Let’s be clear about what happened here. The American Health Care Act failed because it was a terrible piece of legislation. It would have thrown 24 million people off insurance and raised deductibles for millions more — and the savings would’ve gone to pay for tax cuts for millionaires. It broke virtually all of Donald Trump’s campaign promises, and was opposed not just by Democrats but also by Republicans.
Here, for instance, is what Michael Needham, head of the very conservative Heritage Action, wrote: “It is an awful bill that will impact millions of Americans’ lives and is opposed by nearly serious conservative health care analyst. This legislation is a policy, process, and political disaster.”
This is a failure for Speaker Paul Ryan on many levels. He wrote this bill, and when the speaker takes over the process like that, the upside is it’s supposed to create legislation that can pass. On this most basic task, Ryan failed, and failed spectacularly.
Some legislation fails even though the party faithful love it. For the Democrats, the Waxman-Markey cap-and-trade bill was like that — it went nowhere in the Senate, but liberals appreciated that Nancy Pelosi tried. The American Health Care Act wasn’t like that. Republicans were glad to see it die.
But beyond the legislative and tactical deficiencies, the AHCA reflected a deeper failure of moral and policy imagination. Ryan spent the latter half of Barack Obama’s presidency promising to repair the Republican Party’s relationship with the poor (remember Ryan’s “poverty tour”?). He’s spent every day since the passage of Obamacare saying the Republicans could do better. This is what he came up with? The GOP put their greatest policy mind in charge of the House of Representatives and they got ... this?
Throughout the AHCA’s short life, the limits of Donald Trump’s attention span were on sharp display. He never bothered to learn enough about the AHCA to make a persuasive case for it, which is part of the reason it failed. But perhaps more tellingly, he seemed exhausted by what was, in ordinary political terms, an incredibly fast legislative process. The bill is less than 20 days old, but Trump is already telling reporters, "It's enough already.” That’s what you say after working on health reform for years, not days.
It is remarkable that after spending seven years establishing repeal and replace as their top priority, Republicans are abandoning the project less than 70 days after taking power. Doing difficult things in the American political system takes patience, and it is not clear the GOP has any.
Trump’s line on the bill’s failure is it’s Democrats’ fault. “We could have done this, but we couldn’t get one Democrat vote, not one,” he toldRobert Costa. Of course, neither Trump nor Ryan nor anyone else ever tried to get a Democratic vote. They didn’t meet with Democrats, and from the beginning, they used the reconciliation process precisely because it meant they wouldn’t have to deal with Democrats. Trump is going to have a very frustrating presidency if his strategy is to not try to get the Democratic votes he needs and then complain when his priorities don’t pass.
Trump’s new approach appears to be telling the country Obamacare is set to “explode” and, once that happens, Democrats will want to deal. That would all be fine, but Trump isn’t a disinterested bystander — he’s the guy running Obamacare. There’s a lot he can do to sabotage the law — there are things he’s already doing to sabotage the law — and it’s dangerous if that’s his strategy for attaining negotiating leverage.
It’s also unlikely to work. “Here’s the good news,” Trump told Costa. “Health care is now totally the property of the Democrats.” Putting aside the spectacle of the president passing the buck and calling it “the good news,” he may think that — he may want to think that — but when you’re president of the United States of America, and you run the Department of Health and Human Services, and you decided to move on to tax reform rather than come up with something better when your health plan failed, voters tend to blame you for what goes wrong. Trump promised the country results, not excuses.
Republicans would be wise to reflect deeply on what happened here. As Jonathan Chait writes, “Republicans have spent eight years fooling themselves about Obamacare. They have built a news bubble that relentlessly circulates exaggerated or made-up news of the law’s shortcomings and systematically ignores its successes.” Their attacks on Obamacare have been opportunistic and cynical in ways that made its replacement nearly impossible — having promised better coverage for more people, they were flummoxed by the fact that none of their plans achieved, or even attempted, that outcome.
Big policy change is hard. The modern Republican Party has built itself in opposition. Paul Ryan won fame designing budgets that were never meant to pass, and by criticizing Barack Obama. Donald Trump established himself as a political force through his leadership of the crackpot birther movement. This is a party that has forgotten how to do the slow, arduous work of governing. Perhaps it’s worse than that. This is a party, in many ways, that has built its majority upon a contempt for the compromises, quarter-loaves, and tough trade-offs that governing entails. They need to learn from this defeat, or they are doomed to repeat it, and repeat it, and repeat it.
In the interviews Trump is giving today, it is clear he has somehow convinced himself tax reform will be easier. It won’t be. And soon, Republicans will have to raise the debt ceiling, and pass their appropriations bills, and, if they’re going to hold to any of Trump’s budget proposals, find 60 votes to bust the budget caps. And they’re going to do all of that with the myth of Ryan’s policy genius and Trump’s dealmaking skill shattered.
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