Senate Majority Leader Mitch McConnell has delayed the start of the August recess for two weeks, giving his colleagues some extra days to come together on a healthcare bill. Good for him – our elected representatives need a firm boot in the rear to remind them they have a job to do.
Republicans should have repealed Obamacare on day one, with an expiration date three years in the future. Three years to come up with an alternative, to advertise the shortcomings of the Affordable Care Act, to get past the midterm elections, pinch the bail-outs to insurers and to entertain the hundred and one ideas that might actually reduce the cost of healthcare. (Remember tort reform?) But they didn’t. Instead, they have lurched from one self-imposed deadline to another, looking unprepared and addled, and giving critics ample fodder for charges of incompetence.
Now what?
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As so many have said, failure is not an option. The Senate needs to craft a workable bill and get it passed. It does not have to be the best bill ever written – it just has to be better than Obamacare, which improved over time thanks to more than 70 significant changes made to the original legislation and still came up short. The GOP can tinker with their healthcare effort too, as the need arises.
In addition, here are five things that the GOP could do to regain their footing.
First, Republicans need to hone this message that all can agree on: The Affordable Care Act is not affordable, we are working to fix that. Obama often complained that it wasn’t his healthcare program that was flawed, but rather his team’s communications effort. The president was wrong; the ACA was fatally flawed, but he was correct that selling your plan is vital.
The GOP appears to have the worst marketing team since the folks that sent Kendall Jenner to comfort protesters with a Pepsi. Consider the Senate bill’s name – The “Better Care Reconciliation Act”; not exactly snappy and certainly a loser compared to The Affordable Care Act. While quick with pithy one-liners about Obamacare’s death panels or the Gestapo IRS, Republicans have yet to provide a convincing story to Americans about their nascent healthcare bills, or even effectively reminded voters what was wrong with Obamacare. Instead, their creative juices have flowed towards ripping each other’s efforts. “Obamacare-light” anyone?
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Second, they have been cowed by the Congressional Budget Office. A miserable 17 percent approval rating for the “Better Care Reconciliation Act” stems mainly from the abysmal projections published by that outfit, whose job it is to imagine how legislation will impact the country. Imagine is the operative word; there’s a lot of guess work in projecting forward the roll-out of any legislation, and the CBO’s past efforts have been way off the mark.
Writing in Forbes, Brian Blasé noted earlier this year that the CBO’s green eyeshade guys forecast that the Obamacare exchanges would have enrolled 22 million people by 2016; instead, it was only 10 million. Further, sign-ups for Medicaid in states that expanded their programs was about 50 percent higher than projected, and per person spending on enrollees was 49 percent above expected levels.
The GOP should broadcast these CBO failures and cast doubt on their estimates. Also, President Trump should take a page from the Obama manual, and invite CBO Director Keith Hall in for a chat about the virtues of the Senate bill. When the CBO published bad news about the ACA, Obama had a little tête-a-tête in the Oval Office with Hall’s predecessor Doug Elmendorf. Overnight, the forecasts were rosier.
Third, McConnell should have brought – and should still include -- into his working group some of the more fractious members of his caucus. Rand Paul was clearly peeved that his healthcare bill got little attention. Susan Collins, who spent years overseeing the Bureau of Insurance in Maine and the two senators viewed as vulnerable in 2018 – Jeff Flake from Arizona and Dean Heller from Nevada – should also have been involved. All those folks are serious speed bumps for the Senate bill. The Senate Majority leader was right to hammer out the legislation in private, away from the hostile media spotlight, but he needed a more diverse set of blacksmiths.
Related: The Basic Math Problem Facing Republican Health Care Reform
Fourth, President Trump needs to hit the road – even before the Senate finishes writing its bill. He has spent considerable elbow grease trying to bring the GOP together, but his real power lies in talking to the American people. In concert with McConnell, his speechwriter needs to arm him with a blockbuster sales pitch for overhauling Obamacare, stressing lower costs, flexibility, and access, and let Trump loose. He doesn’t need the details -- Americans are not in the weeds on Medicaid minutia, but they know what they want, and they know what’s not working. He could start his pitch with this: “You really will be able to keep your doctor!”
Fifth, expanding on McConnell’s announcement yesterday, both the Senate and House leadership should promise that they will stay in session until they finish their deliberations and present Trump with a bill he can sign. Moreover, they should tell the American people that whatever bill is passed will also apply to Congress.
In fairness to the GOP, crafting a health care bill is not easy. When Democrats pushed through Obamacare, they struggled to gather the needed 60 votes, finally resorting to the same kind of horse trading that the GOP is engaged in today. Senator Ben Nelson was wrestled aboard with the Cornhusker Compromise, a deal in which the federal government would pay Nebraska’s share of its Medicaid expansion. Mary Landrieu was lassoed by the Louisiana Purchase, $200 million of ongoing Medicaid dollars.
More shenanigans ensued, including stripping and re-stuffing a military housing bill with the Obamacare architecture and then altering the rules of reconciliation to circumvent the awkward election of Republican Scott Brown in Massachusetts, which undermined Majority Leader Harry Reid’s vote tally. As Democrat Rep. Alcee Hastings of the House Rules Committee said about the process: “We’re making up the rules as we go along.” It wasn’t pretty.
The GOP effort isn’t pretty either. But it must succeed.
