The rollout of a new health care law to replace Obamacare has produced “a lot of frustration” among conservatives and “a lot of confusion,” House Speaker Paul Ryan, R-Wis., acknowledged Thursday.
Ryan sent a clear message to conservative House members who want the bill to go even further: This is as good as it gets.
“This is the closest we’ve been to repealing and replacing Obamacare. And let me just say it again. This is the closest we will ever get to repealing and replacing Obamacare,” Ryan said during a briefing with reporters at which he took off his suit jacket, rolled up his sleeves and gave an extensive briefing on the proposal, aided by a series of slides and a small laser pointer.
It was a classic performance by Ryan, who has always been known as a policy nerd. But it was an indication that just three days after releasing the text of their plan Monday evening, Republican leaders and the White House realize that the first major initiative of the Trump presidency is in trouble.
“This could have started better, and it needs to end smarter,” wrote Yuval Levin, the editor of National Affairs and a key conservative voice on policy who frequently consults with the speaker.
Besides the expected criticism from Democrats, and objections from hospital and health care groups, the bill came under fire immediately from conservative lawmakers, think tanks and lobbyists. Sen. Rand Paul, R-Ky., has been most outspoken in opposition. On Wednesday night, Trump himself met with leaders of the right-wing groups who have been opposing the bill to repeal and replace former President Barack Obama’s health care law.
One conservative leader at the meeting — Tim Phillips, president of Americans for Prosperity (AFP), which is backed by the Koch brothers — told Yahoo News that his group remains opposed to the health care proposal. AFP opposes a tax credit toward the purchase of health insurance, and the White House is not budging on that point, Phillips said.
At the heart of the dispute is the decision by Ryan and Senate Majority Leader Mitch McConnell, R-Ky., to pass a health care plan replacement through a process called budget reconciliation, which requires only 51 votes in the Senate rather than a supermajority of 60 votes. Republicans hold 52 seats, enough to control the chamber, but the sweeping changes sought by the conservatives would require a regular bill, which could be filibustered by Democrats. It would take 60 votes to overcome a filibuster.
Ryan blamed the “frustration” and “confusion” on a lack of clarity about this particular detail.
“What people are sort of learning is: This reconciliation tool is pretty tight. There’s a lot of stuff we would love to put in the bill, but unfortunately, the Senate rules don’t allow us to do that,” he said.
And indeed, take an already complex topic like health care policy, add to it the arcane nature of Senate procedure, and you have a recipe for a lot of head-scratching.
But another backer of the bill, Ryan Ellis, a senior tax expert with the Conservative Reform Network, made the more pointed accusation that groups like AFP, Heritage Action, the Club for Growth and others know that their demands can’t be met and are being disingenuous or just stubborn.
“They’re being intellectually dishonest by saying they want full repeal, because we all want full repeal and are working toward full repeal. You can’t get full repeal with budget reconciliation,” Ellis said. “They are basically promising people that if we would just fight harder, we could get all these things in the bill, and it’s simply not accurate.”
Levin says that conservatives just want a bill that introduces the free-market reforms that the right has talked about for years.
The Ryan-and-Trump-backed bill “functions within the core insurance rules established by Obamacare, which means it can’t really achieve most of the key aims of the conservative reforms it is modeled on,” Levin wrote.
Levin praised the Medicaid reforms in the legislation but said that Ryan and Trump are having trouble selling other parts of a bill that is a compromise, especially when they are trying to rush it through Congress rather than setting aside time for negotiations.
“A compromise needs to be worked out by the people who need to compromise, so they own it” — rather than presenting a bill as a fait accompli, he said.
But congressional Republicans have long grown accustomed to facing opposition from outside groups like Heritage and the Club for Growth, and from certain groups of the House and Senate Republican lawmakers, and many felt there wasn’t much use in trying to appease them, said Grover Norquist, president of Americans for Tax Reform.
The irony of the push for a narrower reconciliation bill on a tight timeline — McConnell has said he wants the Senate to vote on it next month — is that it’s not clear whether this legislation can even get passed by the House, much less by the Senate. Sen. Tom Cotton, R-Ark., went public Thursday with concerns he has about both the substance of the bill and the rushed timetable.
“House health-care bill can’t pass Senate [without] major changes. To my friends in House: pause, start over. Get it right, don’t get it fast,” Cotton tweeted Thursday morning.
Conservatives like Sen. Mike Lee, R-Utah, want Congress to pass a clean repeal bill now that delays the effect for two years, to both fulfill Republicans’ promise to voters and give them time to work out how best to replace Obamacare, a spokesman said.
But Trump, whose presidency rests on his ability to deliver not only health care reform but also tax reform, deregulation and an infrastructure package, has chosen not to go that route. Trump has said that he wants replacement to coincide with repeal.
Levin said it is “too early to draft eulogies” for the push for health care, but noted that it is vulnerable as a result of the mishandling of its rollout, and that “the intense emphasis on speed and pure momentum is likely to undermine that prospect rather than advance it now.”
“In any case, momentum depends on a strong, successful push at the start,” he added.
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