The dog we had when I was a boy loved few things more than barking at our garbage man.
He even dug a little hole under our fence, just big enough to accommodate sticking his head through for the purpose of getting an unobstructed view. His barks translated roughly as, “YOU’RE REALLY LUCKY THAT THERE’S A FENCE BETWEEN YOU AND ME RIGHT NOW!”
A funny thing happened one morning, though. The garbage man came a little early, just before my dad was about to put the dog in the backyard. As my father opened the side door to let the dog out, our pooch finally had a clear path to the garbage man.
What did he do?
He sprinted past the garbage man so that he could get behind the fence and bark.
Presented with the opportunity to repeal and replace the Affordable Care Act at long last, Congressional Republicans did much the same thing.
President Trump will take a lot of the heat for the failure of the American Health Care Act because he’s an easy and inviting target. But, aside from the usual hasty and ill-advised tweets lauding the bill, most of the blame for this one can’t be laid at Trump’s feet.
The praise Trump heaped on the AHCA after its drafting would have been identical had it been a very good bill. But it was a bad bill. Trump’s political capital takes a hit in the short-term, but he’s better off without the AHCA becoming law.
Congressional Republicans, on the other hand, are in a decidedly different situation.
Despite the fact that Bernie Sanders and others laughably portrayed the defeat as the result of phone calls and town hall turnout, the failure owes largely to a division between pragmatists and purists within the Republican Party. The bill as written occupied a dreaded “no-man’s land” that wouldn’t have changed nearly enough about the ACA to satisfy those who think the law is a disaster. At the same time, more pragmatic or moderate Republicans were undoubtedly worried about the GOP losing voters who would suddenly find themselves without health insurance.
The bill was the worst of both worlds.
Rather than compounding a bad situation, Paul Ryan was at least smart enough to pull the AHCA before a vote. Republicans realized that they would wind up “owning” all of the problems in the health insurance / healthcare law realm, even problems stemming from provisions that pre-dated their intervention. The media and Democrats would re-frame the story to pin the ACA’s surviving baggage on the GOP. Republicans would magically inherit any defects—even ones authored by Democrats.
It was puzzling to see Democrats celebrating so definitively once the bill was pulled. There is no guarantee at all that Republicans won’t revisit repealing and replacing the ACA. While their level of caution (and, hopefully, diligence) will be higher now, there’s nothing stopping them from crafting a new bill that actually does gut the ACA while replacing much of it.
If they want to continue down that road, though, the GOP faces two major problems.
First, President Trump has customarily pivoted to try to deflect criticism, fair and unfair, directed at him over the AHCA. That means taking shots at the most staunch conservatives in the GOP, as well as institutions like Heritage. That would be near-heresy for a mainline Republican, but, since the president has no strong ties to either the GOP or conservatism that pre-date 2015, it’s not surprising for him to maneuver in this way.
This is a problem because Trump can only fight on so many fronts. The media. Democratic leadership. FBI investigations. If he adds “right-wing and libertarian-leaning Republicans” to that list of foes, his ability to get legislative support for his favored policies becomes even more tenuous.
Put simply, Trump’s personal policy preferences, to the extent they exist, have always been largely centrist or even more Democratic-leaning, with the major exception of immigration. That would be fine if he were a coalition-builder, but he’s quite obviously the opposite of that. That leaves him—and Republicans—in a precarious position when it comes to effectuating a legislative agenda.
The second problem is specific to healthcare. One of the few broadly successful messaging efforts by Democrats in recent years has been to re-frame the ACA by de-emphasizing pre-passage promises about cost control or being able to keep plans you like. Rather, the contemporary reckoning is that the single, decisive metric of evaluating healthcare law is the number of Americans who have insurance.
That’s why “24 million may lose coverage” was the anti-AHCA battle cry. That’s also why it will be more difficult for Republicans to replace the ACA.
Even if whatever law they pass to overwrite the ACA does, in fact, flatten or reduce costs while also allowing more flexibility and stability among available plans, any net reduction in those who are covered will be portrayed as a failure. That makes it a much tougher sell for the pragmatic Republicans concerned about constituents who may have a tougher time securing coverage.
President Trump got one thing right throughout this process: Healthcare is a complicated issue. Even with some left-leaning voices surprisingly conceding that the ACA is flawed, taking another pass at making any real changes will test the mettle and political skill of what has been, up to now, an amateurish administration.
But all of that is a moot point if Congress lacks the desire to do more than bark from a safe distance.