Of buck­ets, bridges and back­packs: GOP grap­ples with health-care lex­i­con

The Washington Post Sunday - - POLITICS & THE NATION - @PKCapi­tol PAUL KANE paul.kane@wash­post.com

At times, con­gres­sional Re­pub­li­can lead­ers sound like MBA pro­fes­sors try­ing to teach their stu­dents the right buzz­words to un­der­stand the na­tion’s health-care sys­tem.

Sev­eral of them talk about “buck­ets” for un­der­stand­ing the process for re­peal­ing and re­plac­ing the Af­ford­able Care Act. One lawmaker de­scribed the 2010 health law as a col­laps­ing “bridge” in need of a “res­cue team” to come in and build more “bridges.”

If you can’t un­der­stand buck­ets or bridges, maybe the health­care “back­pack” is your thing.

“So we’re re­plac­ing that big mon­stros­ity of the Af­ford­able Care Act with some­thing Amer­i­cans haven’t had be­fore, which is a health-care back­pack — tai­lored to their needs, which trav­els with them through their life that they con­trol, the health-care back­pack that can go from job to job, state to state,” said Rep. Kevin Brady (R-Tex.), chair­man of the House Ways and Means Com­mit­tee.

Brady chose that metaphor, as did the other law­mak­ers, in­side a closed-door ses­sion Thurs­day in Philadel­phia dur­ing a pol­icy re­treat for con­gres­sional Repub­li­cans. His com­ments are known be­cause some­one anony­mously recorded the al­most-two-hour health-care ses­sion, along with other pri­vate meet­ings on na­tional se­cu­rity and with Vice Pres­i­dent Pence, and then leaked those record­ings to The Wash­ing­ton Post and sev­eral other me­dia out­lets.

The tapes paint an all-too-vivid por­trait of rank-and-file Repub­li­cans strug­gling to fig­ure out how the health sys­tem works and how they should de­scribe it to vot­ers.

Serve up a pop quiz on any com­plex is­sue to your av­er­age mem­ber of Congress, and the re­sults might be fright­en­ing. But on health care, the re­sults look down­right painful for many Repub­li­cans.

So, more than seven years af­ter tea party re­bel­lions started as a re­ac­tion to “Oba­macare,” af­ter dozens of votes de­signed as po­lit­i­cal state­ments to re­peal the law, Repub­li­cans left Philadel­phia still stum­bling over how to do it.

Lead­ers and com­mit­tee chair­men were still ex­plain­ing Thurs­day to rank-and-file Repub­li­cans that it would re­quire at least 60 votes in the Se­nate, where Repub­li­cans hold a slim ma­jor­ity built on 52 seats, to re­place most of the law.

That’s be­cause Democrats ap­proved most of the law in per­ma­nent fash­ion with 60 votes in early 2010, and the fast-track pro­ce­dures that Re­pub­li­can can use this year will ap­ply only to taxes and fund­ing mech­a­nisms with a few other wrin­kles.

That sparked a de­bate over whether the party needed a new slo­gan, an amended ver­sion of the “re­peal and re­place” mantra Repub­li­cans have adopted in re­cent years.

“The word ‘re­pair’ is a lot bet­ter than the word ‘re­peal,’ if you want to be ac­cu­rate,” Sen. La­mar Alexan­der (R-Tenn.), chair­man of the health com­mit­tee, told fel­low Repub­li­cans. He noted that much of the law will still be in­tact af­ter leg­is­la­tion that is be­ing billed as the re­peal passes. Many other laws would have to be passed over time through the regular order of win­ning over enough Se­nate Democrats to over­come a fil­i­buster.

“Say­ing we’re go­ing to ‘re­pair’ the dam­age is more ac­cu­rate,” Alexan­der said.

But oth­ers warned how dif­fi­cult it was to coach GOP law­mak­ers four or five years ago to say some­thing other than just that they would re­peal the ACA.

“That’s what led to ‘re­peal and re­place.’ There’s a much bet­ter set of lan­guage now in ‘re­peal and re­pair,’ all of those things,” said Rep. Greg Walden (R-Ore.), chair­man of the House En­ergy and Com­merce Com­mit­tee, with over­sight of much of the health in­dus­try. “But it’s kind of funny be­cause it took so much en­ergy to get peo­ple to say more than just, ‘We’re go­ing to re­peal Oba­macare.’ We added ‘re­place’ to that, and now we need to get bet­ter.”

The re­al­ity is that Thurs­day’s con­ver­sa­tion was de­tailed and long. One Re­pub­li­can lead­er­ship aide, a vet­eran of many re­treats, de­scribed it in an in­ter­view as “in­cred­i­bly sub­stan­tive” and rich with the sense that 2017 was “the mo­ment” for big things.

Yet the grav­ity of this mo­ment — they con­trol both cham­bers of Congress and the White House — led many law­mak­ers to re­al­ize this wasn’t a hy­po­thet­i­cal ex­er­cise like in years past, back when they knew Pres­i­dent Obama would veto any­thing they drafted. Some Repub­li­cans be­moaned Alexan­der’s idea of “build­ing bridges” to im­ple­ment a se­ries of laws in the months and years ahead to re­place the ACA, in­stead push­ing a go-for-broke strat­egy in one mas­sive bill that would be ready at the time of the re­peal vote. Oth­ers wanted the ex­act op­po­site, fear­ful that a rushed bill would re­sult in a scram­bled health mar­ket and, in turn, po­lit­i­cal blame on Repub­li­cans in the 2018 midterms.

Still oth­ers ques­tioned why so­cial is­sues, such as Planned Par­ent­hood fund­ing, were part of the mix.

“I’m not sure there’s una­nim­ity yet on ex­actly what the tac­tics are go­ing to be,” Sen. John McCain (R-Ariz.) said. “Over­all strat­egy: Re­peal and re­place. Tac­tics: I don’t think they’ve been hashed out yet.”

Of course, McCain made those com­ments to a few re­porters in the ho­tel lobby as he was skip­ping the health-care dis­cus­sion sev­eral floors above.

The back and forth left some Repub­li­cans ex­as­per­ated.

Rep. Vir­ginia Foxx (R-N.C.), chair­woman of the Ed­u­ca­tion and Work­force Com­mit­tee that has a small role in health leg­is­la­tion, is­sued a warning to her col­leagues who have “no back­bone” to do the tough work and vote for what­ever lead­er­ship comes up with.

“I couldn’t be­lieve a week or so ago that I heard there were peo­ple get­ting weak-kneed on the re­peal,” she told her col­leagues. “God, we all ran on the re­peal of Oba­macare, what is wrong?”

Maybe things will get smoother if they just set­tle on buck­ets, bridges or back­packs. Or maybe it’s a home-build­ing metaphor.

“We have to lay the foun­da­tion, we have to in­stall the plumb­ing and the elec­tri­cal,” Brady told Repub­li­cans. “We’ve gotta start build­ing the walls.”


Rep. Kevin Brady (R-Tex.), right, with Reps. Kevin McCarthy (RCalif.), left, and Steve Scalise (R-La.), uses the back­pack metaphor.


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