A second failure by Republicans to replace ‘Obamacare’ exposes incoherence in the party
A second concerted push by Republicans in the U.S. Congress to “repeal and replace” the landmark health-care reform law passed by the Obama administration ended in tears when it failed to garner the minimum 50 votes necessary to pass on the floor of the Senate. The latest proposal, which came to be known as the Graham-Cassidy bill after the Senators who sponsored it, was built on the idea, contra-Obamacare, that each U.S. State could effectively write up its own provisions for implementing certain aspects of healthcare policy. And in return for ensuring that some basic tenets were followed, such as patients with pre-existing conditions not being excluded from health insurance schemes, they would be given sizeable block grants. These grants, effectively “sweeteners” for moderate Republicans nervous about the mid-term elections due in November 2018, were supplemented with the promise of further deregulation of the health-care sector, a giveaway to the more conservative Republican fold. Ultimately neither of these measures worked as intended. Two Republican Party stalwarts, Senators John McCain and Susan Collins, reprised their oppositional role to the effort in July 2017, when the first attempt to repeal and replace Obamacare fell short of the 50-vote mark. Along with libertarian Senator Rand Paul, their resistance was sufficient to sink the bill’s prospects.
The failure to repeal and replace the Affordable Care Act (ACA) represents more than just cracks within the Republican superstructure. It shows that notwithstanding the stunning victory of Donald Trump last November, the party is still beset with conflicting imperatives and has not united under his leadership as President. Factors exacerbating the malaise include the pressure on Senators facing contests in the mid-term elections, where they will have to explain to voters why seven years of anti-Obamacare sloganeering has amounted to nothing. They will further have to find some way to sell the embarrassing, dismal reality that influential Republicans such as Mr. McCain are opposed to the Graham-Cassidy bill as long as they don’t know “how much it will cost, how it will affect [sic] insurance premiums, and how many people will be helped or hurt by it.” A second source of anxiety for Republicans is that the political goodwill they enjoy today hinges ever more on success in a second area of policy reform: a complex overhaul of the tax code. Mr. Trump is poised to announce a major tax cut, going by his tweets; yet will that suffice to unite his squabbling party colleagues around a single conservative banner? The heart of the problem for the Republicans is that the ACA is a powerful institutional recalibration that transferred a measure of control over health-care outcomes from health insurance corporations to patients, not to mention potentially expanding coverage to 30 million uninsured Americans. Whatever the Republicans hope to replace such a patient-centric policy with had better be deeply thought through and masterfully sold to their constituents.