Republicans’ failed attempt to repeal the Affordable Care Act is now receding into the rearview mirror. So it's a good time to take stock. What lessons have we learned? And what do these lessons tell us about what to expect going forward?
Here are my three lessons:
1) Policy capacity and expertise matter.
2) Lobbying matters.
3) The GOP civil war really is real.
In a sense, these are all things we should have known all along. But they continue to be relevant. Taken together, these lessons tell us that Republicans are going to have a hard, hard road ahead.
Policy capacity and expertise matter
Among the many remarkable facts of the failed American Health Care Act is that health care experts both left and right hated it. Almost everybody with a credential to understand health care thought it was terrible.
So why was the bill so widely disparaged? Certainly, there are political reasons (how do you get competing factions to support a bill?) and process reasons (it had to pass reconciliation, which limited what it could accomplish) that put limits on what could be accomplished.
But there’s also a story here about policy knowhow. Let’s put it plainly: Speaker Paul Ryan and his staff clearly lacked the policy capacity to effectively tackle an incredibly complicated subject. As a result, they wound up with an amateur-hour bill.
This should not be surprising. Since Newt Gingrich, the Republican Party has turned increasingly hostile to knowledge and expertise, slashing funding for congressional staff, leaving Congress increasingly reliant on a rotating cast of 20-somethings without policy or process expertise.
This is something Ryan seems to have grasped back in early 2015, when he asked for more funding for the Ways and Means Committee budget, which he then chaired: “The committee needs to add staff, particularly tax, health care and the economics fields, to meet these responsibilities. … We just can’t do the best job if we don’t have the resources.”
Of course, when you’re passing bills that have no chance of becoming law, details don’t actually matter, so it’s easy to cut spending on your own budgets by 20 percent, as John Boehner did, and be fine. It’s also easy to do this if you just want to let corporate lobbyists write the bills for you.
But as Ryan noted in his surprisingly candid postmortem, being a “governing party” is hard. There are trade-offs, and details, to figure out. The Affordable Care Act was 2,700 pages long for many reasons, one being that health care covers about one-sixth of the entire economy. It’s not something you come up with new rules for in one marathon secret bill-writing session.
While congressional Democrats certainly had more policy expertise than Republicans in writing the original Affordable Care Act, they also benefited from tremendous expertise from the Obama executive branch. By contrast, the Trump White House’s knowledge of health care policy appears to have been about as deep as “Tom Price once ran an orthopedic clinic, so maybe he knows something.” Trump’s ignorance of the basics of health care policy was truly stunning, though not surprising.
Perhaps regardless of the policy expertise Ryan and the Republicans had behind the bill, the politics were still fundamentally fraught. But it seems more likely that if Republicans took policy expertise seriously, they also might have taken a very different approach in the first place, rather than coming up with a bill that only seemed to be solving a political problem.
Traditionally, Republicans in Congress have made up for their lack of experienced staff by outsourcing key pieces of the bill-writing process to lobbyists and friendly think tanks. Yet on this significant piece of legislation, neither Ryan nor Trump appears to have worked much at all with industry or think tanks in developing the bill.
This is frankly surprising to me. If I wanted to craft a theory of “maybe they weren’t actually serious about passing this bill,” it would begin here, since it’s quite mystifying why they would do this. In 2009, Democrats spent a lot of time making sure key industry groups would support the Affordable Care Act, because they understood that these groups had a ton of lobbying muscle that could be used to sway wavering members, depending on where these groups came down.
By contrast, most of the major health care industry groups came out against the AHCA. It’s hard to say how much this affected wavering GOP members in close districts, but I’d be very surprised if it wasn’t a factor. It’s very hard to win support for a bill when major industry groups don’t like it.
But it was not only “inside” (the Beltway) lobbying that probably helped tank the bill. It was also “outside” lobbying.
There was a mass mobilization of citizens showing up at town halls and making members of Congress aware that there were real people, with real health benefits, who would be very angry and very vocal about their anger if those benefits went away. This almost certainly contributed to Republicans in close districts getting cold feet on supporting the bill. Grassroots lobbying pressure can be very effective.
Both inside and outside lobbying will be out in full, complicating force if tax reform is next. It’s not clear Republicans are at all ready for this.
The GOP civil war is real
In the weeks prior to the election, a steady stream of articles about the coming GOP civil war began appearing. I wrote one too. All of us saw a party coalition that was deeply fissured. Elites were out of touch with voters. Voters were coalescing into competing factions. Different groups and leaders were jockeying for position.
Obviously, Trump’s unexpected election and unified Republican control of Congress and the White House changed the dynamics. Different factions all had policy goals to accomplish, and a real possibility of actually accomplishing those goals if they could get everybody else on board, with them. That meant different factions within the party had an incentive to play nice with one another.
Most prominently, though Ryan and Trump had made no secret of their disagreements and mutual dislike during the election, they both understood they needed each other. Ryan needed Trump to sign his bills. And Trump needed Ryan to pass his bills.
Now that mutual dependence is wavering. For Ryan, the problem is not necessarily that Trump won’t sign his bills. The problem is that he doesn’t have enough unity in his own caucus to pass anything significant to give to Trump to sign.
This lack of unity was precisely why Ryan was rushing the AHCA to the floor. This is how House leaders had been governing a fractured caucus for years: Do big complicated stuff quickly, and make it a party-line vote before members have time to come to their own independent conclusions about the policy.
Political scientist James Curry has written an excellent book on this dynamic, Legislating in the Dark (read my review here). The problem for Ryan is that this top-down approach to governing has limits. Over time, rank-and-file members come to resent it, and start distrusting leadership. And once trust breaks down, it’s hard to get it back.
But the alternative to the ram-it-through, top-down legislative process would be a bottom-up, deliberative, committee-based process. This would almost certainly be chaos, at least in the short term.
Yet at some point, and maybe soon, Ryan may be forced to make a decision: either make a deal with the House Freedom Caucus on process, which would lead to chaos, or try to make a deal with Democrats on policy that could lead to governing stability. The coming budget supplemental may force this decision sooner rather than later.
But this is only one front for Ryan. The other is Trump. If Ryan can’t cohere his own caucus into delivering legislative victories, he’s less valuable to Trump. And Trump then has two options.
One is the president tries to force Ryan’s ouster in hopes that somebody else will be more effective/loyal. (Majority Leader Kevin McCarthy, who has drawn closer to Trump, seems the most likely candidate.) There is some speculation Trump is already doing this.
The other option is that Trump simply abandons trying a legislative agenda and instead focuses more energy on things he can do by executive order, like what National Review editor Rich Lowry calls “core issues of immigration, trade, and his war with the media/leakers, where he has a lot of authority to act on his own.”
However, Trump needs to be careful. If he comes at Ryan, he needs to make sure he gets him. If Ryan comes to see Trump as the enemy, he has it within his power to let Congress move forward with oversight hearings that could be very damaging to Trump, and possibly pave the way to impeachment, helping Ryan’s friend Mike Pence become president.
Presumably, there’s enough at stake with tax reform that both Trump and Ryan will try to make it work, at least for now. But the politics and details of comprehensive tax reform are even more daunting than the politics and details of health care. Any comprehensive tax reform will drown Capitol Hill in an onslaught of corporate lobbying, and require a deftness and level of policy expertise that barely exists on the Hill these days, and certainly doesn’t exist in the White House, to maneuver.
Perhaps Republicans could work out something simpler. But a big tax cut primarily for the rich without any budget offsets would be very unpopular.
So one scenario is that the tax reform process bogs down for many of the same reasons that health care reform fell apart: Republicans lack cohesion and internal policy knowhow, which is a deadly combination when you’re trying to do big things. Frustration grows, blame expands, and at some point it all combusts.
Then again, it’s also quite likely that the Trump administration limps along, making a series of small-scale pro-business regulatory changes written by industry lobbyists while foregrounding the “immigration crisis” as the defining fight of our time and going to war with the media to distract from the unpopularity of such changes. If this is the case, the Republican civil war may simply resolve into a soft Trumpist takeover. Paul Ryan and Congress become increasingly irrelevant, and the major action takes place at the White House.
Either way, the lack of GOP in-house policy expertise, the prevalence of lobbying, and the real divisions within the party are all realities that will shape and limit the possibilities of what Republicans can achieve with unified government.