I remember well the day Obamacare passed Congress in 2010: the crushing betrayal of Bart Stupak who sold out his principled pro-life stance to appease his party, the guttural tirade from John Boehner (“Hell no, you haven’t!”), the normally staid House of Representatives descending into British Parliament levels of clamor. It was a historic defeat for conservatives and an exceedingly tough one.
May 4, 2017, is not the mirror image of that day. House Republicans this afternoon did manage to replace Obamacare with their preferred American Health Care Act (AHCA) on a slender margin of just two votes, but the worst of the slog is yet to come. Expect several months more of legislative melee, as the Senate tries to squeeze a similar bill through both both the reconciliation process and the Murkowski-Portman moderate front line, while still staying reformist enough as to keep Tea Party legislators in both chambers onboard.
Here’s a rough sketch of the legislative calendar. First, the CBO needs to score the updated AHCA. Then the Senate needs to introduce a bill. Then it needs to be taken up by the Senate parliamentarian to assess whether it can be passed via reconciliation. Then the bill needs to meander its way through the pertinent Senate committees. Then, since the Senate bill will likely be different from the House’s in order to pass muster with moderates, House-Senate conference legislation will have to be hammered out. Then both houses will need to pass the final AHCA.
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All the while, Republicans will be battered at gale-force town halls and watch their congressional phones explode out of their cradles. The left, which four months ago was rotting with all the stench of a cadaver, has suddenly found a spark for its activists. The public reluctantly agrees with them — they might not like Obamacare, but any fiddling with the health care market during such fragile economic times gives them the jitters.
And then comes the aftermath. I’ve already sketched out my many objections to the first-version AHCA: it strikes Obamacare’s individual mandate that forces young customers into the health care exchanges without cutting regulations and implementing other cost-saving measures to compensate for the loss of business. This would exacerbate the destruction of the individual market, not ameliorate it.
The latest AHCA effectively punts this problem to the states, allowing them to strike the costly rules rather than doing it themselves. It’s an improvement, certainly, as well as an attempt to pin any disruptions caused by the law on recalcitrant blue states. But that trick didn’t work with the Obamacare Medicaid expansion — the public blamed Congress, not Republican governors — and I don’t expect it to work here either. If we’ve learned one thing over the past decade, it’s that health care reform is political plutonium, and Republicans are about to be left holding the glowing cylinder.
We’ll see how severe the tremors are and whether voters exact revenge as they have in the past. But amidst all my naturally occurring pessimism, one thing is worth keeping in mind: it was never supposed to get this far. Remember all the post-Obamacare assurances? Customers would learn to love it. The goodies it distributed would prove irreversible. Republicans, by refusing invitations to shape the bill, would be shut out of power. Today, the GOP controls every elected branch of the federal government, the vast majority of state legislative chambers and a majority of governor’s mansions.
The sneering left was wrong about everything. Now they’re hyperventilating on Twitter about how the scaling back of their law, which made insurance unaffordable for so many, is a crime against the common good. So don’t pop the champagne — but don’t deny yourself a little political schadenfreude either.