The health care bill unveiled by Senate Republicans Thursday morning should, by the standards of the normal laws of politics, have approximately a snowball’s chance in hell of passing.
One well-known fact of American politics is that it is extremely hard, in general, to roll back substantial welfare state programs that are already in existence and already delivering concrete benefits to American citizens. A separate fact is that interest groups are influential in the congressional process, and can often shape legislation to suit their interests or block legislation that doesn’t fit their interests. A third fact is that public opinion matters — if you’re going to override the interest groups, you’re going to need the public on your side. And a fourth fact is that though they often fail to deliver, politicians generally make a good-faith effort to implement their campaign promises.
The Better Care Reconciliation Act that Mitch McConnell revealed to the public today fails on all those tests. It should be deader than dead. Not meaningless, by any means, but simply a vehicle that hardcore conservatives in safe districts can use to vent, while more pragmatic members of Congress try to think of a sensible plan B, like working with red-state Democrats on some kind of bipartisan health bill.
But it’s not dead. It might fail, but the chances of passage are very real — with most advocates on both sides now believing the GOP will succeed. Because ever since Donald Trump rode down the escalator at Trump Tower to say he was running for president to stop Mexico from flooding our country with rapists and murderers, nothing about the laws of political gravity have been operating the way they’re supposed to. A fairly transparent grifter got himself elected president of the United States with 2 million fewer votes than his opponent, so anything can happen.
This bill shouldn’t be able to pass
Though more cautious across some dimensions than its predecessor in the US House of Representatives, the BCRA retains the same fundamental structure.
Donald Trump’s explicit campaign promise to eschew cuts to Medicaid is thrown overboard in favor of drastic reductions. Promises that Mitch McConnell himself — and many other Republican legislators besides — made to address the high deductibles experienced on the Affordable Care Act exchanges are betrayed in favor of a program that will push people into even higher-deductible plans. Protections for patients with preexisting conditions are stripped away, as are financial protections that limit older Americans’ exposure to sky-high insurance premiums.
The result is legislation that’s opposed by America’s hospital groups, by the AARP, and by virtually every relevant interest group under the sun. It also polls dismally, even as Obamacare has finally become modestly popular legislation now that it’s under scrutiny.
Under the circumstances, it’s not surprising that the unveiling of the bill was met with a chorus of objections and concerns from various Republican senators plus unanimous opposition from Democrats. After all, you simply can’t pass legislation like this. A newly elected president with a strong mandate and the public at his back can defeat interest group opposition. A president can fulfill pledges to key interest groups even in the face of bad polling. And elected officials can break promises to cater to public opinion or interest group demands. But obviously you can’t break your key promises in order to support a bill that is unpopular and opposed by the major relevant stakeholders.
Except it worked in the House, and there’s every reason to believe the same dynamic could proceed in the Senate.
Water flowed uphill to get Obamacare repeal through the House
The original draft of Paul Ryan’s American Health Care Act failed rather spectacularly.
House leaders believed that to be politically viable, the AHCA had to retain a fig-leaf version of protections for patients with preexisting conditions. That alienated some on the right wing of the caucus who wanted insurance industry deregulation along with big spending cuts. But meanwhile, the AHCA was too harsh for a critical clutch of more moderate Republicans, who worried that the massive losses in insurance coverage the bill entailed violated the promises Republicans had been making to the American people that they were going to replace Obamacare with something better.
The basic problem was the GOP’s years-long campaign against Obamacare had been so suffused with lies that there was no way to fulfill them consistent with the true, but rarely stated, objective of delivering a massive tax cut.
The repeal drive looked dead. But then a funny thing happened. Republican leaders agreed to push the bill to the right by substantially undermining the regulatory protections. That got the House Freedom Caucus on board. And that, paradoxically, got the moderates on board. Even though the new draft of the bill was even harsher on coverage, at the end of the day nobody wanted to have the death of the repeal push on their hands.
So an unpopular bill that didn’t do what Republicans promised their bill would do passed in the face of interest group opposition only after being made even more extreme. Right now, the Senate bill is in roughly the same shape — facing opposition on both sides. It should be impossible to square the circle, especially given the poor fundamentals. But then again, Donald Trump is president.
In Trumpmerica, nothing makes sense
Passage of anything like this bill would offend the laws of political gravity. But then so did Donald Trump winning the Republican Party nomination.
And while we’ve long known that basically anyone who wins a major party nomination stands a decent shot of winning a presidential election, Trump really did not look like he was going to be that guy. He performed poorly in nationally televised debates, his campaign was rocked by the revelation that he told a casual acquaintance on tape that he routinely sexually assaults women, a huge number of his own party’s senators said they wouldn’t vote for him, he was facing a pending trial for fraud, and on the morning of Election Day, everyone — including his own team — thought he was going to lose.
But he won. And he did so in a bizarre way, winning the Electoral College fairly comfortably despite having lost the popular vote by a much larger margin than George W. Bush did.
Since taking office, his signature values — showmanship, shamelessness, and corruption — have spread like kudzu in official Washington. It’s now a country where Cabinet secretaries go on television to lie and claim that a $600 billion cut to Medicaid won’t cause anyone to lose coverage. It’s a country where the speaker of the House introduces an amendment to erode protections for patients with preexisting conditions and then immediately tweets that it’s just been “VERIFIED” (by whom?) that the opposite is happening. Republican senators who a couple of months ago were criticizing the House bill’s Medicaid cuts as too harsh are now warming up to a Senate bill whose cuts are even harsher.
The watchwords of Trump-era politics are “LOL nothing matters.” If you’re in a jam, you just lie about it. If you’re caught in an embarrassing situation, you create a new provocation and hope that people move on. Everything is founded, most of all, on the assumption that the basic tribal impulses of negative partisanship will keep everyone on their side, while knowing that gerrymandering means Republicans will win every toss-up election. If you happened to believe that Republicans in office would deliver on their health care promises, well, you might be interested in a degree from Trump University.
