On Thursday evening, facing mounting conservative opposition to a watered-down Obamacare replacement bill, President Trump let loose an ultimatum on Twitter. The frustrated 45th President told House Republicans via Twitter that they should “pass the bill today or keep Obamacare in place.” While I understand that this ultimatum was intended to push fence-sitters toward voting for the Ryan-backed American Health Care Act (ACHA), it is not an ultimatum the President can afford to keep. If the Republican Congress cannot come to consensus and repeal Obamacare completely, and replace it with a free-market cure in the short-term, Republican dominance of Washington will be a thing of the past come next November.
For seven years, congressional Republicans have campaigned on ending Obamacare and replacing it with a conservative reform package that would lower costs and increase access to care through the free-market system. That they are now scrambling at crunch-time to come-up with a replacement bill is appalling; they have had seven years to prepare for this moment and, yet, they have fumbled at the one yard line. President Trump has said that he is ready to move-on to tax and immigration reform in the absence of a “yes” vote on the AHCA. This would be a disastrous move for his presidency.
President Trump’s reform agenda is endangered by the failure to repeal and replace Obamacare. Speaker Ryan’s effort to pass a watered-down bill through Congress alienated the House Freedom Caucus, an organization founded with the help of now- White House budget director Mick Mulvaney, and led to the bill being twice pulled from the floor.
Instead of writing the bill with the input of House Freedom Caucus members, Speaker Ryan set himself up for failure by excluding them from its formulation. There should have been inclusion of the Freedom Caucus on the front-end, not panicked outreach and threats once the bill was introduced.
President Trump was not well served by the Republican House leadership this week, and, yet, he went to the mat to defend a bill that was doomed from the start. Tweaking Obamacare is not what got Republicans elected; they promised a full repeal and replacement of Obamacare once and for all. The President cannot now pivot onto other issues until an Obamacare repeal is passed. Conservative voters are fed-up, and the Republican base will not tolerate leaving Obamacare in place one minute longer than necessary. The President and the Speaker of the House need to reconvene the entire House Republican Caucus and rewrite legislation that will have near-unanimous GOP support so that the House can pass a bill and send it to the Senate.
The American Healthcare Act is certainly better than Obamacare, but it needs to be better to keep Congress’s and the President’s promise to the American people. By ending the Obamacare “death spiral,” fully repealing Obamacare’s mandates, and providing for health insurance competition across state lines, the House Republican Leadership would make significant progress toward putting forth a passable bill.
I understand President Trump’s frustration with last week’s failure of healthcare reform legislation, but walking away is not an option at this point. If Obamacare stays in place, tax and immigration reforms will not pass, and Nancy Pelosi will have a realistic shot at the Speaker’s gavel again in 2018. These are costs Americans cannot afford to pay.