GOP created a health care dilemma
Eight years after Republicans denounced President Barack Obama and the Democrats for using their majorities to ram through a partisan health care plan, the current GOP majorities and President Donald Trump are trying to do the same thing.
But there are significant differences, and the outcome could be very different.
The Democrats made clear that their goal was universal health care coverage, which their leaders had long supported. While they fell short, they did cover an additional 20 million Americans, reaching the highest level of coverage in history.
The principal Republican goal is very different: To end what Trump calls “the disaster” of Obamacare, especially the taxes financing it and the mandate that all have insurance. But in their zeal to “repeal and replace” the former president’s signature achievement, their plan would do more to provide large tax reductions for the wealthiest taxpayers than to ensure the “insurance for everybody” President Trump promised.
The nonpartisan Congressional Budget Office said Monday the House GOP proposal would wipe out Obamacare’s gains by taking coverage away from 24 million during the next decade, a figure disputed by Health and Human Services Secretary Tom Price, who insisted Sunday on NBC’s “Meet the Press” that “nobody will be worse off financially.”
That’s hardly the only difference.
The Democrats spent months honing their plan, including extensive public hearings and a months-long negotiation with Senate Republicans that ended when GOP leaders pressured members against joining any bipartisan effort. The Republicans drafted their plan in secret, made no effort to reach out beyond their base and have presented it as basically a take-it-or-leave-it.
Obama and his administration were intimately involved in drafting and selling the health care bill. The current GOP bill is the product of Speaker Paul Ryan and his allies, and the extent of Trump’s involvement is transitory and inconsistent.
The Democrats reached out to the health care community, tailoring some aspects to receive significant support from such industry groups as the pharmaceutical manufacturers and the American Medical Association. Republicans made no such effort and, as a result, most organized groups oppose their plan.
And while a significant minority of House Democrats favored a single payer plan that could not pass the Senate, the party’s House leadership blocked a separate vote on it and forced the more moderate legislation through the House, 220-215.
Republicans face something of a similar political situation, but the ultimate results could be quite different. A significant House minority and conservative senators like Rand Paul of Kentucky want to terminate the entire Affordable Care Act up front, including provisions that allowed expanded state Medicaid programs. But a growing number of Republicans in the closely divided Senate oppose the House bill’s plan to limit Medicaid funds.
Trump’s contradictory responses exemplify the resulting confusion. When he met with Ohio Gov. John Kasich, one of many GOP governors eager to maintain the Medicaid expansion, Trump seemed sympathetic to easing the cutbacks in the House bill. But when he met with conservative groups pushing to eliminate the Medicaid expansion as early as next year, some said they were encouraged by what he told them.
By the end of the week, the White House reiterated that Trump stands behind the House bill’s reduction of Medicaid funds, starting in 2020.
Part of the GOP problem is numerical. While both parties undertook their efforts with House majorities, the Democrats also had the 60 Senate votes that are enough to do almost anything legislatively without help from the minority. They passed Obamacare with a bare 60-vote majority.
This year, Republicans have only 52 Senate votes, requiring them to use a two-step process that lets them change the program’s taxes and subsidies with just 50 votes, plus Vice President Mike Pence, and try to do the rest later.
The month-long debate has displayed a potentially insoluble GOP dilemma. Any action aimed at increasing support from House conservatives by restricting Medicaid benefits will jeopardize Senate Majority Leader Mitch McConnell’s ability to hold enough GOP senators.
Republican leaders hope that, when push comes to shove, they can persuade enough Republicans in both houses to back their bill in the belief that failure would show them unable to govern and lead to a GOP political disaster in 2018. They may well be right.
But if they succeed, the question may become whether their success costs so many Americans their health care that it also costs Republicans the House or Senate.