As the American Health Care Act heads toward an uncertain future in the House, there is speculation that Republicans might be better off if the bill is killed quickly in its first vote. With many members of the Freedom Caucus lining up against the bill, Margot Sanger-Katz and Nate Cohn, who respectively cover healthcare and elections for the New York Times opined on which was worse for the GOP, having the bill fail or having it pass.
“I think there are two big forces behind the progress of this bill,” Cohn said. “One is that no one wants to be responsible for its failure. So I agree that if the House passes something, there will be a lot more pressure for the Senate to figure something out. They might not be able to do it, but they might really try.”
“Two is that the speed is good for the Republicans,” he continued. “It has a better chance of passing if they move quickly, before public opinion turns against it. It’s better for the Republicans if it fails quickly, because they can move on to other things.”
“I think the Republicans are in a tough spot either way, but I think they’re better off if the bill fails,” Cohn continued. “They’ll get bad press, but voters have fairly short memories and I think the Republicans will move on. They’ll still be able to blame problems on Obamacare, even if it will be less credible. If they pass this plan, I have no idea how they intend to defend it. And I think hurting vulnerable Americans would go against the core of Trump’s appeal to the decisive Obama-Trump vote in the Midwest and Northeast, with little benefit. I think the best position for a lot of Republican members is to vote for the bill, but hope it fails. On the other hand, if the bill passes, it will be nice to be among the Republicans who voted against it.”
If the bill does manage to pass the House, it won’t pass the Senate as written. “The Senate has more of a moderate problem than the House, it appears,” said Sanger-Katz. “There are two senators — Lisa Murkowski and Susan Collins — who don’t like that the bill defunds Planned Parenthood. There are a few senators from states that expanded Medicaid who are worried about changes to that program. There are also some concerns about the generosity of tax credits, particularly for older Americans.”
If the bill is amended to win the votes of Murkowski (R-Alaska) and Collins (R-Maine), it will face increasing opposition from Senators on the right such as Rand Paul (R-Ky.) and Ted Cruz (R-Texas). Still, the best chance for repeal and replace seems to be to pass versions of the bill in both houses and work to improve it in the conference committee that irons out the differences.
The biggest problem for Republicans is the lack of a clear direction if the AHCA fails. “My sense is that there’s just no policy consensus about health care among Republicans,” Sanger-Katz said. “I think they would need that kind of vision and consensus to get something ready in advance.”
Finding a consensus is easier said than done. Many of the problems with the current bill result from trying to find a consensus where there is none. Conservatives want a complete repeal of the Affordable Care Act which is not mathematically possible in the current Congress without Democrat defections. Moderates want to protect citizens of their states that rely on the Obamacare’s Medicaid expansion. The resulting standoff makes it unlikely that enough Republicans can be satisfied to pass any bill without compromise from both sides.
The current bill is the result of an “effort to write this bill, in a hurry, with a jumble of provisions, [that] seems to suggest that they are just trying to find something that can pass, as opposed to articulating a clear policy vision for what they want health care to look like in this country,” Sanger-Katz said.
If the current compromise bill, written to get something passed, cannot pass, what is the future of the Republican repeal and replace effort? Amending it to satisfy members of the Freedom Caucus would probably spur moderates to vote “no” and vice versa. If the bill dies, there is no clear path forward.
Failure of the current bill might have the effect of moving healthcare reform to the left. If conservatives cannot be brought on board, President Trump may tack to the left and craft a bill that could pass with a coalition of moderates from both parties.
Failing to repeal Obamacare won’t be good for Republicans. Neither is passing a bill that leaves much of Obamacare intact. Finding a bill that can pass will require walking a tightrope that leaves the GOP vulnerable to attacks from both the left and the right.