Try to wrap your head around this possibility: the House Freedom Caucus, the most conservative members of an extremely conservative Republican majority, might be the saviors of the Affordable Care Act.
How is such a thing possible? The answer is their devotion to ideological purity, which it turns out may be as disruptive a political force when the GOP is the ruling party as it was when they were the opposition.
As Republicans have flailed about trying to figure out how to fulfill their promise to repeal the ACA, the chamber’s most conservative members have gotten increasingly frustrated. After all, control of both ends of Pennsylvania Avenue was supposed to produce an orgy of legislating, with no priority more important than driving a wooden stake through the heart of Obamacare. Yet here they stand almost a month after achieving absolute power, and not a single bill has been sent to the White House for Donald Trump’s signature.
So last night, in an apparent attempt to get the repeal train moving, the House Freedom Caucus voted to oppose any repeal bill that would be less comprehensive than the bill both houses of Congress passed in late 2015, which President Obama vetoed (more on what that means in a moment). They threw down a gauntlet before their timid colleagues: either we go big or we don’t go at all.
If the 30 members of the Freedom Caucus stuck together to vote against a repeal/replace bill, it would be more than enough to defeat it, assuming that they’d be joining all of the Democrats in the House. And Obamacare would be saved.
That’s obviously not their preferred outcome, but what they want is something that right now Speaker of the House Paul Ryan and much of the rest of House Republicans are terrified of delivering. The Freedom Caucus is pressuring Ryan to forget about trying some kind of piecemeal approach and just go ahead and repeal as much as possible of the damn thing. This is an approach Ryan has already discarded, since throwing 20 million people off their coverage and destroying the individual health insurance market — all without being able to tell them what will replace it — might not be such a wise move politically.
Republicans still need more time to untie their Gordian Knot, having finally learned that health care reform is complicated and involves tradeoffs (who knew?). But the Freedom Caucus doesn’t care.
That’s for a couple of reasons. First, they come from extremely conservative districts where the only threat they face is a challenge from the right. And second, they spent the last eight years fetishizing hard-line politics, where the only appropriate stance to take was total and complete opposition to anything Barack Obama wanted to do, and compromise was inherently evil, no matter what the particulars of a given situation.
Obama may be gone, but their feelings about compromise remain. So when someone like Ryan says that maybe there are a few parts of the ACA we should hold on to, their natural response is, “NO!” That puts them right back in their happy place: fighting the power, standing up for their principles, refusing to yield no matter the consequences.
So they’ve decided to make their courageous stand. “If it’s less than 2015” — meaning the bill Congress passed that year — “we will oppose it,” said Rep. Mark Meadows (R-N.C.), the chairman of the Freedom Caucus. The trouble is that Republicans passed the 2015 bill knowing full well that Obama would veto it, which meant it was without risk.
Because that bill was passed under “reconciliation” rules, it couldn’t repeal the entire law, only the provisions that have a direct effect on the budget. But that was an enormous amount: it did away with all the taxes that paid for the ACA, the individual and employer mandates, the subsidies that allowed millions of people with moderate incomes to afford coverage, and the expansion of Medicaid that insured millions more.
Now that they’ll be held accountable for the changes they make, Republicans aren’t all sure they want to get rid of all that. Republicans might want to kill the taxes, but that would mean they’re going to have trouble paying for a replacement. Republicans would like to convert those subsidies to refundable tax credits, but it’s not yet clear how Republicans would design them. Many Republican states took the Medicaid expansion — and saw their uninsured rates plunge. They like the flexibility involved in Republican plans to turn Medicaid into a block grant, but they don’t want to give up the money they’re getting from the federal government.
In short, this stuff is complicated, especially if you want to avoid the enormous public backlash that would increase exponentially if you just repealed the law. There may be no way to avoid that backlash, particularly since everything Republicans are considering is guaranteed to produce more uninsured people, higher out-of-pocket costs, and enormous disruption to the system (and that’s if it works as planned). But Ryan and other GOP leaders are hoping to finesse it all with a carefully constructed Jenga tower of a bill that minimizes the political damage they’ll suffer. Some parts of the ACA (the popular ones) will likely be kept in some form, and the whole thing will be rolled out gradually, perhaps with a delay that pushes the most dangerous parts of the transition past the 2018 midterm elections (or even the 2020 elections). And it’s already clear that Ryan doesn’t want to rush into anything when the political stakes are so high.
To the Freedom Caucus folks, however, nothing is complicated. A compromise with the public’s desires or with their party’s leaders is just as repugnant to them as a compromise with Obama. The only question is whether they’re being pure and true. And if what Ryan comes up with feels like a compromise, they may just decide that knocking down the tower is what it takes to remain pure and true — even if it means the ACA would stay in place, at least for a while.