In the wake of the rapid and total collapse of the American Health Care Act today, I sat down to write at New York about the GOP’s health care policy options going forward, before realizing there might not be any. Here were my thoughts:
The good news for Republicans that nobody much appreciates right now is that there was nothing mandatory about this whole messy enterprise. Yes, if they just give up on enacting a budget-reconciliation bill for fiscal year 2017 (that’s technically what the American Health Care Act is), they will defy the “instructions” they gave themselves back on January 13 when they enacted the budget resolution that put this runaway train in motion. Yes, there are both political and fiscal consequences for just bagging it. But there’s no judge who will fine them for it. So technically, the president is right: They can “move on,” and they can “punish” the American people by letting the Affordable Care Act stay in place.
And there was certainly nothing in Speaker Paul Ryan’s press conference after the bill was pulled to suggest any present intention to go back to the drawing board and come up with another bill. He admitted repeatedly that Obamacare would be in place “for the foreseeable future.” And then Donald Trump put the lid on the coffin by repeatedly saying nothing would happen on health care until Democrats joined in after Obamacare “explodes.”
Barring some second wind for a repeal/replace effort, or the unquenchable possibility that Donald Trump will change his mind, it will probably become an agenda item that slips into the future, or at least until 2018. The possible exception, particularly if the current system of individual health insurance continues to struggle with higher premiums and the withdrawal of insurers from purchasing exchanges, would be for Republicans to ask Democrats to cooperate in some sort of “fix” that they could market as sort of repeal-and-replace on the cheap.
Is it possible Democrats would be interested in this sort of deal once they finish celebrating the implosion of Trumpcare? Probably not anytime soon. The only vehicle for a bipartisan compromise at the moment is the Cassidy-Collins proposal that lets states decide whether to stick with Obamacare (including the Medicaid expansion) or move in a more conservative direction. This might have been enticing to some blue-state governors and Members of Congress back when it looked like Republicans had the means to enact something far more draconian. But at the moment it would look like a betrayal of Democratic constituencies in red states.
What might happen instead is that Republicans, freed from the responsibility of actually enacting anything, which their trifecta and the budget reconciliation made possible, will retreat to proposing impracticable health-care legislation they know Democrats won’t support and can easily filibuster. It will be just like Obama is still president and Republicans could demagogue on health care to their hearts’ desire!
In the short term, Republicans will have to deal with some immediate challenges exacerbated by this fiasco, like the need to satisfy their anti-abortion constituents by “defunding” Planned Parenthood, pursuing a tax-cut package without the improved revenue “baseline” that AHCA would have provided, and finding a new vehicle for “reforming” Medicaid (i.e., capping federal expenditures).
From a longer perspective, Republicans now understand how Democrats felt when the Clinton Health Plan went down to defeat in 1994. If it takes them half as long as it took Democrats to take another swing for the fences on health-care policy, we won’t soon see any vindication of the doomed effort that died today.