Politics

How the GOP Plans to Kill Obamacare

It’s the same strategy the Democrats used to pass Obamacare.

U.S. Senator Mitch McConnell
Sen. Mitch McConnell speaks at the Jeffersontown Chamber of Commerce luncheon in Louisville, Kentucky, on Wednesday.

Bryan Woolston/Reuters

Republican leaders have settled on a new strategy for passing their yet-to-be-revealed health care reconciliation bill, the Wall Street Journal reported on Monday. It goes like this: They put together a bill that seeks to best negotiate members’ competing interests and then they “dare” any members who didn’t get their particular legislative ponies to vote the whole thing down.

This strategy is also known as the strategy by which any difficult legislation ultimately gets passed. No one in the majority enjoys voting for a bill that includes trade-offs, which all meaningful bills do. It exposes them to consequences from either the right or the left. When members are in town, they would much prefer to vote on a couple of post office names and then pop out of the Capitol to enjoy brown-liquor cocktails and thick red steaks with lobbyists.

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The most apt comparative example of a successful employment of this specific strategy was the 2010 passage of the Patient Protection and Affordable Care Act, the bill these Republican leaders are hoping to repeal, replace, repair, or what have you. As our dear president has discovered well after everyone else, health care reform is “complicated.” (Its difficulty equals, or even surpasses, comprehensive tax reform, the viper nest that congressional Republicans have chosen to enter immediately after health care.) It was complicated for Democrats in 2009 and 2010, and its reversal will be complicated for Republicans in 2017 and beyond. Putting some patchwork proposal together and then warning any reluctant member not to make him or herself into The One Who Killed Health Care Reform isn’t a bad strategy. It works when all members recognize that some sort action is necessary.

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“Republicans can afford to lose no more than two GOP votes in the Senate and 22 in the House, assuming they get no support from Democrats,” the Journal writes. “Advocates of the strategy hope that knife’s-edge math will be an asset rather than a liability. They are betting different groups of Republican lawmakers can be pacified with a handful of concessions, then will swallow hard and vote for a longstanding repeal pledge, first in the House, then in the Senate.”

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That’s mighty similar to the process by which Democrats, as Republicans would say, “jammed through” Obamacare. There’s one meaningful difference: Republicans aren’t wasting a year trying to perform the alchemy of earning their opponents’ support. They’re advancing, in practical fashion, straight to the party line battle stations necessary for passing ideological legislation, and they’re doing it under reconciliation.

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Democrats had similar “knife’s edge math” to work with—the knife was even sharper in the Senate, where Democrats could afford to lose zero votes—and it was an asset for them, too. It didn’t give wavering senators as much leverage over leadership as vice versa. Sure, they got their individual carve-outs, forever memorialized by clever nicknames from Sen. Mitch McConnell’s staff, from then-Sen. Ben Nelson’s “Cornhusker Kickback” to then-Sen. Mary Landrieu’s “Louisiana Purchase.” Actual policy-focused adjustments were also made to earn votes of individuals or blocs.

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Former Connecticut Sen. Joe Lieberman got the public option and the Medicare buy-in killed, a moment progressives remember well. On the other side of the spectrum, Sen. Bernie Sanders got billions in funding for community health centers. In the House, the gravest last minute-threat to the legislation was the group of pro-life Democrats, led by former Michigan Rep. Bart Stupak, who wanted crisper language separating abortion coverage from federal insurance subsidies. The situation was not that these members could have gone either way. They knew a bill needed to pass after the process had gotten that far, and they were looking to eke out some small distinctions on their behalf. None of them wanted to be the Democrat, or small bloc of Democrats, that killed universal health coverage when, for the first time ever, it was millimeters away from achievement.

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And no Republican, or small bloc of Republicans, wants to be the Republican that kills “repeal” of Obamacare because it goes either too far or not far enough.

That doesn’t mean that negotiating the fault lines here will be simple. The major obstacle will be money. Moderate Republicans feel that the replacement elements of the reconciliation bill won’t adequately constitute a “replacement” of either the exchange subsidies or the Medicaid expansion. Conservative Republicans will feel that federal monies greater than zero dollars disbursed on “replacement” of either the exchange subsidies or the Medicaid expansion will constitute treachery against both small-government virtues and the Christian God. Conservative Republicans are demanding that the reconciliation bill also defund Planned Parenthood. Some key moderates demand the opposite.

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But once carve-outs are issued, policy disputes negotiated, and a final bill put first on the floor of the House and then on the floor of the Senate, which Republican or small bloc of Republicans wants to be the one that casts the deciding vote against it? There may be 293 different Republican opinions about what to do with health care in Congress. There are also 293 Republicans who recognize that, after years and years of promises to their base, they need to pass something that can reasonably be sold as “repeal.” That’s going to be the strongest incentive there is.

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