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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

March 23: TrumpCare Hits Dead End, Or At Least Cul-De-Sac

Near the end of a crazy week in Washington, Republicans just postponed a House vote on their “must-pass” health care plan. I offered a quick explanation at New York.

[I]t was not terribly surprising given the news from a White House meeting earlier today between Donald Trump and members of the conservative House Freedom Caucus, wherein Trump made a “final offer” and very few HFC folk bought it.

It had appeared Wednesday night that Trump and Paul Ryan might have found a way to blow this flawed bill out of the House by promising to include the repeal of Obamacare’s list of “essential benefits” heath plans needed to provide to qualify for federal subsidies (the list includes ten key categories, such as hospitalization, emergency services, and pregnancy care). That had previously been thought to be an unavailable concession thanks to Senate rules limiting budget reconciliation bills to budget-germane provisions. But those backing TrumpCare were now offering assurances (backed up by Sen. Mike Lee, a key Senate conservative who had opposed the original AHCA) the Senate parliamentarian would play ball with this broader bill. So presumably conservatives who wanted more of a complete repeal of Obamacare could, in theory, vote for the bill in the House and then vote against the final House-Senate conference report in case the reports about the parliamentarian’s flexibility were in error or just a ruse.

But the gambit backfired when HFC members meeting with Trump pocketed the “essential benefits” concession and demanded more. According to one account, they wanted even highly popular provisions like protections for people with pre-existing provisions and allowing dependents up to age 26 going on their parents’ policies to be repealed. Regardless of the exact demands, it’s clear conservatives called Trump’s and Ryan’s bluff: if all Obamacare regulations are now on the table, why stop with one or two?

Indeed, even before the vote cancellation, influential conservative commentator Ramesh Ponnuru was arguing that the new information about the parliamentarian meant Republicans should rethink the whole bill, not rush it out of the House. And if nothing shakes loose in the next few days, that may be the new GOP excuse for additional delay.

The trouble is this: even if these reports are right and Republicans don’t have to wait for some improbable second or third “prong” of regulatory or legislative action to get rid of Obamacare, GOP conservatives and “moderates” don’t agree at all on which provisions to trash and which to keep. And the search for a compromise won’t be improved by a fight over features of the bill that could easily be understood and “scored” as making life worse for real-live categories of people now benefiting from the Affordable Care Act.

For now Republicans at both ends of Pennsylvania Avenue have reached a cul-de-sac on health care and need either to turn around and try a different path or pull off some sort of politically dangerous minor miracle. This very bad week for Donald Trump has gotten a lot worse, and for once Paul Ryan is his full partner in misery.

Stay tuned for more GOP health care madness.

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