US Republicans get their health Bill – but it may cost them

In voting to repeal former president Barack Obama’s signature healthcare law, House Republicans on Thursday finally delivered on a key Trump administration goal and on a campaign promise that they have made for the better part of a decade – but at a potentially steep price.

After failing to get the votes for an original replacement measure in March, Speaker Paul Ryan worked tirelessly to do what his predecessor, John Boehner, could not, bringing together his most conservative members and their moderate colleagues behind a piece of legislation laden with political peril.

The victory may give potential momentum to the rest of Trump’s agenda – particularly the arduous task of rewriting the tax code – and it helps restore Ryan’s reputation, for now. No longer is he the guy who speaks loftily about policy but cannot deliver results; now he has proved that he can produce the votes. His volatile relationship with Trump, too, may settle down for now.

But by leaning on members to vote for a Bill that many fear will take too much healthcare from too many people, Ryan has exposed moderate Republicans to withering political attack, especially in the roughly two dozen districts where Hillary Clinton prevailed, but also in places where the Affordable Care Act’s popularity has been increasing.

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“If you’re in a very moderate-to-Democratic district, yeah,” Republican Peter King said of the potential risk to Republicans, conceding it is a worry for his entire party. In recrafting the Bill, Ryan worked with an attentive White House, edging out the committee chairmen who had helped write the original measure and turning to conservatives. This moved the Bill significantly to the right and also empowered the conservatives, whom many Republican leaders had hoped to marginalise in the era of Trump.

The president’s economic populism and flexibility on policy seemed at first to be totally out of step with the far-right members who essentially ran Boehner out of town. The vote on Thursday could serve as an augury for high-stakes spending and policy fights.

‘Interesting dynamic’

“This is definitely a win for the Freedom Caucus,” said Charlie Sykes the former conservative radio host and longtime friend of both Ryan and Reince Priebus, Trump’s chief of staff. Priebus made getting a healthcare Bill passed in the House a career-defining moment for himself. and he negotiated at length with the conservative politicians. “They moved the Bill right, and the moderates caved,” Sykes said. “That creates an interesting dynamic.” To get his victory, Ryan cast aside many promises he had made when he became speaker, throwing together Bills without hearings and a sinewy committee process, making back room side deals to buy off individual lawmakers, and voting for Bills before the Congressional Budget Office could put a price tag on them.

This process alienated committee chairmen, whose work took a back seat to the efforts of an elusive chairman of the House Freedom Caucus, Republican Mark Meadows, and it chipped away at their authority. Meadows and his fellow conservatives, who have toiled for years as philosophical bomb throwers in the legislative process, got the attention of the White House, which worked hard to meet their needs and pressure moderates to come along.

Ryan spent much of April calling and visiting colleagues to get the measure passed. But in the end, there is little guarantee that the Senate will be able to live with the House Bill. This is particularly true for senators from states where the Medicaid program expanded under Obama’s program.

“Senate Republicans may look back on the appeasement of the Freedom Caucus as a poison pill,” Sykes said.

At the very least, the Senate will take far longer to get its legislative process going. And whatever it passes could end up being so far from the House version that no compromise between the two chambers can be attained. That would mirror the situation that House Democrats faced in 2009 when they voted for a politically risky cap-and-trade Bill that the Senate never took up. Many of them then lost their seats.

“I sincerely hope that the Senate won’t mimic the House and try to rush a Bill through without hearings or debate or analysis,” senator Chuck Schumer of New York, the Democratic leader, said on the Senate floor on Thursday. Schumer gave a preview of the Democratic blitz facing House Republicans – who will return to their districts for a week off to gauge the voter’s reaction – describing the measure as a “breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans.”

Political costs

Republicans have guessed that there would be political costs, especially with energised Democrats looking to beat back Trump’s agenda and make a run at retaking the House in 2018. But they have also bet that their own base has been long depressed by their inability to repeal the healthcare law, and believe the issue will generate needed energy.

“The upside for Republicans is that they can return to their districts and tell GOP voters that they acted on a campaign promise,” said Nathan Gonzales, editor of Inside Elections. “The downside is that the alternative may not go far enough for base Republicans, may go too far for moderate voters and create a backlash that puts the House majority at risk in 2018.”

On Thursday, a united Republican front presented their floor vote as a rescue mission, unity exercise and moral imperative. “Everyone was talking about how this was the moment to save Americans,” from the current healthcare law, said Republican Vicky Hartzler. “We’re proud of this product.”

– (New York Times service)