USA Politics

For GOP, health-care saga becomes deepening test of credibility

Finding the patterns

Republicans have long pledged to repeal and replace Obamacare. Now they’re in charge of Congress, yet struggling to cultivate the legislative give-and-take required to govern.

Senate Majority Leader Mitch McConnell of Kentucky, left, and Senate Majority Whip John Cornyn of Texas speak with the media after a June 27 meeting of Senate Republicans with President Trump at the White House. After failing to get their health-care bill to a vote before Congress's early-July recess, Republicans are seeking to revise their proposal.
Alex Brandon/AP
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When Republicans swept last November’s elections, the sky appeared to be the limit. Obamacare would be repealed and replaced. The tax system would be overhauled. American infrastructure would at last get a major infusion of cash.

All of this may yet happen, but promises of speedy change haven’t materialized. Health-care reform is stalled in the Senate, and the details of tax reform are still on the drawing board. Then there’s President Trump, who has complicated efforts to revive health reform by suggesting “repeal first, replace later” – a stark turnabout from his pledge to do both at once.

And in eye-popping fashion, Mr. Trump has sucked the oxygen away from policy altogether since last Thursday with sensational tweets attacking the media personalities and outlets – most recently a video of Trump body-slamming a “CNN” avatar.

But it’s congressional Republicans whose credibility is on the line, foremost. After eight years of Barack Obama, and years of symbolic votes to undo the Affordable Care Act (ACA), they now have an ally in the White House – one who is eager to sign major legislation.

Since Trump won the presidency, “the Republican Party, particularly in Congress, has not understood that their job is to govern,” says GOP strategist Ford O’Connell. “And when you govern, sometimes you have to man up and walk the plank.”

That means voting for legislation you don’t love, and that may even cost some members reelection. And for both leaders and rank-and-file members, it means developing the “muscle memory” of legislative give-and-take – not just on symbolic measures, but also on bills that could become law.

For now, Senate Republican leader Mitch McConnell is working to recover from the embarrassment of having to call off a vote last week on his chamber’s plan for Obamacare repeal and replace, called the Better Care Reconciliation Act. He and his team have been laboring behind the scenes to rework the bill and garner support. Trump, too, has been making calls to senators, according to top administration officials.

No one said replacing the ACA, or Obamacare, would be easy. The Republican majority in the Senate is slim – 52 to 48. That means the party can lose only two votes, with Vice President Pence breaking a tie.

And President Obama’s signature reform has grown in popularity since Trump took office, as support for the GOP replacement loses altitude. A Fox News poll taken last week shows only 27 percent of registered voters favor the Senate bill, its best showing among the latest polls.

The Republican effort to replace the ACA has been a giant game of “beat the clock” – in part by design. Trump himself wanted fast action, as promised during the campaign. In addition, the Republicans are attempting to replace the ACA via a legislative technique known as reconciliation, which requires only a majority to pass, but can be used only once per fiscal year. That gives the party until Sept. 30, which isn’t much time, given the legislative calendar.

Senator McConnell wanted his colleagues to vote quickly, a week after the bill was unveiled and days after the nonpartisan Congressional Budget Office had issued its report laying out the projected impact. But aside from the Trump imperative, and the legislative calendar, why the effort to move so quickly?

“It’s a rendezvous with arithmetic,” says John Pitney, a political scientist at Claremont McKenna College in Claremont, Calif. “When you’re restructuring a significant chunk of the economy, the costs suddenly come to the fore.”

Professor Pitney points to reduced funding for Medicaid, health care for low-income Americans, and other changes to coverage via the exchanges. “The longer this plays out, the more you’re going to hear from people who stand to suffer,” he says.

Some senators have already faced confrontational voters at town halls, and more such exchanges can be expected. Republicans defend the legislation as a market-oriented remedy to a collapsing ACA, aiming to bring down premiums and allow consumers more choice.

McConnell’s memoir is called “The Long Game” for a reason. Known as a smart political tactician, he could shelve health-care reform and come back to it later. House Speaker Paul Ryan, after all, failed to bring his first version of repeal and replace to a vote, and later succeeded. McConnell could do the same. In the meantime, the ACA would remain in effect, and blame for its deficiencies would fall on Democrats. The Republicans could then move on to tax reform – a legislative initiative that Trump reportedly sees as his most important.

But without health-care reform, pressure would be even higher to notch a major legislative success. And with reports that populist White House adviser Steve Bannon wants to raise the 39.6 percent tax rate on the highest earners – those who earn more than $418,400 a year – tax reform may be even more difficult than previously thought.

Of course Trump has plenty to show for his short time in office. He got the Senate to confirm a conservative judge, Neil Gorsuch, for the Supreme Court – albeit aided by a historic rule change ending the filibuster for high court nominees. Trump’s controversial travel ban to the US for citizens of six largely Muslim countries was allowed to go into effect, with some exceptions, ahead of a full hearing by the Supreme Court in the fall. And through both executive action and legislation, the president has eliminated dozens of government regulations deemed a burden on the economy.

But it’s the delicate business of enacting big, complicated legislation that may be most confounding in a new era of unified government.

“The difference between the two parties is that the Republican Party is so good at campaigning and so bad at governing, or at least at passing legislation,” says Cal Jillson, a political scientist at Southern Methodist University in Dallas.

Michael Bailey, a professor of American government at Georgetown University in Washington, says it’s not even fair to blame ideological diversity within the GOP for the party’s challenges. In this era of partisan polarization, the most liberal Republican is still more conservative than the most conservative Democrat, studies show.  

“The Republicans are pretty strongly conservative – even the quote-unquote moderates are pretty conservative,” says Professor Bailey. “They don’t have big ideological divisions, and they don’t have big geographic divisions…. So it’s all the more amazing that they’re having these troubles.”