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At this writing, the House Republican leadership, at the urging of Donald Trump, has withdrawn its bill to repeal and replace the Affordable Care Act. Having wasted more than six years casting doomed votes for repeal while offering no alternatives, the GOP finally confronted the possibility of actually getting it done, through control of both houses of Congress and the presidency. They could not pull it off.

Obamacare Repeal Fails

The first inconvenient reality they confronted was that they could not simply repeal the law and revert to the pre-2010 reality. Too many people had come to depend on such provisions as requiring insurance companies to insure preexisting conditions, subsidized premiums for low income people, and keeping young people on their parents’ policies until age 26. Through years of railing against Obamacare, the Republicans discovered that they had lost the fundamental argument: health care for all had become a right (or, as they prefer to say, an entitlement).

Having criticized the year-long process that produced the Affordable Care Act, the GOP leadership tried to produce its replacement with a week behind closed doors, without consulting doctors, hospitals, insurance companies, or patients.

Then, having criticized the year-long process that produced the Affordable Care Act, the GOP leadership tried to produce its replacement with a week behind closed doors, without consulting doctors, hospitals, insurance companies, or patients, and to ram in through three committees in another week, without any hearings to allow those affected to be heard.

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Textbooks say that the President is effectively the Chief Legislator, that the legislative process in Congress depends heavily on processing what the president proposes. Trump and his staff hadn’t read those books, and he had no proposal of his own; he thus signed on to Speaker Ryan’s plan. He thereby rendered his own reputation hostage to a plan that he had not proposed, and that violated several campaign promises, most notably that everyone would have insurance at much lower cost than under the ACA. The report of the Congressional Budget Office made clear that numbers of uninsured would double, and premiums would go up in the first years.

Inevitably, they then discovered that their own party was riven into factions that couldn’t agree on the details. The hard right Freedom Caucus (three dozen or more) derided the bill as “Obamacare Lite,” and refused to support it. The pathetic remnants of the moderate Republicans (the Tuesday Group) suddenly found relevance as their votes were needed, and demanded less draconian cuts in benefits and subsidies. But anything the leadership did to satisfy the moderates would further alienate the right wingers, and vice versa.

In the end, with no Democratic support, the GOP leadership could not reach a majority. Rather than see their bill formally defeated, they pulled it back. They flunked first major test of the Republicans in the Trump era. Trump, the Great Negotiator, could not get to a deal.

There is plenty of room, and plenty of time for this party and this president to enact their remaining, scary agenda. They will probably figure out eventually a more productive approach to replacing or reforming the Affordable Care Act. But for sheer hubris, unmitigated incompetent overconfidence, this episode will dog them for years.

john peeler

John Peeler