Being against things is easy; governing is harder. That was the explanation of Paul Ryan, speaker of the United States House of Representatives, and arguably the third most powerful person in Washington, after his Republican Party, along with President Donald Trump, pulled their health care reform bill from consideration by Congress. The move is a stunning defeat for the new president and his party, one with ramifications far beyond the provision of health care in the U.S. or domestic politics in the country.
Since the Affordable Care Act (ACA, but usually called Obamacare) was passed in 2010, Republicans have insisted that repealing that legislation was their top priority and would be their first act upon reclaiming the White House. They passed repeal legislation under President Barack Obama, but he understandably vetoed those efforts to erase his signature domestic initiative. Trump’s election last year was supposed to allow the realization of that long-frustrated ambition.
But, as Ryan ruefully noted, governing is harder than opposing. As Republican legislators contemplated their options, they realized that repeal, while theoretically easy, would not suffice. The prospect of depriving 24 million people of health care was not a winning strategy (and denying the validity of those projections did not make the potential costs go away.) The party could not agree on a replacement plan, however. Hard-line conservatives stuck to their ideological position, arguing that the provision of any care was a betrayal of their principles and complaining about the cost of any residual health care services provided by the federal government. Moderates sought to preserve some of the popular features of the ACA, but they would cost money and undermine the claim that Obamacare had truly been repealed.
As a result, the party remained bitterly divided, unable to muster a majority of its own members behind a single bill. The GOP failure to reach across the aisle — reflecting the belief that they did not need Democratic votes to pass this legislation and that they could get the majority of votes without being forced to compromise on the bill — meant that the lack of party unity was fatal to any hope of legislative success. Rather than passing repeal on the symbolic seventh anniversary of the signing of the ACA, House leaders first postponed the vote and then after a day of fruitless arm twisting, gave up.
Obamacare will now continue, although Trump has said that it is in a death spiral and suggested that Democrats will soon be knocking on his door to help craft an alternative or be blamed for the problems that emerge. In the meantime, he and the Republicans will move on, turning their attention to tax reform, the Holy Grail for conservative lawmakers.
The failure of ACA repeal efforts has consequences that extend far beyond the provision of health care in the U.S. This defeat is a powerful blow to the GOP and Trump, undermining confidence in the party as an agent of change and tarnishing the reputation of the president as a man who can get things done. The emerging notion that legislative failure is a humiliation to the president has the potential to transform legislative dynamics in Washington in critical ways.
First, there is the problem of a party in disarray, unable to organize and govern. Despite controlling the White House, Senate and House of Representatives, the GOP could not find common ground among its own members to pass even its top legislative priority, and even when it had passed similar legislation only a year ago. The party has lost credibility.
The president may have sustained even more damage. This was his first big legislative fight and he proved unable to put together a majority among his own party members. The first implication of this debacle is that Trump can be challenged. Republican legislators do not worry that opposition to the president will hurt their own political prospects. That means that they do not need to support his agenda.
Second, the failure exposed Trump’s ignorance of the political process. He was quoted as saying “no one knew how complicated health care was” — news to the people who have been working the issue for years — and he demonstrated no patience for the time-consuming work of legislating. Passing the ACA took two years; Trump lost patience in two months.
Third, the president’s much-vaunted skills as a deal maker could not even convince ideological allies of the need to rally together. Candidate Trump promised an end to business as usual and to break the logjam in Washington; President Trump has done neither.
That failure will loom even larger as Trump and the GOP take on the still more formidable task of reforming the tax system. This effort will require far more patience, a far more subtle touch and a far greater willingness to reach out to the Democrats if it is to be successful. All those who oppose the president’s agenda are likely to be emboldened by this failure. That list includes Democrats and Republicans, and even governments overseas who worried about a newly unified and assertive U.S. government. But if a weakened president worries some, the prospect that Trump will now do something to prove the naysayers wrong is just as troubling.
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