After a day of bad reviews for the GOP leadership’s preferred Affordable Care Act replacement, the House Freedom Caucus was ready for the spotlight. Dozens of reporters and cameramen had set up at the House Triangle. Some cable networks were even taking the Freedom Caucus news conference live, harking back to the time when tea party protests could rattle or derail business in Congress.
But a few reporters were being held inside the Capitol by security guards. Vice President Pence was wrapping a visit to the Hill, talking to Freedom Caucus members, a few of whom had served with Pence when he was a congressman. When the vice president left, some of the conservative rebellion’s leaders were taking a measured — if still skeptical — tone about the American Health Care Act.
“What the vice president is saying is that this foundation is a good foundation,” said Rep. Mark Meadows (R-N.C.), chairman of the Freedom Caucus. “The bill that was introduced last night is still open for negotiation.”
“I’m glad we finally got a bill out,” said Rep. Louie Gohmert (R-Tex.), an aphorism-loving conservative who often breaks with leadership. “It’s not 2,500 pages. It’s a starting point.”
Twenty-four hours after its debut, the AHCA has attracted an astounding array of critics. Every major grass-roots organization of the right — Americans for Prosperity, Heritage Action for America, FreedomWorks, the Club for Growth — has opposed it. Conservative health-care wonks like Forbes’s Avik Roy and the Cato Institute’s Michael Cannon called the bill a disaster. Breibart News, which the president’s political strategist Stephen K. Bannon ran for years, has also criticized it. AARP has already run an online ad against the bill’s cost scale, dubbing it an “age tax.”
In Congress, Sen. Rand Paul (R-Ky.) had called the bill “dead on arrival,” while senators who wanted the bill to retain the ACA’s Medicaid expansion hesitated to take a position. Sen. Cory Gardner (R-Colo.), who’s charged with expanding the GOP majority in 2018, told reporters multiple times Tuesday that he was “working through the language of the bill.”
Groups that had spent millions of dollars to elect Republicans, and had successfully lobbied against components of the ACA, were given only rudimentary rundowns of what would be in the replacement. But supporters of the AHCA were confident Tuesday that when the process was over, holdouts would not want to fumble even a compromised repeal bill. The critics’ varied responses, and the spin from leadership, revealed just how much slack there was in the “repeal” campaign.
Freedom Partners and Americans for Prosperity, the two nerve centers of the Koch donor network, came out against the AHCA on Tuesday morning. “As the bill stands today, it is Obamacare 2.0,” the group’s leaders wrote in a joint letter to Ryan and the key committee chairmen. “Passing it would be making the same mistake that President Obama, Harry M. Reid, and Nancy Pelosi made in 2010. Millions of Americans would never see the improvements in care they were promised, just as Obamacare failed to deliver on its promises.”
When that letter went out, 200 grass-roots members of Americans for Prosperity were meeting ahead of a lobbying trip to the Capitol. It was the official launch of a campaign called #YouPromised, in which the Koch network and its supporters would demand total repeal of the ACA.
Tellingly, the activists were revved up for their work with speeches from people who had lost coverage when their insurers dropped or re-priced plans to meet the ACA’s standards. One of them, Julie Boonstra, had starred in a 2014 TV ad campaign in Michigan, where she made claims about what the ACA had done to her coverage that were later debunked. But Boonstra was one of the stars of a new ad for the #YouPromised campaign, in which people who blamed the 2010 law for their canceled coverage demanded that Congress repeal it.
But the ad did not really bind Republicans to any kind of repeal plan. Being crafted before the AHCA was released, it couldn’t respond to the GOP’s bill. In the absence of a bill, however, it defined the problem facing Congress as the existence of the ACA; the problems cited in the ad would not be fixed by any repeal plan, or any replacement.
That ad actually resembled one designed to build support for whatever the GOP came up with. The American Action Network, a 501(c)(4) that has so far run $8 million of ads (and pieces of mail) about the ACA debate, released a new ad this week that defined the problem with the current ACA: It cost some people their coverage. In the long version of the ad, a woman named Elizabeth tells a horror story about her family’s plan being cut before a birth and a surgery, and suggests a plan that would ensure cheaper coverage.
The American Action Network did not respond to a question about Elizabeth’s story, leaving it unclear what about the AHCA would ameliorate her situation. In fact, the American Action Network’s ad blitz has talked up a Republican plan for months, without ever saying what the plan might include. The only concrete promise: The Affordable Care Act, which was not working, would be repealed.
The lack of detail about what a replacement must include has left Republicans with plenty of rhetorical running room. At a news conference Tuesday afternoon, House Speaker Paul D. Ryan (R-Wis.) sad that the basics of AHCA were “what we ran on,” referring to the whole Republican Party. At the White House, Health and Human Services Secretary Tom Price concurred with Ryan that his (Price’s) old repeal legislation was at the heart of the AHCA, meaning that Republicans had debated this in public.
At Tuesday’s Freedom Caucus news conference, the conservatives who could bring down the whole bill insisted that the AHCA, as is, did not meet their standards. But in one meta moment, Meadows acknowledged that “repeal” and “replace” had come to mean many things.
“Repeal, to many, meant to many that we would repeal the entire Obamacare plan,” Meadows said. “All the taxes, all the mandates. When he talked about replacement, it took on another meaning to many, meaning that people with preexisting conditions would not be kicked off their plans. Let me tell you, those two things are still the focus.”
And all of that discussion was taking place without the data that Republicans needed to meet the president’s standard for repeal — a Congressional Budget Office score. On the campaign trail, Donald Trump had diverged from his rivals by suggesting that people who had coverage would keep it if he was elected. They would, he said at one rally in Las Vegas, receive “great health care for a fraction of the price” that they were used to.
On Wednesday, members of the House Ways and Means committee would meet to mark up the AHCA without any independent estimate of whether the bill would meet Trump’s standard. And several “repeal” campaigns would be underway without a clear agreement of what repeal would achieve.