Despite the fact that it deserved to fail, the failure of the Republicans' American Health Care Act (AHCA) is a bad thing.
The bill was horrible - Obamacare 0.5, a giant "screw you" to anyone not rich, and a policy nightmare that would have denied millions of Americans health care. It deserved to fail. But, its failure is going to resonate throughout the political system in complicated ways.
The failure to even bring it to a vote has badly damaged Paul Ryan. He's always been overhyped and under-talented, but this failure reveals his incompetence as Speaker. Ryan tried to take a legislative short-cut and it blew up in his face. The hard work of crafting complex legislation take time, patience and the ability to bargain. It's not an unpleasant process. Ryan tried to jam a major reform through Congress without the complicated process. On the quotes that's floating around is that 56% of people disliked the bill; in an environment this partisan, that's an accomplishment.
Ryan may hold onto his speakership. But, his influence has been greatly diminished; his inability to get enough votes for a major campaign promise will undermine him. We may yet see him follow Boehner — wash his hands of the problems and walk away. An ungovernable party will become even more fractious. A majority unable to govern is a recipe for disaster.
In this article at the conservative site Town Hall, Steve Chapman makes a number of interesting points but his primary argument is that health care is intractable and probably unfixable:
One factor is that when it comes to their health care, Americans nurse a deep distrust of change. They may not be satisfied with what they have, but they assume anything different will be worse.
Another is that a lot of them really didn't know what the ACA did but disliked it because they associated it with a president they opposed. Given that Obama's approval rating hovered around 50 percent for most of his second term, it's not surprising that his signature initiative evoked widespread disdain, particularly among Republicans.
Stubborn ignorance also plays a role. An NPR/Ipsos poll in January found that more than half of Americans didn't realize that the number of people with health insurance rose under Obamacare. One in three mistakenly thought it put restrictions on end-of-life care -- remember the "death panels"?
The ACA also clashed with intractable preferences. It forced individuals to purchase insurance. It meant more government interference in private markets. It expanded a major entitlement, Medicaid. It required new taxes. It didn't reduce total health care expenses for most people. All of these features grated.
The politics of health care shifted under the Republicans feet - people suddenly realized they would lose things if Obamacare were repealed.
Trump has led voters to believe they can have all the stuff they want and none of the stuff they resent. But neither he nor anyone else has found a plausible way to accomplish that.
The mournful realities are inescapable. If you remove the individual mandate, you allow younger and healthier people to opt out, which would mean higher premiums for older and sicker ones. If you cut the cost of Medicaid, you leave a lot of poorer Americans without coverage, forced to rely on expensive emergency room care. If you eliminate the taxes, you raise the federal deficit.
You can't have it all. Our aversion to this simple truism has yielded a dubious achievement: Compared with other Western nations, we have more people without insurance, spend far more of our national income on health care, and are less happy with our system. That's what you get when you resist fundamental tradeoffs.
The Republican party is facing a huge problem. Despite having a governing majority, they are a minority party. Their goals and objectives are at odds with what the majority of Americans want. We don't have a parliamentary system, but our system is trying to act like one; the "minority" government is being hamstringed by its own weaknesses. It's objectives are running into fierce public opposition and are crashing. With a minority president, who is easily the most unpopular president in decades (that's an accomplishment in a post George W. Bush world), they don't even have the effective power of a bully pulpit to build support for their policies.
At even more basic level, the Republican party does not know how to govern. They control the elected 2/3 of the Federal government but are unable or unwilling to be a governing party. Ezra Klein argues:
Big policy change is hard. The modern Republican Party has built itself in opposition. Paul Ryan won fame designing budgets that were never meant to pass, and by criticizing Barack Obama. Donald Trump established himself as a political force through his leadership of the crackpot birther movement. This is a party that has forgotten how to do the slow, arduous work of governing. Perhaps it’s worse than that. This is a party, in many ways, that has built its majority upon a contempt for the compromises, quarter-loaves, and tough trade-offs that governing entails. They need to learn from this defeat, or they are doomed to repeat it, and repeat it, and repeat it.
In the interviews Trump is giving today, it is clear he has somehow convinced himself tax reform will be easier. It won’t be. And soon, Republicans will have to raise the debt ceiling, and pass their appropriations bills, and, if they’re going to hold to any of Trump’s budget proposals, find 60 votes to bust the budget caps. And they’re going to do all of that with the myth of Ryan’s policy genius and Trump’s dealmaking skill shattered.
This observation should strike terror into us. Governing is not easy. It shouldn't be. It is serious work for serious people and the current Republican party is unable to govern. God help us if there's an actual crisis.
Republicans' failure to keep their campaign promise is going to lead to trouble. Ira Glasser examined their failure and concluded with:
This ain’t over (it is way too early to gloat), but other complex battles over tax code revisions and the long promised Mexican wall and very ambitious infrastructure spending lie immediately ahead, and before long the spectre of the midterm elections will begin to loom.
Meanwhile, the as yet unresolved travel ban initiative, so far stopped in its tracks by the courts, as well as the increasingly threatening Russian connection investigation, continues to contribute more chaos and frustration.
So far, so good, for those opposed to Trump’s initiatives. But can the Democrats take advantage? And even if they do, can they overcome the grossly gerrymandered Congressional districts that will continue to give Republican candidates a decisive advantage in the 2018 midterm elections?
Much may depend on what happens with other legislation and other issues during coming months.
But out there in Trumpland, I suspect this health care debacle has got some Republican voters wondering. And rightly so.
I think he's mistaken; out in Trumpland, voters are not going to be wondering. They're seething.
Breaking this major campaign promise, perhaps the only campaign promise every federal level Republican agreed on, is going to play badly with the Republican base. Expect the Republican base to become even more radical. The Republican base has been fed a steady diet of "government cannot and does not work" and the failure to repeal Obamacare will prove that. Think about it- Republicans have majorities in both houses of Congress and control of the White House and they could not deliver on one of their biggest promises. The conclusion many Republican voters will draw is that the hated "establishment" stabbed them in the back; expect "establishment" to be defined as anyone in office more than one term; it will include Paul Ryan and pretty much everyone to the left of Louie Gohmert. Their voters won't forget this betrayal.
What about Trump's lame attempt to blame Democrats? That won't persuade anyone. Republicans have majorities in both houses of Congress; their voters expect them to deliver. They failed.
Decades of anti-government propaganda has convinced many of those Trump voters the problem is the "establishment" and the one they can punish happens to be Republican. Expect lots of challenges from the right to even the most right wing Republicans. A party that govern, that has been internally ungovernable, is going to get pulled further to the right and become even more fractious and problematic.
Despite being awful policy, the implications of the failure of the health care reform effort could be with us for a long time. The failure of the AHCA is likely to deepen rather than resolve our partisan divides. It’s likely to cripple the Republicans which means it will have crippled the federal government’s ability to act.