The effort to convert candidate Barack Obama’s health policy platform into what became Obamacare began just days after the 2008 election, with the release of a detailed white paper written by Senate Finance Committee chairman Max Baucus that bears remarkable resemblance to the Patient Protection and Affordable Care Act, which became law nearly a year and a half later.
Everything that happened in between—dozens of public hearings, hundreds of private ones, countless Congressional Budget Office cost estimates, White House negotiations and agreements with industry and consumer stakeholders—had an impact on the final bill, but the process began with a remarkable degree of Democratic consensus, reflected in the similarities between the initial and final products.
We know from this recent history what a successful legislative effort to reform the health care system looks like. The GOP effort to repeal and replace Obamacare looks nothing like it.
Republican leaders emerged victorious from the 2016 election with no intra-party health care consensus of any kind, and thus, no basis upon which to introduce a blueprint in advance. Without a starting point in mind, nor a single goal, the path has become nearly impossible to trace, as has any sense of what victory would look like to them. As time goes on, their legislative shenanigans look less like the considered advances of parliamentary masters and increasingly resemble defensive maneuvers meant to delay their admission of defeat—and to avoid blame when that day comes.
After weeks of infighting, House Republicans on Monday unveiled a bill that would repeal and replace Obamacare, in the hope that setting events in motion will impel members of Congress to set aside their reservations and pass it. That bill has reportedly undergone several changes, big and small, in recent days—based on both internal ideological dissension and private indications from CBO that their ideas will result in a significant increase in the rate of uninsurance.
For instance, in a reversal that reeks of amateurism, Republicans decided to change the very structure of their reform plan—from one that offers tax credits to all marketplace purchasers, to one that imposes a means test upon beneficiaries—because its haphazard original design promised not just to roll back the Obamacare coverage expansion, but to force millions of people off of their employer-sponsored coverage as well.
“[T]he combination of major re-writes to the bill and the lack of a CBO score at any point in the process thus far should cause significant pause on Capitol Hill,” wrote Republican health policy consultant Chris Jacobs. “Members are being asked to vote on legislation before knowing its full effects, or even how it will look in its final version.”
Hiding details from members is a strategy that can only work in the shortest term, because votes are permanent even if legislative detail is not. House Republicans might be confronted with a bill without knowing its content or what its effects would be, but they know that information will come to light at some point, and that their votes can’t be undone.
Nevertheless, GOP leaders are taking such extraordinary steps to control information that they triggered an impromptu scavenger hunt on Capitol Hill last week among senators and House Democrats who were being denied access to new bill text.
House Republicans have admitted they might move draft legislation through a key House committee before an official CBO cost estimate is complete, meaning they hope to amend and advance it to the full House before its likely effects on cost and coverage are known. By the time CBO releases that score, it will already be obsolete, meaning the full House might also vote on (and even pass) major health care legislation with blinders on.
This isn’t a strategy that will ultimately protect any House Republicans from the political consequences of their votes, but it may be a viable way to shift the legislative onus to the Senate and divert the pressure on House Republicans from conservative interest groups. Senate Republicans see this gambit for what it is, and, to use proper parliamentary terminology, they’re fucking pissed.
“Let me tell my Republican leaders who may be listening, don’t give Lindsey Graham take-it-or-leave-it options,” the South Carolina senator told constituents, “because I’ll leave it.”
Rob Portman, Cory Gardner, Shelley Moore Capito, and Lisa Murkowski—more than enough GOP senators to submarine any Obamacare repeal effort—wrote to their majority leader, Mitch McConnell, on Monday advising him that the details emerging from the House fall below their standards, and that they “will not support” it as is.
Movement conservatives have always opposed an inclusive, national conception of the social compact, which means Republicans imagine governing differently than Democrats do. Because liberals want to expand and strengthen the social safety net, Democrats seek opportunities to enact big, cohesive, era-defining policies. Republicans, by contrast, might just be happy to tear down what they can, when they can. Their antic legislating is, in part, an outgrowth of the fact that their ultimate goal is to undermine what exists, rather to than forge something new.
Democrats shouldn’t assume, in other words, that the process will fail because it is dysfunctional. Republicans have lied and over-promised to their voters for years about the horrors of Obamacare. Faced with a choice between failure and passing something they claim fulfills those promises, they may yet talk themselves into throwing millions of people off of their health plans. The danger hasn’t passed. The process is foundering, yes, but that’s in some measure to obscure who’s to blame if they ultimately can’t see it through to the end.