsidies, and/or fewer Americans covered by insurance. None of these potential outcomes will strike the average politician as being particularly popular with the electorate.
The other problem is the existence of serious internal divisions within the congressional GOP. The 2016 election and its aftermath have temporarily eclipsed these conflicts from public view. But a sitting Republican speaker of the House was forced out of office less than 18 months ago by a rump faction of his own party, and there is no reason to believe that the dynamic that led to that extraordinary event has faded away completely.
Indeed, as Congress prepares to debate ACA repeal, we are seeing an all-too-familiar pattern emerging once again. The policy positions of the Republican congressional leadership are simultaneously under attack from two directions: from Democrats, who criticize them as unacceptably conservative, and from the Tea Party right, which characterizes them as not conservative enough. The House Freedom Caucus and like-minded Republicans in the Senate, supported by several key conservative interest groups, are now pushing for a reform bill that is far more "repeal" than "replace," and are threatening to join the Democrats in voting down any health care legislation that fails to meet their ideological demands.
These two problems merged on Thursday into a single bizarre scene in the Capitol building. Annoyed at leaks of previous legislative drafts that produced damaging headlines, Republican House leaders have decided to keep their latest health care reform proposal a secret from everyone except Republican members of the Energy and Commerce Committee. Rumors that the secret plan was being guarded in a basement room in the Capitol prompted congressional critics to engage in a mock-treasure hunt to determine its location and contents. While some Democrats tried to get in on the fun, the chief detective on the case was Republican senator Rand Paul of Kentucky, who even played to the cameras by bringing along a photocopier in order to make a duplicate copy of any legislation he encountered. (The bill's whereabouts, if a draft indeed exists on paper, were not ascertained.)
Paul, a Tea Party ally, has already vowed to oppose any legislation that leaves large sections of the ACA in place, and such a rebellion would need to attract only two other Republicans—such as fellow right-wing purists Ted Cruz of Texas and Mike Lee of Utah—to deny Republican leaders a majority vote for reform in the Senate. As Paul has not only failed to endorse the leadership's repeal efforts but is now openly mocking them to Capitol Hill reporters, prospects for imminent passage of an ACA replacement seem rather remote at this point.
Paul knows full well that his behavior is making the passage of ACA repeal less likely; similar maneuvers by Tea Party types have doomed leadership-backed legislation repeatedly over the past 6 years. But now the White House is in Republican hands as well. For the first time in years, intra-party squabbling and acts of purer-than-thou symbolic position-taking can actually endanger the legislative program of a Republican president.
From what we can tell, there is apparently very little communication between Congress and the White House over policy, so that congressional Republicans have resorted to parsing the president's rhetoric in public speeches in order to divine his views on health care reform. But here is a Republican senator engaged in what looks like a public act of sabotage against one of Trump's biggest stated legislative goals—which immediately raises some curious questions. What, if anything, are the president and his advisors doing, or planning to do, about this ostentatious display of partisan independence? Will they devote any attention and energy to trying to whip Paul, or any other disaffected Republican, into line on ACA repeal? Or do they not actually care enough about the issue to bother?
Republican plans to propose a detailed replacement for the ACA have always faced two major problems. The first is that it doesn't appear possible to develop an alternative policy framework that doesn't result in higher government costs, higher consumer costs, a reduction in the quality and quantity of care provided, or a combination thereof. As a party committed, at least in principle, to shrinking the size and scope of the federal government, Republicans understandably don't want to raise public expenditures above where they already are—but the alternative reform options would produce higher premiums and deductibles, less generous subsidies, and/or fewer Americans covered by insurance. None of these potential outcomes will strike the average politician as being particularly popular with the electorate.
The other problem is the existence of serious internal divisions within the congressional GOP. The 2016 election and its aftermath have temporarily eclipsed these conflicts from public view. But a sitting Republican speaker of the House was forced out of office less than 18 months ago by a rump faction of his own party, and there is no reason to believe that the dynamic that led to that extraordinary event has faded away completely.
Indeed, as Congress prepares to debate ACA repeal, we are seeing an all-too-familiar pattern emerging once again. The policy positions of the Republican congressional leadership are simultaneously under attack from two directions: from Democrats, who criticize them as unacceptably conservative, and from the Tea Party right, which characterizes them as not conservative enough. The House Freedom Caucus and like-minded Republicans in the Senate, supported by several key conservative interest groups, are now pushing for a reform bill that is far more "repeal" than "replace," and are threatening to join the Democrats in voting down any health care legislation that fails to meet their ideological demands.
These two problems merged on Thursday into a single bizarre scene in the Capitol building. Annoyed at leaks of previous legislative drafts that produced damaging headlines, Republican House leaders have decided to keep their latest health care reform proposal a secret from everyone except Republican members of the Energy and Commerce Committee. Rumors that the secret plan was being guarded in a basement room in the Capitol prompted congressional critics to engage in a mock-treasure hunt to determine its location and contents. While some Democrats tried to get in on the fun, the chief detective on the case was Republican senator Rand Paul of Kentucky, who even played to the cameras by bringing along a photocopier in order to make a duplicate copy of any legislation he encountered. (The bill's whereabouts, if a draft indeed exists on paper, were not ascertained.)
Paul, a Tea Party ally, has already vowed to oppose any legislation that leaves large sections of the ACA in place, and such a rebellion would need to attract only two other Republicans—such as fellow right-wing purists Ted Cruz of Texas and Mike Lee of Utah—to deny Republican leaders a majority vote for reform in the Senate. As Paul has not only failed to endorse the leadership's repeal efforts but is now openly mocking them to Capitol Hill reporters, prospects for imminent passage of an ACA replacement seem rather remote at this point.
Paul knows full well that his behavior is making the passage of ACA repeal less likely; similar maneuvers by Tea Party types have doomed leadership-backed legislation repeatedly over the past 6 years. But now the White House is in Republican hands as well. For the first time in years, intra-party squabbling and acts of purer-than-thou symbolic position-taking can actually endanger the legislative program of a Republican president.
From what we can tell, there is apparently very little communication between Congress and the White House over policy, so that congressional Republicans have resorted to parsing the president's rhetoric in public speeches in order to divine his views on health care reform. But here is a Republican senator engaged in what looks like a public act of sabotage against one of Trump's biggest stated legislative goals—which immediately raises some curious questions. What, if anything, are the president and his advisors doing, or planning to do, about this ostentatious display of partisan independence? Will they devote any attention and energy to trying to whip Paul, or any other disaffected Republican, into line on ACA repeal? Or do they not actually care enough about the issue to bother?
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