Trumpcare Passed Because Moderate Republicans Are Wimps
Just a few weeks ago, the American Health Care Act looked utterly dead. This week, the zombie bill lurched back to life and rampaged through the House, passing 217–213. What happened?
It’s actually a heartwarming story, once you leave aside the fact that the AHCA is, in its current form at least, a pretty terrible bill. Different factions of the party came together to resolve their differences and to achieve a rare moment of Republican unity. Hurray! There’s only one problem. While the conservatives who helped reanimate this legislative corpse are in no danger of losing their seats come the 2018 midterms, members of the Tuesday Group aren’t so lucky. Their willingness to get to yes shows that today’s Republican moderates are team players. It also shows they suffer from a lack of political imagination that might soon prove politically fatal.
To have any hope of passing, the AHCA could only afford a handful of Republican defections. When Paul Ryan struggled to win over the hard-right House Freedom Caucus, with its 30 or so members, the bill’s future was very much in doubt. Worse still, once it became clear that the Freedom Caucus was dragging its feet, moderate Republicans who were already anxious about voting for a profoundly unpopular bill also jumped ship. All was lost. Republicans looked clueless. Ryan was sad. The Freedom Caucus had handed him a humiliating defeat, and he was pissed. The message coming out of the House GOP leadership was that Ryan and his allies were serious people who intended to deliver on their promise to repeal and replace Obamacare, but the pesky Freedom Caucus screwed everything up.
The Freedom Caucus, led by Rep. Mark Meadows, wasn’t exactly thrilled with this implication. Its members’ take was that they were happy to figure out how to make the bill more to their liking, if only the House GOP leadership was willing to negotiate in good faith. Being rock-ribbed right-wingers, they didn’t want to be blamed for leaving Obamacare intact. Many of them resented the fact that while many moderate Republicans were just as skeptical about the AHCA, it was the Freedom Caucus that was getting all the blame. So as the Washington Post reports, Meadows decided to team up with a moderate Republican, Rep. Tom MacArthur, to devise a compromise that could satisfy both the right and the left of the House GOP conference. Whereas the initial drafting of the AHCA was a top-down process led by Ryan and his closest allies, here we had a fuzzier, more democratic, bottom-up process, one in which Republican members took it upon themselves to reach out across the intra-GOP ideological divide.
The MacArthur amendment allowed states to waive some of Obamacare’s insurance regulations. The details are tricky—Timothy Jost has described them in great detail over at Health Affairs—and they’ve freaked out many observers who fear they could unravel protections for people with pre-existing conditions. Defenders of the amendment insist that states wouldn’t exactly be eager to nuke politically popular insurance market protections without having a good reason to do so. But that’s obviously not all that reassuring to opponents, who have every reason to focus on the worst-case scenario. Why did the GOP coalesce around an amendment that created such an obvious political vulnerability? The answer is that Republicans were more focused on papering over their internal divides than on crafting a package that would be politically bulletproof or even mildly bullet-resistant.
What the MacArthur amendment really did is give the Freedom Caucus a plausible ideological case for getting behind the AHCA. The caucus was apparently willing to go even further in the name of compromise, up to and including accepting more generous premium subsidies for lower-income individuals. But while spending more money was a concession they would have been willing to make, the House’s staunchest conservatives weren’t about to demand that the GOP leadership increase federal spending.
But winning over the Freedom Caucus wasn’t enough to pass the AHCA. Ryan still needed to win the support of the Tuesday Group, and many of its members seemed even more resistant to cutting a deal than their counterparts on the right. Unlike the Freedom Caucus, who’ve developed a sense of solidarity after years spent doing battle with the House GOP leadership, the moderates are a more diffuse group, one that has little experience acting as a cohesive bloc and making demands. By and large, GOP moderates are good soldiers. They break with leadership when they must, but they are genuinely inclined to trust Ryan and his lieutenants. To put this a bit less generously, moderate Republicans are wimps.
Did moderate Republicans make it clear they’d only vote for the AHCA if the premium subsidies were more generous for people who might otherwise have been too poor or too sick to buy decent coverage? Nope. They didn’t do this even though the Freedom Caucus likely would have gone along with such an approach. Did they demand that the tax cuts for the rich that are embedded in the AHCA be dialed way back if the bill was going to trim the growth of future Medicaid spending? Not a chance. Moderate Republicans often represent relatively affluent districts, and their voters in these districts are more affluent still. Nevertheless, they are vulnerable to accusations of heartlessness, which in a good year for Democrats could be enough to drive them out of office.
Going forward, the Tuesday Group needs to be more than just a collection of swing-seat Republicans who are afraid of their own shadows. If the Freedom Caucus stands for shrinking government, the Tuesday Group should stand for a cause of its own, like modernizing government for the 21st century (or some other appropriately moderate-sounding cliché). Don’t just roll over when Ryan comes looking for your votes. Craft a coherent program and insist on shaping legislation. In the case of the AHCA, moderate Republicans could have come to the table with a more coherent set of ideas, like transforming the existing Obamacare exchanges into well-funded high-risk pools. With an attractive enough program, the Tuesday Group might develop a pretty appealing brand, which could help it weather ups and downs in the popularity of the larger GOP. That won’t be possible unless the moderates get it together and grow spines.
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