by Arthur H. Garrison
The Bible warns that pride goeth before the fall. When Trump ran for office he said the Affordable Care Act (ACA) disparagingly referred to Obamacare, was a disaster and would collapse under its own weight and that when he becomes president he would fix it day one. He said it would be beautiful.
Well he failed. But the reason for the failure started not when Trump
allied himself with Paul Ryan, it started on the day Obama became president.
When Obama was elected the Republicans were decimated. The Democrats had full control of House and a filibuster-proof majority in the Senate. He won the presidency with a coalition of voters that outvoted rural and southern white voters. Obama was elected with urban suburban, young, female, blue voters. Obama had broken the Nixon/Reagan southern strategy that had governed modern political theory on how to win the presidency.
The Republicans, after a period of tears and complaints, decided that their strategy would be to oppose Obama “in toto” from the start. To tie all types of Republicans together and to give them a coherent political strategy, the party leadership and conservative talk radio decided that the primary policy narrative would be to oppose the ACA. It became Republican orthodoxy.
Their strategy also included the mobilization of white rural, southern and Christian social Conservatives who viewed Obama and his presence in the White House as both an abomination “per se” and the culmination of the loss of their country which began in the 1950s and 1960s at the hands of both political parties.
The strategy proved to be successful. The Tea Party Republicans in 2010, 2012, 2014 and 2016 pushed the Republican party from a beaten party to a party that now holds both branches of Congress and the presidency. Each election cycle, the one promise that held all Republicans together was opposition to Obama “per se” and repeal and replace the ACA.
Now here is the truth of the matter, the rhetoric over the ACA – not actual policy alternatives – was the glue holding the party together. This is the reason they had no plan when Trump took the presidency. They opposed the ACA because it was attached to Obama.
Once Obama was no longer the focus of the ACA and the positive aspects of the ACA took center stage, voter support for the ACA became a force to be dealt with within the Republican base. Congressional Republicans found themselves split between the Tea Party true believers and Republicans who had constituencies that did not want to sacrifice their health care on the altar of Obama distain.
When Paul Ryan finally presented his plan, it pleased no one because it sought to make Medicare a block grant which would leave the Republican governors holding the bag for funding health care in 2020 while providing half a billion dollars in a slush fund to support losses by the insurance industry. The Tea Party Republicans, now known as the Freedom Caucus, revolted because the law in fact was neither repeal nor replace of the ACA.
Ryan argued that his bill was a repeal and replace through three steps. The first step was a parliamentary procedure to get a budget bill that would pass in the Senate. The second step was the budget bill being supplemented by the current Health and Human Services Secretary using his administrative and regulatory powers to kill parts of the ACA. The third part of the strategy would be senate Republicans passing bills that would finish off the ACA with the help of about ten Democrat senators in red Trump states.
Trump, once being a supporter of universal health care, and having promised to replace the ACA with better health care that included everybody, backed the Ryan bill. Trump along with Ryan tried to appease the Freedom Caucus with agreeing to relieve insurance companies from providing services in base plans including prenatal care, mental health care and drug treatment.
The Freedom Caucus was not mollified. The attempted appeasing of the Freedom Caucus not only achieved nothing but resulted in the loss of moderate conservative Republicans. Having failed to appease the Freedom Caucus and walled in by the moderate conservatives, Ryan was jammed by Trump who saw the writing on the wall and told the Freedom Caucus that no further appeasements would be offered.
The rest of the party, actually liking most the ACA, found a way to despise the Ryan bill while looking like they were still in line with the seven year old narrative of opposing the ACA. With failure clear, Ryan withdrew the bill rather than losing the vote on the record.
Trump, being a consummate salesman and blame dissipater, has left the blame on Ryan and the Freedom Caucus. The result being that, Ryan left in a weakened position as Speaker; the Freedom Caucus proved they are a legislative veto on Ryan; Trump proved he will not be controlled by the Freedom Caucus and their politics without political cost, and according to Trump, the ACA is moving off of the Republican to do list.
The result of all this: The ACA is left intact. But it was never about the ACA anyway.