Donald Trump recently suggested Republicans would replace the Affordable Care Act. He then executed a partial retreat (in response to strong pushback from top Republicans) and said this change would occur after “Republicans hold the Senate & win” the House in the 2020 elections.
There’s nothing new about Trump making unwise and capricious declarations, only to postpone or moderate them in response to resistance from people who know better (see his announced U.S. withdrawal from Syria). But in the case of health care, Trump injected an especially toxic political issue back into the national conversation, handing Democrats a knife they will twist gleefully between now and Election Day.
According to the Wesleyan Media Project, health care came up in more than half of the ads run by Democratic candidates last year. Several Republican incumbents like California Rep. Mimi Walters and Michigan Rep. Mike Bishop—both of whom went on to lose in 2018—were haunted by it. Take a look at this brutal ad run by Bishop’s opponent, Elissa Slotkin, and imagine some version of it being run in every House and Senate race next year. Democrats must be overjoyed by the prospects of getting to run this play one more time.
If Senate Republicans want to avoid a similar fate in 2020 (goodbye, judicial nominations!), they should exorcise this issue, rather than relitigate it. If ever there were a time to “leave well enough alone,” this would have been it.
The fundamental problem isn’t that Republicans don’t have a popular health-care alternative—it’s that the one they have isn’t coherent.
I’m not one to agree with Chuck Schumer, but when he says Republicans “have no health-care plan. It’s the same old song they’ve been singing. They’re for repeal. They have no replace,” he’s not exactly wrong. Way back in January 2017, I warned that Republicans should punt on an Obamacare repeal-and-replace strategy. I based this warning on several days of extensive conversations with health-care policy experts and a desire to find a workable Republican alternative.
I looked at the ideas, which included a litany of proposals like allowing people to purchase across state lines, tax deductions and refundable means-tested tax credits to incentivize coverage (in the absence of a mandate), Portable Health Savings Accounts, an auto-enrollment feature, and allowing virtually anyone to be able to form or join a large group to get coverage. Some of these were fine reforms, but none of could garner a consensus because they either weren’t free market enough—or because they weren’t able to deliver on the promise of universal coverage and guaranteed coverage for pre-existing conditions.
“It feels like Bush’s Social Security [privatization] all over again,” one senior industry official told me at the time. “It’s really hard to see how this ends up with as many people being covered at the same or lower costs. It’s a mess.”
My sources were right. It was a mess. But here’s the thing: even if the political environment was conducive to upending the health care of tens of millions of Americans (it’s not), Republicans are no more prepared with a viable alternative than they were two years ago.
In the interim, Republicans scored a win by scrapping the individual mandate. That satisfied the main libertarian-conservative complaint with the Affordable Care Act. They should pocket that and move on.
Of course, they thought they had. The issue is having a renaissance by virtue of Mick Mulvaney, erstwhile Freedom Caucus member and acting White House chief of staff, as well as Donald Trump, who never saw an Obama victory he didn’t want to reverse.
Call me a defeatist, but I think this issue is a loser for Republicans. Until they have a practical consensus solution that makes it easier for Americans to get health care (and I’m not holding my breath on that), they should quit trying to make fetch happen.
But it’s not just health care. There doesn’t seem to be any Republican policy agenda at all. Maybe Republicans should stop obsessing about Obama’s legislative legacy and start worrying about their own?
Issues have built-in skews, and health care, for whatever reason (theories abound), skews liberal. If Republicans are talking about health care, they’re probably losing.
Frankly, this is possibly true even when it entails Democrats pushing for Medicare for All, but it is most certainly true when it involves Republicans potentially rolling back Obamacare.
In the immortal words of political powerhouse Kenny Rogers, sometimes “You’ve got to know when to hold ‘em and know when to ‘fold em, know when to walk away, and know when to run.”
Someone better play Trump that song before it’s too late.