After a bruising midterm election in which widespread insecurity over the future of health care helped pace extraordinary gains for Democrats, allowing them to retake the House of Representatives, President Donald Trump has decided to re-up this failed strategy.
This week, the White House let it be known that the administration would not defend the Affordable Care Act in a case that could end in the wholesale invalidation of the Obama-era health care reform law. Such a result would cause no end of chaos, beginning with the prospect of tens of millions of Americans losing their current health insurance plans. Nevertheless, Trump expressed exuberant confidence, declaring that he would make the GOP the “party of health care.”
A strong vow, indeed. But the idea that the GOP could ever be “the party of health care” is something of a stretch.
The problem that Republican lawmakers refuse to confront is that their own philosophies are misaligned with the desires of the American people. Most Americans, including die-hard members of the GOP base, prefer their health care to be stable and affordable, with ready access and no surprise costs. Most Republican health care proposals, on the other hand, position health care as the hard-won privilege of those who make the correct moral choices in the Randian free market.
The idea that health care might be a human right is categorically rejected; health care models proven to produce better outcomes through some measure of government intervention in the marketplace come in for similar castigation as an un-American brand of socialism — whether it’s a wholesale single-payer plan that would eliminate the need for private health insurance, or a more modest proposal to allow the government to option to bargain for lower drug costs.
Because these two points of view are impossible to reconcile, the GOP can never really replace Obamacare with a bill that manages to achieve the same basic benchmarks for health care access and premium cost.
As a result, Republican alternatives to Obamacare tend to be at their best when they are in a liminal state between being and nothingness. Once loosed from their Schrodinger’s box, exposure to the real world causes these bills to be revealed as paradoxical scams. And lest you think this quantum mechanics metaphor is inapt, let’s recall that the GOP literally stashed one of its health care proposals in a basement hidey-hole, refusing to even let its own members look upon it.
But even a rudimentary recollection of the GOP’s recent history renders such metaphors unnecessary. In the decade since the passage of the Affordable Care Act, Republicans have been trapped in a cycle of proposing alternative bills that then never arrive, after which the party, stricken with criticism over their inactivity, begins the process anew. It has always been this way, and there is no reason to believe this is ever going to change. But let’s go to the tape.
GOP political consultant Karl Rove, 2009: “In politics, you can’t beat something with nothing, so it is critical that the GOP offers an alternative to President Barack Obama’s government-run monstrosity.”
In 2009, as Democrats began to assemble the ideas that would, after much intra-party wrangling, lead to the Affordable Care Act, Republicans were still attempting to gin up an alternative out of the remains of the plan Sen. John McCain (R-AZ) put forward on the stump. While it may have been unfair to expect much more than policy protoplasm from the GOP so early in Obama’s first term, early signs suggested that Republican legislators were going to struggle to get on the same page.
In May, Sens. Tom Coburn (R-OK) and Richard Burr (R-NC), along with Reps. Paul Ryan (R-WI) and Devin Nunes (R-CA), introduced the Patient’s Choice Act, which like Obamacare had Mitt Romney’s Massachusetts reform as an obvious antecedent. A month later, Reps. Eric Cantor (R-VA) and Dave Camp (R-MI) threw together their own plan, which was termed a “four-page exercise in public relations” by one observer. In July, Rep. Tom Price (R-GA) put forth the “Empower Patients First Act,” which bore such a close resemblance to other Republican bills that it caused some to wonder what was so markedly wrong about its predecessors that it needed to be created in the first place. Finally, in November, Rep. John Boehner (R-OH) offered an “Amendment in the Nature of a Substitute” to the emerging Democratic health care reform bill.
Nothing came of any of these early efforts. The CBO made mincemeat of Boehner’s amendment. The Patients Choice Act was referred to committee and never emerged. There was an “Improving Health Care For All Americans Act” and an “Empowering Patients First Act,” both of which came to naught. As Sen. Max Baucus (D-MT) famously quipped, “I started reading a couple, three, of the Republican plans, but frankly, there’s only so much time in the day.” Many of these initial ideas went on to serve as the recombinant DNA of future Republican failures.
American Spectator columnist Fred Barnes, 2010: “Republicans… ought to go beyond advocating repeal of Obamacare, tell voters what they’d replace it with, and explain the benefits.”
As 2010 got underway, and the Democrats’ bill continued to draw inspiration from Mitt Romney, the GOP’s alternatives sought refuge in the minimal. The Weekly Standard offered a single-page alternative to Obamacare called “The Small Bill” that never really garnered much attention beyond its own masthead. Meanwhile, the White House’s first effort to bridge the partisan divide was met by the GOP offering “a blank sheet of paper” as a counter-proposal. As if to underscore the GOP’s nihilist position, Sen. Bob Bennett (R-UT) was defeated in the second round of balloting at his state’s Republican convention for the crime of working productively on a bipartisan alternative with Sen. Ron Wyden (D-OR).
But on March 23, 2010, the GOP watched as the Patient Protection and Affordable Care Act became the law of the land. Repealing Obamacare thus became the order of the day and Republicans quickly got back to the process of throwing bill after bill at the wall to see if any might stick. Rep. Paul Broun (R-GA) offered up the “Repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010,” as his fellow House colleagues created a parallel bill that would do essentially the same thing but with an even longer name. Both bills went to committee and never returned.
Hope for the GOP nevertheless arrived in November with the election of a new Republican majority in the House.
Weekly Standard contributor Jeffrey Anderson, 2011: “[Republicans] need to show the American people that the choice is not between Obamacare and nothing. They need to provide a meaningful, sensible alternative to Obamacare’s comprehensive failings.”
In March of 2011, the Washington Post’s Ezra Klein declared that it was “put up or shut up time for Republicans,” who, in his estimation, “managed to make it through the health-care debate without offering serious solutions of their own, and — perhaps more impressive — through the election by promising to tell us their solutions after they’d won.” This earned him the ire of his conservative colleague, Jennifer Rubin, who accused Klein of “pretending there is no alternative to the deeply flawed Obamacare.”
This was the first instance of what would soon become a pattern, in which failed Obamacare alternatives led to conservative pundits to order Republicans back to the drawing board. This would lead liberal pundits to remark about the dearth of Republican ideas, which in turn would prompt conservative critics to lambaste their lefty counterparts for failing to note all of the ideas that had failed in the first place.
The obvious way of breaking the cycle was, of course, to simply come up with a plan and stick with it. This proved to be so difficult that talk of replacing Obamacare actually began to fade. As Politico reported in July: “When they took control of the House, Republicans could barely stop talking about their plans to ‘repeal and replace’ the health care reform law. Six months later, they hardly talk publicly about those plans at all.”
Romney health care adviser Avik Roy, 2012: “Conservatives are sorely mistaken if they believe that they can continue to campaign against Obamacare, without offering their own strategy for making health care more affordable for American families and the federal treasury.”
In January of 2012, with the health care law hanging in the balance thanks to a looming Supreme Court case, the Hill reported that “House Republicans will be ready with a plan to replace President Obama’s healthcare law once the Supreme Court determines the law’s fate this summer” — and that an alternative to Obamacare would be ready to go no matter how the Roberts court ultimately ruled.
As you might expect, the Hill would subsequently report in May that “Republicans might not offer a comprehensive plan to replace President Obama’s healthcare law if the Supreme Court strikes it down this summer.” In fact, in July, Cantor would tell NBC News’ Tom Brokaw that Republicans were merely preparing “to begin work” on the bill.
Weeks later, the Los Angeles Times would report that Republicans had “all but given up pushing alternatives” to Obamacare.
Washington Examiner contributor Mona Charen, 2013: “As Obamacare’s rising costs and constricted choices alienate the American people, Republicans should be ready with an alternative that is market-oriented, assembled and on the launchpad.”
Correctly predicting that the Obama administration’s implementation of the Affordable Care Act’s state marketplaces would be a fraught affair, Ryan would make an attempt to reboot the repeal-and-replace effort, telling the attendees of the Wisconsin state GOP convention, “This is the moment that we have to offer them real hope and give them real alternatives.” Price would answer the call and offer up another replacement bill, the “Empowering Patients First Act of 2013.” Like so many other bills, its short life ended after it was referred to committee.
Nevertheless, members of the GOP attempted to renew their vows. Rep. Kevin Brady (R-TX) would tell Newsmax that the party would definitely “plan to have an alternative to Obamacare ready by this fall.” Indeed, the Republican Study Committee would offer up the “American Health Care Reform Act of 2013,” which ThinkProgress described as a grab bag of health care ideas that the GOP had been proposing “since at least 2007.” Like so many other GOP alternatives, this bill would also slip into the afterlife of committee limbo.
Price would tell Fox News that the Republicans would definitely “bring forth a bill” to “unite Republicans around health care issues” sometime after the new year because, as he said, “You can’t beat something with nothing.”
Karl Rove, 2014: “Republicans can easily pick [Obamacare] apart, but they won’t win over voters without their own ideas.”
True to their word, Senate Republicans unveiled the “Patient Choice, Affordability, Responsibility, and Empowerment Act” not soon after the start of the new year. And true to form, wrote Jonathan Chait, “Within hours of the new plan coming into contact with political reality, things began to fall apart,” as its authors realized that actually attempting to invent a funding mechanism for covering the uninsured invited political attacks. Once that became apparent, the authors “changed the language… insulating them from political attacks, but also neutering [the proposal’s] value.”
By April, it was reported that the roll-out of the Republican alternative would be delayed once again. The Republican Study Committee briefly attempted to mount a campaign for Rep. Phil Roe’s (R-TN) “American Health Care Reform Act of 2013” (also known as HR 3121), going so far as to wear lapel pins that read “HR 3121, There’s A Better Way.” The whereabouts of those lapel pins has been lost to history, but HR 3121 died in committee.
In June, Cantor, through a spokesperson, reaffirmed that he was continuing “to work towards bold legislative solutions to replace Obamacare.” Weeks later, Cantor lost his primary election to David Brat.
Wisconsin Gov. Scott Walker (R), 2015: “We must repeal Obamacare… but we can’t stop there. The president’s policies must be replaced with a plan that will send power back to people and the states.”
With Obamacare once again in the crosshairs of the Supreme Court — this time in the King v. Burwell case — Republican lawmakers repeated their vows to have an alternative ready to go no matter how the matter was resolved. Committees received instructions, task forces were enjoined, and the result was an “outline of a plan” cobbled together by a trio of Republican senators which would be forced to “compete with with several other replacement options.”
By the time the Supreme Court began hearing the oral arguments in King, GOP lawmakers had not yet mapped out their path to a replacement. Nonetheless, the New York Times declared that “the search for a replacement by Republican lawmakers” was now, in its seventh year, “finally gaining momentum.” And the Senate’s budget set an end of July deadline for the replacement bill.
But when July rolled around, the same old inactivity and excuses returned. Politico reported that “Republican lawmakers… say that the deadline doesn’t really mean anything.”
“It’s not a hard and fast deadline,” House Majority Leader Kevin McCarthy (R-CA) insisted, adding, “I don’t think there’s a reason why we have to hurry.”
Indeed, they did not hurry. And so in December, House Speaker Ryan announced, “We think this problem is so urgent that next year, we are going to unveil a plan to replace every word of Obamacare.” Days later, Ryan added a proviso: “I don’t have an exact timeline.”
Rep. Fred Upton (R-MI), 2016: “Give us a little time, another month or so…I think we’ll be pretty close to a Republican alternative.”
In January of 2016, Fox News reported on a major breakthrough, in which the GOP-led Congress “within hours of reconvening” was going to pass a bill to repeal and replace Obamacare in the House, which, once combined with its Senate equivalent, would “send the measure to President Obama, daring him to veto it.”
Obama vetoed it. The fact that the repeal and replace measure was combined with another measure that would end funding for Planned Parenthood raised suspicions that perhaps the proposal was nothing more than veto bait all along.
Nevertheless, Republican lawmakers rededicated themselves to a more sincere effort to create an Obamacare replacement. With the heat of the presidential campaign season providing incentives of its own, Ryan vowed that he would come through with a proposal even if the gaggle of GOP candidates failed to do so. But by June, as Donald Trump secured the GOP presidential nomination, the best Republican lawmakers had at hand was “a white paper that is less detailed than legislation would be.” And so the task got handed off to Trump and his running mate, Mike Pence.
“Plans you don’t even know about are going to be devised,” Trump promised.
Sen. Bob Corker (R-TN), 2017: “To be honest, there’s not any real discussion taking place right now.”
With the inauguration of Trump, GOP lawmakers — occupying consolidated majorities in both houses of Congress — were finally on the glide path to repealing and replacing Obamacare. At least, that’s probably what most people thought the Trump presidency was going to play out. In practice, however, owning all of the veto points didn’t enable the GOP to either repeal or replace Obamacare. Rather, it only illuminated internal divisions and intra-party dysfunction that the president lacked the mental fortitude or the temperament to alleviate. Throughout Trump’s first spring in office, Republicans were seemingly at one another’s throats more often than they were at the task of passing their long-promised Obamacare replacement.
House Republicans managed to narrowly pass the American Health Care Act by a 217-214 vote, prompting a Rose Garden celebration in which Trump expressed confidence that passing the Senate would be a mere formality.
Instead, all of the familiar patterns returned. The Senate missed its self-imposed July 4 deadline. The CBO filleted the bill — noting that it would leave 22 million people uninsured as a result of its passage. Revisions and horse-trading failed to improve matters. In the end, Senate Majority Leader Mitch McConnell’s proposed “skinny repeal” was the last vestige of the effort left alive — and McCain, who had been the deciding vote in allowing the matter to come to the Senate floor in the first place, cast the vote that killed the effort. A later, even more last-ditch effort to revive the dead measure floated by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) would similarly fail.
Taken as a whole, it’s hard to ascribe the “party of health care” moniker to a party that can’t seem to coalesce around a plan on most days, let alone pass a plan when consensus is achieved — even with full congressional majorities and the presidency in hand.
Despite this, some Republicans remain cheerful and optimistic even after Trump’s decision to throw everybody’s health insurance into arrears. As Graham enthused, “This is sort of like a new lease on life… Obamacare has failed and it’s not going to work… we have done enough to go after Obamacare, but not enough to replace it.”
“If we don’t have a proposal on health care then that is a mistake going into 2020,” he added.
Sounds awfully familiar.