Editor’s note: House Republicans plan to vote Thursday on an Obamacare replacement plan, called the American Health Care Act. On Tuesday, Post Opinions writer Jennifer Rubin and Alice Stewart, former spokeswoman for Sen. Ted Cruz’s 2016 presidential campaign, discussed how passage of the bill would affect the GOP’s political fortunes. The email discussion was moderated by Post Opinions digital editor James Downie and has been edited for style and clarity.
James Downie: Jen, you said to me before we started this debate that the Republican Party might be better off if the American Health Care Act doesn’t pass Congress. Why?
Jennifer Rubin: Thanks for asking me to do this. On the substance, Alice knows better than anyone that the legislation is a dog’s breakfast. It’s a bill that does not repeal Obamacare and does not address the most acute issue, namely rising premiums. Speaker Paul Ryan (R-Wis.) keeps promising that will be addressed in the third prong of legislation, but as Sen. Tom Cotton (R-Ark.) points out that is never happening (since there are not eight Democratic votes). If the GOP passes this, it will be stuck with the worst of all worlds — a highly regulated insurance market with skimpier tax credits than were available under Obamacare. That, plus the roll back on Medicaid expansion, explains why so many conservatives and moderates oppose it.
The bill was so unworkable Ryan had to come up with a last minute “manager’s amendment” to, for example, try to improve support for rural, older voters who are badly hurt. But there is no legislative language laying that out. Those who vote for this literally won’t know what is in the bill. In short, it’s bad legislation that will hurt people, many of whom voted for President Trump. If it passes, the problems with the bill and the hard luck cases will be on the heads of Republicans.
[Republicans’ four-point plan to help the poor get poorer]
As for the politics, it has already split the party and pitted Republicans against one another. It gets a pitiful level of support. Voters, as opposed to politicians and political insiders, rank health care relatively low on their priority list. Voters really are not clamoring for this. Rather than get mired down in an endless negotiation back and forth with the Senate and be responsible for a lousy outcome, Republicans would be wise to move on to jobs, just as the president said he wanted to do.
If the GOP is convinced this is a winning issue, they can run on it in 2020 and ask for a filibuster proof majority in the Senate.
Alice Stewart: I appreciate the opportunity to weigh in on this important issue. As I heard all along the presidential campaign trail in 2012 and 2016, the “Affordable” Care Act is unaffordable for millions of Americans. Republicans in the House and Senate campaigned on repealing and replacing Obamacare. President Obama promised the American people “if you like the doctor you have, you can keep your doctor” and that average premiums would go down $2,500 a year, neither of which turned out to be true.
The current House plan is a good start, but changes need to be made for it to pass. As Jennifer knows, the “sausage making” of legislation is hard work. I applaud the administration for sitting down with people on all sides of the issue. The Republican Study Committee and the House Freedom Caucus are instrumental in passage of a bill. They need 216 votes to pass in the House and both groups need to come together.
I support the Freedom Caucus and their conservative measures. They want a bill that guarantees lower premiums, an immediate roll back to Medicaid expansion and reasonable work requirements for able-bodied people without dependents. These are measures that Senate conservatives, like my former boss, Sen. Ted Cruz, will support. They are aware that if they don’t deliver lower premiums, they are not delivering on their promises to their constituents. They will hold out for a bill that is right, and not just one that is right now.
[How to save the GOP health-care plan]
Rubin: I’m not hearing from Alice — because she is an honest person — an argument for this bill. Obamacare’s faults don’t make the case for this particular bill. Significant numbers of Freedom Caucus members are saying the bill does not do what it is supposed to. Perhaps they have internalized the real lesson of Obamacare: Don’t pass a bad bill, take responsibility for people’s health care and hope it gets fixed later. Right now, Sen. Cruz won’t vote for the bill. And he’s right. It should die in the House.
Stewart: President Trump said Tuesday that the GOP will lose seats if the bill fails. The reality is, they will lose seats if they pass a bad bill.
I would imagine, some are probably wishing they had listened to Jennifer’s earlier suggestion that they should have stuck to jobs and the economy in the first year. However, ignoring Obamacare is not an option, and failure is not an option. These members of Congress go back to their districts each weekend and hear the stories of constituents who have lost coverage, had their premiums skyrocket and have limited choices. It’s one thing to be in the minority and point out the problems; now that we have the majority, there is no reason the GOP can’t compromise and work towards a bill that delivers on their promises.
Downie: Will the GOP base punish those who vote against the bill?
Rubin: Well, I definitely share Alice’s concern that if you pass a bad bill the voters will punish you. The House effort seems to be the very definition of a bad bill. I would urge, as Sen. Tom Cotton and others have, to slow this down. No one is asking that health care be fixed today. There are lots of other ways to proceed. One would be to break this up into parts, as many Republicans previously suggested. Try a Medicaid reform bill, for example, using the plan four GOP governors submitted recently to House and Senate leaders. Use another bill to try to address the regulations that are keeping premiums in the exchanges artificially high.
It’s tempting to squish this all together in reconciliation but as we discovered it leaves a Swiss cheese bill that no one likes. The outcome will be much more to Republicans’ liking if they proceed the way I suggest.
[Democrats should offer solutions, not silence, on health care]
And yes, it does involve dealing with the Democrats. Again, the problem (one of them) with Obamacare was in making it the effort of just one party. Unless we are going to rip up health-care legislation every four years, maybe we should see what can be done on a bipartisan basis. If Democrats are intransigent R’s can run on the issue in 2018.
Stewart: Look, I’m not convinced that the GOP base is sold on the bill yet. And the fact that Trump is still engaging in “The Art of the Deal” with House members, indicates it’s still a work in progress until Thursday. If the final piece of legislation is acceptable to the base and their congressman votes against it, then yes, they will suffer the consequences. They will be the dog who caught the car and didn’t know what to do.
Downie: What do you think the fallout will be if the bill passes the House but fails in the Senate? Or will Senate Majority Leader Mitch McConnell (R-Ky.) make sure it gets through (and if so, how will the bill change)?
Stewart: It’s no secret, the Senate is rarely in a hurry to go anywhere, especially down a dead end road on a health-care overhaul.
While you have Sen. John Cornyn (R-Tex.) saying “if they pass it, we will pass it,” there are many others, such as Cotton, Cruz and Sen. Mike Lee (R-Utah) who have made it clear they will not support a bill that does not address rising premiums and deductibles which make insurance unaffordable for Americans. They want to keep their campaign promises on repealing and replacing Obamacare.
These Senate members want the House to slow down and get a bill that is right, and not just right now.
[The real world of Obamacare repeal]
Rubin: The Senate sure does slow things down, which is by design. McConnell is the savviest legislator in either party. If the bill comes over from the House, it will spend a long time in committee while he builds support. He’ll only bring it to the floor if convinced it can make it through reconciliation and get 51 votes. I don’t think that is going to happen anytime soon.
Downie: Let’s get final thoughts and predictions. Will the House bill stay largely unchanged, and how many votes will it get?
Rubin: In the Trump era I try whenever possible to avoid prognostication. That said, some news organizations now are reporting there are enough votes to defeat the bill in the House. As a result, I would expect Ryan to pull the bill and announce “productive conversations” will continue. Trump will try not to mention health care for the next month.
Stewart: Freedom Caucus members will not walk the plank on a bill that doesn’t lower premiums. Without that voting block, the bill will not pass the House.
I expect Speaker Ryan will wisely give in to the demands of the conservative House members and put forth a bill that he knows will have the votes needed to pass in the House and be a lot more palatable to Senate Republicans.
This does not mean it’s smooth sailing in the Senate. Many live by the Pottery Barn rule — “You break it, you own it.” If they repeal Obamacare, they want a viable replacement on the table. Many are demanding a full repeal or there is no deal in the Senate.