In legislating, there is always the tension between what is ideal vs. what can pass.
Some Democrats wanted to amend the Affordable Care Act to add a “public option” to the offerings of private insurance companies. The idea was that if insurers strayed too far down the profit-taking path, people could switch to an option where that wasn’t a consideration. But Democratic leaders calculated that such a change would undermine the hard-to-win cooperation of insurers and torpedo the entire bill. So the public option was rejected.
Fast forward to today, and “what can pass” would appear to be the only consideration for the president and House Republican leaders as they barter for a replacement.
Plan A – their first attempt – rankled the tea party wing (aka the Freedom Caucus) because it was too much like Obamacare. Plan B, which ran aground last week, failed because more moderate Republicans said it didn’t preserve enough of Obamacare (of course, they didn’t phrase it that way).
Unlike the architects of the current health care law, congressional Republicans have not reached out to insurance companies, health care providers, hospitals or any direct stakeholders before crafting legislation. They made promises to repeal, and the quality of the replacement looks to be an afterthought. Certainly after seven years, there should be more substance to their plans. Instead, they appear to be making it up as they go along, while shielding the public from the process.
This secrecy has spawned speculation that Republicans know they’re cornered and there’s no way out.
One theory is that President Trump pushed hard for replacement legislation last week, so he could add that “victory” to a list of 100-day accomplishments. Another theory is that the House wants to pass something – anything! – and then shift the blame to the Senate for its inevitable demise.
When nothing happened, the president blamed Democrats for not jumping aboard a plan they consider worse than the first. Some Republicans feel the same way, knowing that Plan B was devised to lure Freedom Caucus votes, not theirs.
Trying to debate the ever-shifting plan is a fool’s errand, because the sole goal appears to be political survival. When asked where she stands, Rep. Cathy McMorris Rodgers doesn’t pick Plan A or Plan B. She merely rehashes criticisms of Obamacare and speaks in generalities about a replacement.
Politically, this may make sense. Why choose which sinking ship to board? But at some point, a health care solution has to transcend politics. People are scared. They hear from politicians that the ACA is doomed, but they can’t see what its replacement will be because the people scaring them don’t know either.
The irony is that the ACA is gaining in popularity now that the public has something – however sketchy – to compare it with.
Republicans, including the president, would do well to read those polls and beat a quiet retreat on the issue until they can come up with a serious proposal. If they can’t overcome their intraparty divisions, then some Republicans should consider working with Democrats to improve the current law.
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