The partisan trench warfare over Obamacare could soon be stilled by a fragile peace.
Over the past few days, President Donald Trump has declared the Affordable Care Act “dead” and promised a new vote soon on the most recently failed Republican health care bill, while simultaneously trying to sabotage the current law as a ploy to draw Democrats into negotiations — that have now tentatively succeeded in returning the debate to square one, with Trump endorsing a bipartisan proposal to fortify Obamacare, still very much alive, for a couple years.
But even as Trump swerves from one tactic to another, the facts on the ground remain: very little has changed in the nearly seven months since the first GOP repeal effort flopped.
On Friday, March 24 House Speaker Paul Ryan stood up at a press conference on Capitol Hill and conceded defeat. His Republican majority could not move legislation to undo the Affordable Care Act. “Obamacare is the law of the land,” he said. “It’s going to remain the law of the land until it’s replaced. We did not have quite the votes to replace this law, and so, yeah, we’re going to living with Obamacare for the foreseeable future.”
It’s late October now and the state of play on health care remains fundamentally the same. Ryan’s House passed a bill in May, but the Senate failed to follow suit. Republicans and Democrats have a deal, in principle, for a short-term fix — but only to patch a problem Trump himself created. Trump said he was on board with the tentative agreement forged by Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray. Though he also said another repeal vote was in the offing. (And the day isn’t done yet!)
“Lamar has been working very, very hard with … his colleagues on the other side, and, Patty Murray is one of them in particular, and they’re coming up, and they’re fairly close to a short-term solution,” Trump said during a press conference in the Rose Garden with Greek Prime Minister Alexis Tsipras. “The solution will be for about a year or two years, and it will get us over this intermediate hump.”
Short-term fix or no, the President’s obsession with harpooning Obamacare prevails. If his Republican allies are out for simple political profit, Trump is clearly in for more. It feels like vengeance — erasing the law, and with it his predecessor’s name, at any cost.
Also on Tuesday during the press conference, Trump again pronounced Obamacare “virtually dead.” Before their meeting, he told reporters the law was on “its final legs.”
The remarks echoed a wishful assessment he delivered during a televised Cabinet meeting on Monday.
“Obamacare is finished,” he said then. “It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”
Reality disagrees.
Obamacare is not, in any literal sense, dead or gone. Trump’s effort to sabotage it has consisted of signing an order to cut off some key federal reimbursements and to undermine it by allowing some non-compliant insurance plans. He claimed, during the Cabinet meeting, that his decision was meant to provoke bipartisan talks. But those conversations predated his intervention. Their first round was cut off by Republicans as they rushed late last month to bring up for a vote doomed legislation from Sens. Lindsey Graham and Bill Cassidy.
Rather than seek another tack, Trump continues to insist that Senate Republicans have the support to pass that bill. (They did not, and do not.)
“We either have the votes or we’re very close to having the votes,” he said on Tuesday, “and we will get the votes for having, really, the potential for having great health care in our country.”
Pretty to think so, but even if it were true, his next shot is a long ways off. Reconciliation rules, which would have allowed Senate Republicans to pass something with a simple majority have expired for now and the party is currently wired to focus on their tax plan, itself still a work in progress. But again, the whip count should be a secondary concern to the more fundamental issue — that all these years after Obama signed the ACA into law, the GOP still has no ideologically coherent or politically popular plan for undoing it.
Trump during the Monday press conference burbled something about timelines. Obamacare, he noted, took more than a year to pass. But that was because, unlike these Republicans, the Obama-era Democrats — despite their own, even heavier majorities and ultimate decision to take a party line vote — held hearings, took a shot at serious negotiations with the GOP, and tried to go out into the country to sell the plan to voters. Those town hall meetings were a mess, sure, and there was plenty of internal debate among Democrats on Capitol Hill, but the purpose of the exercise was clear.
Republicans, by contrast, never settled on an explanation of what exactly they were after apart from smashing the current law. Their sales job this year was a disaster from the get-go. And because Washington is a chatty town — on the record, off it, and in the spaces in between — and the President’s inner monologue rarely remains so, the complications were laid bare over and over again.
Trump talked a bunch about Obamacare on Monday and Tuesday, but, again, never quite articulated a path forward — apart from his familiar, inscrutable pledge to “get health care that’s much more affordable and much better healthcare.” In May, he promised, “Our healthcare will soon be great.” Rewind to the days after his election, in November of last year, and the song was the same: “It’ll be great healthcare for much less money,” he said in a 60 Minutes interview. “So it’ll be better healthcare, much better, for less money. Not a bad combination.”
His only nod to big-ticket action that could rope in Democrats came during a Monday riff that might’ve put a smile on, of all people, Sen. Bernie Sanders’ face.
On the question of prescription drug prices, Trump said, “You go to England, you go to various places, Canada, you go to many, many countries, and the same exact pill from the same company, the same box, same everything is a tiny fraction of what it costs in the United States.”
Both the UK and Canada use forms of socialized medicine. This gives their governments better negotiating positions and helps to drive down drug costs. Maybe Trump, in his desperation to wipe Obama’s name off the books, would consider a compromise and sign on to Sanders’ “Medicare for all” bill?
Until then, expect a lot of rhetoric, some green shoots of compromise (like we’ve seen Tuesday) and then more work to scythe down the law as a whole.
Former Trump aide Steve Bannon issued the rallying cry — and probably the closest thing to an honest assessment of where this goes from here — over the weekend at the Values Voter Summit in Washington.
“Not gonna make the (cost-sharing reduction) payments,” he said, “gonna blow (Obamacare) up, gonna blow those exchanges up, right?”
Maybe, maybe not. The deal in Senate between Murray and Alexander is hardly done and dusted. Paul Ryan could squash it in the House. Beyond that, what follows is as much a mystery as it was on the day Trump took office.