By Jack Boyle, re-posted with his permission.
I’ve watched the ongoing action over the effort to repeal Obamacare and feel the need to comment on some things that have I’ve not seen addressed in the discussion thus far.
Most important is the universal identification of the Freedom Caucus as the culprit that scuttled the effort. This is a profoundly misleading and purposely inaccurate idea; one that has been crafted and is being pushed by exactly those people and groups that were the target of the Trump presidential campaign – the bi-partisan political establishment.
\Much has been said and speculated about the strategy and tactics of the House effort; the decision to repeal and replace in one bill, the way the bill itself was written, the 3 phase process, the rollout of the bill, the artificial deadline for passage.
The core question remains, what caused passage of the bill to fail and what did the Freedom Caucus have to do with it?
First let’s consider the bill itself. The positive things in the bill included the cancellation of the Obamacare taxes ($1 trillion over 10 years) and the elimination of the Medicaid spending guarantee to the states ($900+ billion over 10 years – potentially). This would provide a trillion dollar tax reduction for use in the tax reform package and a $100+ billion spending reduction. What conservative could possibly be against that?
The problem was that the bill was supposed to be about health care, not tax reform. The most simple negative issue with the bill was the fact that it was not a repeal of Obamacare.
In pursing repeal and replace in one bill many parts of Obamacare were rolled back, but the health care mandates were left in place. These are the things that make the care so expensive, things like requiring elderly people to buy maternity benefits. And this was the issue that caused many people (Rand Paul, et al) to call the bill Obamacare lite.
The proponents of the bill maintained that the mandates issue could not be addressed in the initial bill in order for the bill to qualify for reconciliation status (51 votes) in the Senate. Instead the bill contained “the secretary shall determine” language matching Obamacare language which would allow the mandates to be dealt with (presumably killed) in phase two of the plan. Considering that the secretary in question would be HHS Secretary Tom Price, an implacable foe of Obamacare, placing one’s faith in “the secretary” was not unreasonable.
Members of the Freedom Caucus and others, however, kept coming back to the fact that Republicans had explicitly and vociferously run on a platform of repealing Obamacare for 3 national election cycles, that Republicans had voted for repeal dozens of times during the Obama presidency knowing that repeal could not take place, that now that Republicans controlled all branches of government repeal was the expectation of Republican voters and of the electorate in general, and that repeal was something which this bill manifestly did not do. And, however ironclad Tom Price would be in uprooting the mandates and other Obamacare pathologies, Price would clearly not be HHS secretary in perpetuity.
Further complicating the move toward passage was the poisonous, cynical, hypocritical atmosphere on Capitol Hill. A conservative member of the Ohio House congressional delegation, NOT a Freedom Caucus member, observed that there is no trust on the Hill; no expectation that any promise not explicitly contained in the legislation would actually happen.
At this point the latent, ever-present frustration with trying to make a House measure conform to Senate rules blossomed, momentarily replacing the frustration of the moderate majority with those annoying Freedom Caucus conservatives. Members gradually became aware that the measure has been written with an expectation of the way Senate rules would be applied; no one had actually asked the Senate parliamentarian for a ruling. After a conversation with the parliamentarian, Senator Mike Lee (R-Utah) reported that canceling of the care mandates would not disqualify the measure for reconciliation treatment. The cancelation of mandates, having a significant positive effect on spending, would appropriately be included in a budget reconciliation measure.
Suddenly here was an opening that would allow all sides to come together. To all the other tax and organizational benefits of the AHCA would be added repeal of the coverage mandates. This would allow Republicans who care about voting in the way they tell the voters, to at least plausibly claim actually to be doing so. Late in the day on Wednesday, March 22, the chairman of the Freedom Caucus, Mark Meadows (R-NC), had a lengthy meeting at the White House. That evening he told reporters, we have a deal, we’re working out the final details. He was effusive in his praise of President Trump, Trump’s engagement, his knowledge of the issue, his willingness to work with and consider all sides and arguments.
Problem solved! Obamacare is history!
Not so fast. Suddenly Republican “moderates” were having problems with the bill. How could they justify taking away all this coverage from people? Dave Joyce and Mike Turner of Ohio announced their reservations with the bill. Moderates in other states spoke up as well. Their opposition was confusing; why oppose a measure that you had voted for numerous times in previous congressional sessions and which simply made explicit items that had been left to the “secretary shall determine” (wink, wink, wink) in the earlier version which you supported just a few hours earlier?
House leadership went to work to try to impose party discipline; by definition these member are part of the “pressure for favors” congressional method of activity. But moderate opposition continued to grow. In fairness, not all members of the Freedom Caucus accepted the Meadows-Trump agreement either. The vote scheduled for Thursday, March 23 was postponed, and on Friday, the 24th, eleven of the thirty Republican members of the House Appropriations committee had announced their opposition according to theHill.com. At midday on Friday when Rodney Frelinghuysen (R-NJ), chairman of the Appropriations Committee, posted his opposition to the bill on his Facebook page, Speaker Ryan pulled the bill.
It appears that it was movement away from the bill by moderate Republicans led by Appropriations Committee members that killed it. These are the members of congress who spend the government’s money. They find it easy to raise contributions from companies that do business with the federal government but they then find that their donors have serious expectations about how the members vote on appropriations.
The hospital associations, who by the way led the lobbying battle to expand Medicaid and who get the bulk of Medicaid spending, the pharma companies, the medical device companies, the medical associations, the health insurance companies; all get the bulk of their revenue either directly from the federal government or through payments mandated and governed by government regulation. These are the groups that worked with the Democrats in the writing and passage of Obamacare and who stand to lose with its repeal: coverage mandates, the sale of insurance across state lines, the cancellation of Obamacare subsidies, the rollback of Medicaid, all these things would disrupt their payment streams.
These groups have the most to gain from undercutting Obamacare repeal, to gain from an effort to “fix it” rather than repeal and start over. The more complex the plan, the more steps involved, the more opportunities there are for special deals, cut-outs, subsidies, supports. This is big business’ and lobbyists’ home ground. The complex process created to accomplish this legislation gave the lobbyists many points at which to intervene and mitigate damage to their clients. One can assume that much champagne was consumed by K Street that Friday evening.
It is cooperation by our elected representatives with these and other companies and lobbyists that has created the years long frustration on the part of the electorate; frustration with the fact that no matter what tools we give our representatives, control of the house, control of the senate, control of the white house, nothing seems to get done.
These groups and their lobbyists are the core of the bi-partisan Washington establishment. They are exactly the connections, the obligations that Trump ran against in his campaign; this is the swamp that he promised he would drain.
The members of the Freedom Caucus were by and large very supportive of Trump’s candidacy. In this health care effort they perhaps can be faulted for taking Trump both seriously AND literally. They thought when Trump said repeal Obamacare that Trump meant repeal Obamacare.
Why has this aspect of the bill’s failure not been covered by the media? Of course it is because the media is a core part of the establishment. The last thing they want is close coverage of the appropriations process. Has Rodney Frelinghuysen’s name ever been mentioned in the national media, even in this week’s coverage?
President Trump is a smart savvy operative and he has accomplished much in a short time. Perhaps this misfire can be understood in the sense of a business manager delegating an important task to a subordinate manager who was unable to bring in success. Or perhaps Trump has decided that the swamp is too deep, that there are too few Freedom Caucus members and their requirements too stringent to be able to get to the 218 number needed to pass things in the House. Perhaps he has decided, like Obama and the oceans, to lower the swamp a few feet instead of draining it.
Less understandable is Trump’s decision to attack the Freedom Caucus. Perhaps Trump has decided that someone had to take the blame and that the Freedom Caucus, despite the criticisms, would remain in the game because of their commitment to policy rather than to politics. Perhaps he’s decided that they’re too much trouble and he doesn’t need them.
This is a dangerous time for the administration and its agenda. One wonders if Trump has wandered into “fool me once” territory.
But the fact is the bi-partisan establishment, the spenders, killed the AHCA, not the Freedom Caucus.