Five Questions for House Republicans on Health Care Reform
This week, House Republicans will vote to repeal and replace the Affordable Care Act. Because I worked as part of President Obama’s legislative team to pass that law, and lived through the turbulent politics that followed, I suggest House Republicans answer these five questions before they leap off their political precipice. Unless they can answer all five questions with a firm “yes,” Republicans should either oppose the bill or convince their leadership to spend more time on it.
1. Are you prepared for a marathon?
Starting next week, there are only 13 weeks of legislative session before the August recess. In that time, the Senate must develop, deliberate, and vote on a new version of the health care bill while also confirming a Supreme Court nominee, finishing spending for FY17, developing a budget plan for FY18, raising the debt ceiling, and addressing critical deadlines for FISA and FDA user fees. Then there are important but not “must do” matters like filling more than 500 executive branch vacancies, confirming more than 100 lower court judges, and of course, tax reform. Everything on this list will consume time, energy, and political oxygen. Are you prepared for many months of health care debate?
If yes, proceed to #2.
2. Have you accepted that the Senate will get the last word?
Let there be no illusions: the House bill is not becoming law. Too many Senate Republicans have expressed opposition, and the President has said major changes are coming.
Knowing this, the Republican leadership will use several arguments to get you to vote for this dead cat. They’ll promise a Manager’s Amendment to fix the worst of the political problems. They’ll say the bill is a strong start for negotiations with the Senate. They’ll argue that pausing now dooms the bill and your party. These are familiar arguments to me — I made similar ones, believing them at the time. But trust me: a yes vote on the current bill will get you condemnation from conservative voices, non-ideological constituents, the health care community, consumer advocates, and pretty much every American who has a bad experience with their health care going forward. According to numerous public polls, the current law is substantially more popular than your draft bill…let that sink in.
In political parlance, when the House votes for a political stinker that has no viable path through the Senate, this is called “walking the plank.” You ready to take that stroll?
If yes, proceed to #3.
3. Are you prepared to defend a partisan bill?
In 2009, Democrats spent months courting Senators Olympia Snowe, Susan Collins, and Chuck Grassley. I personally met with dozens of House Republicans to solicit ideas and win support. When the House passed its version of the Affordable Care Act, it didn’t have nearly as many Republicans as we once hoped, but it did have the support of one — Congressman Joseph Cao of Louisiana. Further, the enacted law included several elements that were verifiably Republican in pedigree, including the exchanges (see Mitt Romney’s plan in Massachusetts), the individual mandate (Sen. Bob Dole’s alternative to President Clinton’s employer mandate), and a provision allowing cross-border insurance with the agreement of the states involved. Are you comfortable with a bill that has even less bipartisan buy-in?
If yes, proceed to #4.
4. Are you confident that the President will have your back?
In a quiet moment, ask yourself: Is the President a reliable ally? You and your leaders are making difficult choices — will President Trump defend your choices, or will he saw off the branch after you’ve climbed onto it? He has already said that your bill will hurt a lot of people, particularly in rural areas. Is he likely to spend his political capital on provisions that can’t pass the Senate?
If yes, proceed to #5.
5. For the rest of your days, are you willing to defend the real-world results of “TrumpCare?”
Just as the Affordable Care Act became known as “Obamacare,” this legislation will not be known by its formal name. In the years to come, you’ll be defending “Trumpcare” and the baggage or benefit his name brings with it. You’ll also carry responsibility for constituents losing health care, premium changes, fluctuations in access and benefits, and many, many other aspects of the public’s health care experience. Close your eyes and imagine the town hall meetings, daily interactions with constituents, and campaign ads that connect you to Trumpcare. Are you ready to own it?
If your answers to all of the above are in the affirmative, then you are ready to vote yes. Just don’t say you weren’t warned.