It seems like we’ve heard this before: “Send me to Washington so I can finally rid small businesses of the burdens of the Affordable Care Act.”
Republicans had their best opportunity in a generation. Control of the House of Representatives, the Senate and a president practically itching with pen in hand to sign a repeal into law. But that didn’t happen nearly as well as planned (or promised).
We’ve seen this movie play out before and it effectively cost John Boehner his position as Speaker of the House of Representatives. For Boehner, it was dealing with those in his party on the far right; those who are more prone to say no to anything and oppose everything. Those who truly believe the perfect just is not the enemy of the good, it’s the only outcome.
Typically when Boehner was trying to strike a deal with the Senate and the White House, he would lose the votes needed from his right, so in order to achieve the simple things such as keeping the government open, he had to look leftward and give Democrats some of what they wanted to secure the votes.
This time around, Boehner’s successor, Wisconsin’s Paul Ryan, was given the same choice, but worse. Ryan was opposed by those on his right, as well as those on his left, all within his own party. Members of the Freedom Caucus, a faction of about 25 conservatives that wanted nothing less than full repeal. That included Title 1 of the law, which did away with essential benefits such as dependent coverage, plus a prohibition, discrimination or exclusion based on preexisting conditions. They wanted it eliminated, which would have significantly disrupted the marketplace.
To the Speaker’s left, those known as moderates who are near the middle of road ideologically believed the bill would lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals. That left Republicans well out of range of getting the votes needed to pass and like the ACA before it, not one vote was to be expected from the minority party.
Not only did Republicans suffer from the embarrassment of this legislative failure, but they also left more than $800 billion on the table that was to be used for tax reform. According to the Congressional Budget Office, the House plan reduced revenues by nearly $900 billion over the decade, including $592 billion in tax cuts. Passing these tax cuts now as part of a health package enabled the GOP to offset its costs through cuts to health-care spending — particularly in Medicaid, which CBO estimated the House health-care bill cuts by $880 billion over 10 years.
Paying for tax cuts must come from somewhere, and Republicans were hoping it would come from health-care reform, but as of this writing that’s not to be. Now that health care’s repeal and replacement probably is moot, there’s that much less money on the table — and much more to do to achieve tax reform.
Kevin Brady (R-Texas), the chairman of the House Ways and Means Committee, repeatedly has said he expects the House will pass a bill this spring. Spring ends June 19. Another fight is to be expected, with winners and losers. Can they avoid the same fate?
This article was originally titled “Will it stay or will it go?” in the May 2017 print edition of PM Engineer.