As a Senate leadership aide during the passage and implementation of the Affordable Care Act, I have been asked several times since Friday whether I take any joy in the epic explosion of the Trump-Ryan repeal-and-replace bill.
I love schadenfreude as much as the next person, but what happened on Friday isn’t even worthy of the term—because I don’t think this fight is over by a longshot, and because what Republicans “have gone through” to date isn’t all that noteworthy.
Congressional Democrats and the Obama administration suffered through a year-long draining, legislative and political fight battle royale to—just barely—get the ACA over the finish line.
Looking back, we underestimated how complex the process and policy would be. There were starts and stops, frustrating setbacks, and daily infighting. But despite it all, we believed in what we were doing and after 13 long months we accomplished a monumental goal.
Compare that to what we have just witnessed from the Trump administration and Congressional Republicans. They spent 18 days trying to figure this out. Eighteen frigging days. That was the extent of their resolve. And if you dissect the very short life of the Trump-Ryan plan it is obvious that for as horrible as the policy was, the presentation was that much worse.
Ask yourselves this question: For seven years, you’ve made repeal-and-replace the centerpiece of your political existence. You finally get the opportunity to do so, aided by a Republican president, a Senate majority, and the largest House majority in generations. To accomplish this, would you do all of the requisite work needed to achieve success or would you make a weak attempt destined to fail?
The most laughable moment of this debacle was during Friday’s White House press briefing when it was asserted President Trump had done everything he could to pass the Republican health care bill.
In the matter of one week in December 2009, Senator Harry Reid convinced the anti-war Senator Russ Feingold to vote for a war funding bill, broke a sickly Senator Byrd out of the hospital because we needed his vote and kept the Senate in on Christmas Eve—all in an effort to pass the ACA.
That, Mr. President, is doing everything in your power.
So, I can’t empathize with Republicans or respect their efforts, not only because I don’t agree them, but because they didn’t make any effort in the first place. But herein lies the problem for Democrats and supporters of the ACA—this is just the first battle.
It is obvious at this point neither President Trump or House Republicans know yet how to effectively govern.
“Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” Rep. Joe Barton memorably said hours before his party pulled the bill it’s been promising for seven years. “We knew the president, if we could get a repeal bill to his desk, would almost certainly veto it. This time we knew if it got to the president’s desk it would be signed.”
Of course, there’s a little pleasure in hearing your opponents admit they’re frauds. But that state of play won’t last. Republicans will learn from their mistakes and will get (nominally) better at using the levers of power to their advantage.
They also have petty and powerful motivators for taking another shot at dismantling the ACA. To their core, it kills Republicans politicians that President Obama has successfully expanded the country’s social safety net in such a consequential and meaningful way.
And after years of promising their most fervent supporters repeal, they know they can’t just turn the page now and say “we tried.” Republicans are going to figure out a way to gut the ACA, because while they know little about health care policy they do have a good grasp on the concept of self-preservation. They might be damned in the next life if they kill it, but they’ll be screwed by their base in this one if they don’t.
So while I suspect we won’t see another big repeal-and-replace effort, it is a certainty Republicans will continue to undermine the fabric of the ACA through smaller yet equally devastating methods. Trump said after the bill was pulled that “the best thing politically is to let Obamacare explode” and there’s plenty he can do to withhold the support and funding the system needs to stay viable. Congressional Republicans will oblige by codifying funding cuts into law through the appropriations process. Quick and easy tweaks to help improve the law will be ignored in an attempt to make “Obamacare” collapse under its own weight.
While the Obama administration made heavy investments in the promotion of the ACA to draw more Americans into the health care exchanges and ultimately make them stronger, there’s little chance we’ll see HHS Secretary Tom Price, one of the law’s leading enemies when he served in the House, continue those efforts.
Democrats must be wary of these moves, and call them for what they are—a death by a thousand cuts.
It would be wise for Democrats to introduce its principles for fixing ACA now in order to win the messaging fight and show American voters who the adults are in the room.
If there is one thing I learned from my time in Senate is that health care is like a horror-movie villain that keeps coming back (although in our version the black guy didn’t die, he got re-elected).
In 2009, every two or three days some journalist, political pundit or health care expert would declare the ACA dead. Hell, at one point Obama Chief of Staff Rahm Emanuel said as much. I thought of those amidst Friday’s breaking news alerts and weekend headlines declaring that the anti-ACA forces had been defeated, as though that were the end of the story. Democrats should enjoy the sight of Republicans with egg on their face but remember that we won a battle, not the war.
This was not a real effort to repeal ACA. It was a ham-handed first attempt that will cause some humiliation, but it doesn’t mean Republicans won’t get their collective heads out of their you-know-what and try again. We must be vigilant for when that day comes.