After seven years of relentless attempts to repeal and destroy Obamacare, the recent failure to do so by Republicans is more than a tad embarrassing. The withdrawal of the American Health Care Act, better known as the Republican replacement for the Affordable Care Act (Obamacare), has important ramifications which shouldn’t be underestimated.
First, it cements the power of the Freedom Caucus. The far-right Freedom Caucus, about three dozen conservative legislators led by Mark Meadows in the House, wanted a total Obamacare repeal and thought the proposed changes didn’t go far enough. Some representatives called it “Obamacare-lite,” frustrated that it retained a similar framework. With the partisan nature of Congress preventing almost any Democrat from working with President Donald Trump, the Freedom Caucus can hold Trump and Paul Ryan hostage into the foreseeable future. Frustrations are already mounting, with Ryan and Trump sending angry digs at the Freedom Caucus and attempting to shift blame and threatening their seats if they continue to resist the GOP establishment. Yet, with Meadows being hailed as a hero in his hometown and Trump’s low approval ratings, the pressure doesn’t seem like it will be enough. As long as the Freedom Caucus remains unified, they can kill any bill which they don’t deem conservative enough. How long will Trump maintain his cool in the already frustratingly complex and slow legislative process before he blows his top at the Caucus?
Second, it’s important to consider the economic and political impacts for the legislature and White House. The White House has indicated that it believes delivering on the Obamacare repeal is vital for GOP political prospects. A number of Democratic senators who rode Obama’s coattails into power are up for reelection in states which Trump won. If the GOP manages to energize this same group like Trump did, it could solidify their majority or even get the 60 seats necessary to overcome a democratic filibuster. If they break their promises, they could face a party fracture, or perhaps create enough frustration to draw blue collar workers back into the Democratic fold. Additionally, the healthcare reform was vital for the other congressional goals that he outlined in his campaign. Without the estimated $330 billion deficit reduction from the AHCA, it becomes astronomically more difficult to slash the corporate tax rate, let alone implement a one trillion dollar infrastructure plan.
With both of those concerns in mind, the GOP and White House have little choice but to attempt AHCA 2.0, which is exactly what they’re doing. Unfortunately for Trump, it turns out passing bills is almost as complicated as healthcare. Who could have known! Even if the AHCA had passed in the House, it would have moved to the Senate, where the bill was generally considered dead in the water. Even if it had passed in the Senate (with amendments), it would have needed to go to a committee to hammer out the differences in the bills and return for one more vote in both the House and the Senate. Considering the razor thin majority in the Senate, 52-48 seats, it only would have taken three Republicans to break rank in order to stop the bill. The Democrats have been fully united in opposition to the replacement, with no engagement or bipartisan negotiations coming from either side. The next bill will need to appease both moderates and the far right, an almost impossible task as shown by attempt number one. With widespread opposition from interest groups such as the Koch brothers, AARP and AMA, Congress would face heavy pressure to opt out of the likely unpopular bill. This pressure would only grow greater as amendment after amendment would be added to appease various members whose goals are at odds.
Alas, the frustratingly likely outcome of all these shenanigans is collapse and replace. Once the plan is a proven failure, moderates will be fine gutting the bill because Democrats and Obama take the blame. No matter how mediocre the alternative is, it will be better than the collapsing system of rising premiums and fleeing insurers. Don’t be surprised if Trump and Congress put pressure or subtly incentivize the collapse before the upcoming midterm elections, nor should you expect our healthcare system to reach “tippy top” anytime soon.
Alex Screaton ’19 (firstname.lastname@example.org) is from Lake Elmo, Minn. He majors in chemistry and political science.