At times, congressional Republican leaders sound like MBA professors trying to teach their students the right buzzwords to understand the nation’s health-care system.
Several of them talk about “buckets” for understanding the process for repealing and replacing the Affordable Care Act. One lawmaker described the 2010 health law as a collapsing “bridge” in need of a “rescue team” to come in and build more “bridges.”
If you can’t understand buckets or bridges, maybe the health-care “backpack” is your thing.
“So we’re replacing that big monstrosity of the Affordable Care Act with something Americans haven’t had before, which is a health-care backpack — tailored to their needs, which travels with them through their life that they control, the health-care backpack that can go from job to job, state to state,” said Rep. Kevin Brady (R-Tex.), chairman of the House Ways and Means Committee.
Brady chose that metaphor, as did the other lawmakers, inside a closed-door session Thursday in Philadelphia during a policy retreat for congressional Republicans. His comments are known because someone anonymously recorded the almost-two-hour health-care session, along with other private meetings on national security and with Vice President Pence, and then leaked those recordings to The Washington Post and several other media outlets.
The tapes paint an all-too-vivid portrait of rank-and-file Republicans struggling to figure out how the health system works and how they should describe it to voters.
Serve up a pop quiz on any complex issue to your average member of Congress, and the results might be frightening. But on health care, the results look downright painful for many Republicans.
So, more than seven years after tea party rebellions started as a reaction to “Obamacare,” after dozens of votes designed as political statements to repeal the law, Republicans left Philadelphia still stumbling over how to do it.
Leaders and committee chairmen were still explaining Thursday to rank-and-file Republicans that it would require at least 60 votes in the Senate, where Republicans hold a slim majority built on 52 seats, to replace most of the law.
That’s because Democrats approved most of the law in permanent fashion with 60 votes in early 2010, and the fast-track procedures that Republican can use this year will apply only to taxes and funding mechanisms with a few other wrinkles.
That sparked a debate over whether the party needed a new slogan, an amended version of the “repeal and replace” mantra Republicans have adopted in recent years.
“The word ‘repair’ is a lot better than the word ‘repeal,’ if you want to be accurate,” Sen. Lamar Alexander (R-Tenn.), chairman of the health committee, told fellow Republicans. He noted that much of the law will still be intact after legislation that is being billed as the repeal passes. Many other laws would have to be passed over time through the regular order of winning over enough Senate Democrats to overcome a filibuster.
“Saying we’re going to ‘repair’ the damage is more accurate,” Alexander said.
But others warned how difficult it was to coach GOP lawmakers four or five years ago to say something other than just that they would repeal the ACA.
“That’s what led to ‘repeal and replace.’ There’s a much better set of language now in ‘repeal and repair,’ all of those things,” said Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, with oversight of much of the health industry. “But it’s kind of funny because it took so much energy to get people to say more than just, ‘We’re going to repeal Obamacare.’ We added ‘replace’ to that, and now we need to get better.”
The reality is that Thursday’s conversation was detailed and long. One Republican leadership aide, a veteran of many retreats, described it in an interview as “incredibly substantive” and rich with the sense that 2017 was “the moment” for big things.
Yet the gravity of this moment — they control both chambers of Congress and the White House — led many lawmakers to realize this wasn’t a hypothetical exercise like in years past, back when they knew President Obama would veto anything they drafted.
Some Republicans bemoaned Alexander’s idea of “building bridges” to implement a series of laws in the months and years ahead to replace the ACA, instead pushing a go-for-broke strategy in one massive bill that would be ready at the time of the repeal vote. Others wanted the exact opposite, fearful that a rushed bill would result in a scrambled health market and, in turn, political blame on Republicans in the 2018 midterms.
Still others questioned why social issues, such as Planned Parenthood funding, were part of the mix.
“I’m not sure there’s unanimity yet on exactly what the tactics are going to be,” Sen. John McCain (R-Ariz.) said. “Overall strategy: Repeal and replace. Tactics: I don’t think they’ve been hashed out yet.”
Of course, McCain made those comments to a few reporters in the hotel lobby as he was skipping the health-care discussion several floors above.
The back and forth left some Republicans exasperated.
Rep. Virginia Foxx (R-N.C.), chairwoman of the Education and Workforce Committee that has a small role in health legislation, issued a warning to her colleagues who have “no backbone” to do the tough work and vote for whatever leadership comes up with.
“I couldn’t believe a week or so ago that I heard there were people getting weak-kneed on the repeal,” she told her colleagues. “God, we all ran on the repeal of Obamacare, what is wrong?”
Maybe things will get smoother if they just settle on buckets, bridges or backpacks. Or maybe it’s a home-building metaphor.
“We have to lay the foundation, we have to install the plumbing and the electrical,” Brady told Republicans. “We’ve gotta start building the walls.”