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Trump and the timing of the Obamacare reform attempt — 46 Comments

  1. There were suggestions that Trump and his advisors understood that the bill will fail from the beginning and insist on moving it to the floor to make a trap for Ryan and other hard-core Republicans. This will shift the blame from Trump himself and help him purge the House from establishment Republicans.

  2. Trump of course declared that repeal and/or replacement were a priority. However, this is still the failure of Congress, within which you can assign real blame to the different factions.

    Ryan and the rest of the leadership had better be working on this in the background because the problems of the ACA will only get worse. Democrats know this, which is why their supporters in the punditry are already writing that Trump and/or the Republicans own Obamacare.

  3. Or a person could say that Trump’s not a policy wonk, so he relied on Ryan to tell him the bill was a good one. –neo

    That’s the line of reasoning Paul Mirengoff took at Powerline. However, neo blows that out of the water as far as I’m concerned:

    But Trump had better have a mind of his own and the ability to judge such things–or have advisors who are independent of Congress who can explain such things to him so he can understand, or we are in deep trouble.

    By now Paul Ryan is, or should be, a known quantity to Trump. If after all those two have been through, Trump blindly assumed he could leave healthcare up to Ryan and it would all work out, Trump is not the savvy manager he was sold as.

    Furthermore Trump didn’t just leave it up to Ryan. The bill was important to Trump, so he sent Steve Bannon to talk to the Freedom Caucus, which was balking. Bannon said:

    “Guys, look. This is not a discussion. This is not a debate. You have no choice but to vote for this bill.”

    The art of dealmaking at its finest!

  4. Sergey:

    Oh, so you think Trump wants to support the conservative makeup of the House, and help swell the ranks of the Freedom Caucus that opposed him on this?

    I certainly don’t think he does; the establishment GOP is more in tune with him on health care policy than conservatives are.

    The effect of what happened with the health care bill is to make the entire GOP look bad, including Trump.

  5. This will shift the blame from Trump himself and help him purge the House from establishment Republicans.

    Sergey: That’s one theory. I think voters are more likely to blame Trump, and you can depend on Democrats and the MSM to reinforce that in spades.

    Besides, Trump’s takeaway in his own words:

    “We all learned a lot. We learned a lot about loyalty. We learned a lot about the vote-getting process. We learned a lot about some very arcane rules in obviously both the Senate and in the House. … Certainly, for me, it’s been a very interesting experience.”

    Unless Trump is misleading readers, Trump blames the Freedom Caucus for being disloyal, not establishment Republicans. The FC better watch their backs.

  6. Here’s where the art of the deal failed big time.

    It appears that Trump thought he could roll the conservatives. Well, lesson learned.

    In exchange for their acquiescence on the AHCA, why didn’t Trump offer them something on trade and illegal immigration. They’re allies on this issue, and he’s going to need their support anyway. Basically it would be a three way trade. FC acquiesces on health care, in exchange moderates support trade/illegal immigration.

    Strong arming only works from a position of power. They needed to give something for the FC to go back to their districts and say- ‘we had to give on this, but look at what we got on these issues’ sort of thing.

  7. In 2000 Trump wrote a book, The America We Deserve, in which he said this about healthcare:

    “We must have universal healthcare…I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses…

    Doctors might be paid less than they are now, as is the case in Canada, but they would be able to treat more patients because of the reduction in their paperwork..

    The Canadian plan also helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. If the program were in place in Massachusetts in 1999 it would have reduced administrative costs by $2.5 million. We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

    He also said:
    “I would put forth a comprehensive health care program and fund it with an increase in corporate taxes.”

    I don’t care what he said to get elected, these are his longtime stated beliefs. All this talk about who is to blame for failure to pass ACHA is so beside the point. The man wants socialized medicine, single payer, whatever you want to call it. Take off the blindfolds, remove the ear plugs, and accept the reality.

  8. I still find it interesting that a vote wasn’t taken. Can anyone really explain that? Is it really all that more damaging to take a vote and lose in the House than to pull a bill because a certain faction claims it won’t vote for the bill.

    I could have a faulty memory, but I remember that no one knew the ACA was going to pass in the House right up until the final aye was entered. Indeed, I remember a number of the conservative Democrats had declared against the bill, but ended up voting for it when they were pressed to actually vote.

  9. I still find it interesting that a vote wasn’t taken. Can anyone really explain that?

    Yancey Ward: From what I read it wasn’t going to be close. Ryan informed Trump the bill would lose by 10-12 votes. Ryan recommended passing on the vote and Trump agreed.

    Why make the situation even more humiliating with headlines screaming “Trumpcare loses by 11 votes!”

    neo’s point that the fumble makes the entire GOP look bad is correct.

  10. All of this just proves what I always feared most about Trump: he doesn’t really know much about issues. He is shallow and intellectually lazy.

    So what we have now is the circular firing squad with Breitbart and Judge Jeanine on one side and the GOPe on the other. A hell of a lot of angry but ill-informed voters are choosing sides and don’t recognize that there is no utopia. It’s all disgusting.

  11. Yancey Ward:

    My guess is that the reason the bill wasn’t voted on was that they knew for certain it would be voted down, and not just by a hair but by quite a few votes. Now, that would have looked worse than what actually happened.

    As far as Obamacare goes, I believe that the Democratic leadership always knew it was going to pass. They knew how many Democrat votes they had and they didn’t need the Republicans to pass it. The press may have spun it as a suspenseful vote, but I don’t think it was. I assumed that if the Democratic leaders brought it up for a vote they knew it would pass.

  12. The Other Chuck:

    Long ago, I accepted the reality that Trump is to the left of most Republicans and many Democrats on health care reform. I even wrote about it during the campaign.

    This post is addressed, however, to those who might say he never talked about repeal and never pushed it happening quickly, and therefore bears no responsibility for what happened with the bill. They would like to blame Ryan completely and absolve Trump. I am merely pointing out that anyone who does this is wrong.

  13. In one form or another the Republican House has voted to repeal Obamacare, or parts of it, 50 times in the last 7 years. In 2012 Republicans nominated the man who was the original architect of it, George Romney, to run for President. Then they elected a man in 2016 who repeatedly stated that he was for universal healthcare as a replacement for the half-ass attempt of Obamacare.

    Are we supposed to take these people seriously?

  14. The Other Chuck:

    Romney was not the original architect of Obamacare, or even of so-called Romneycare. I’ve written about this many, many times. See this and this for just two of these many times.

  15. Neo, Ryan merely tried to get a compromise passed. You are right that assigning him blame for Trump’s lack of leadership is wrongheaded. It seems obvious that Trump didn’t care if the ACHA passed because in the long run it wouldn’t resovle the problem to his satisfaction and long held beliefs.

  16. Ok Neo, I remember reading your articles about Romney and how he had to compromise in a state like MA and how he was deceived. Doesn’t matter. It had his name on it. He was governor. Just like Schwarzenegger in California had to compromise and ended up passing our version of Cap and Trade. Excuses, excuses. Bleh.

  17. The Other Chuck:

    Of course it matters.

    Unless you think he shouldn’t have even tried to be governor in a state such as Massachusetts and move it slightly to the right.

    Of course it matters. You called him “the original architect” of Obamacare. Call him “someone who compromised because he was governor of a mega-liberal state,” and criticize him for that. Don’t call him “the original architect” of Obamacare, or even of “Romneycare” a name given to the bill ex post facto, by those who wanted him to lose in 2012.

    I happen to be very interested in the truth rather than talking points. “Romney was the architect of Obamacare and Romneycare” is a talking point. I realize it’s also a kind of shorthand, but it presses a button for me because I argued and argued about it during 2012. So whenever I see it said again, I try to correct it.

  18. I think if someone had put the repeal on his desk on Day 1, he would have signed it, just like he started doing a lot of things right away

    But no one did.

    Who knows, maybe Ryan and crew would have done that, but back at that time most people on the right really didn’t have high confidence Hillary wouldn’t be the one in office.

    I don’t really remember anyone standing out, and talking about how it wasn’t important to get to the repeal as soon as possible. Sure wasn’t a loud voice anyway. I think we have to blame a lot of people for that, not just Trump or Congress.

  19. I think if someone had put the repeal on his desk on Day 1, he would have signed it, just like he started doing a lot of things right away

    groundhog: I’m not a fan of Trump, but on Day 1 at least, I believe Trump did exactly what he planned to, no more or less.

  20. Here’s what I don’t understand.

    For the past 7 years we’ve been regaled with fairy tales about how the Republicans had no less than half a dozen comprehensive proposals for health care that were either alternatives to Obamacare or replacements for it or both. Where are all these proposals now? I would have imagined they’d be “shovel ready,” so to speak, as to be enabled for passage on day one of Trump’s presidency. Perhaps he was operating under similar assumptions?

  21. Yackums:

    I don’t get the progression of your logic.

    If there are at least half a dozen plans, that’s 5 too many to assume there’s any agreement on it. The problem was disagreement from the different factions, which seemed pretty obvious.

    What’s more, we might assume this or that. But it’s Trump’s business, as president or as presidential candidate, to know these things—or, if he doesn’t know them, to learn them and learn them accurately and quickly.

  22. Yackums, 4:23 pm — “Where are all these proposals now?”

    In the dustbin of history.

    No one ever said any of the proposals had the support of even a plurality of Republicans [do correct me if I’m wrong].

    I’m not enough of an insider to know what sort of jawboning and arm-twisting were employed, but I am enough of an insider (read, interested observer) to know that for the most part, the Democrat side is much more disciplined (via arm-twisting, threats, skullduggery, and heaven knows what else) than is the Republican side.

    The Democrat leaders put out the talking points du jour, and the Democrat hacks, including so-called journalists and assorted media hoo-hahs, ask “how high”. The Republican hacks ask not “how high”, but “what’s in it for me?”

    As far as I can tell . . . your mileage may vary . . .

  23. Yackums:

    I want to add that I wrote this post about the plethora of plans in June of 2015, and how hard it could be for the GOP to come up with an Obamacare replacement. You might want to read it.

    It was obvious enough that Trump should have known there was a problem, and he should have said to Ryan and the supporters of this bill to go back and come up with a better one. Instead, he pushed an inadequate bill and threatened those who wouldn’t vote for it.

  24. I think a fundamental flaw with whatever number of replacement plans the GOP had at its disposal, was these were clean sheet of paper plans.

    The Republicans didn’t really have that option, so for the most part (maybe for the entire part) these were useless, given the constraints the senate rules placed on the replacement plan.

    Now it was learned late in the process that the senate rules may have allowed more aggressive changes to the ACA and one has to wonder how hard the senate was working to see the ACA fundamentally changed, since according to one article I read, no one had bothered to ask the parliamentarian how expansive the bill could be and still fit the reconciliation process.

    The Republicans could have passed a repeal bill just like the ones they sent Obama if they’d wanted to put Trump in a very difficult position, since I assume he would have vetoed it. Would they be off the hook and all the blame rest with Trump had they done that? I wonder if they would have had the votes to even do that, because it’s not entirely clear that the public is still as universally upset at the ACA.

  25. All this deference to Trump’s supposed dealmaking skills reminded me of something I read about Iranians. They have a concept called “Zerangi” that exalts sharp dealing above all other considerations. (I’ve excerpted a description and link below). Trump’s “deals” are in this mode and they benefited him and not his business partners. But successful politics requires relationship building and at least the appearance of trust. The time scale of national politics is also pretty long term. Legislation enacted today can have years before it’s impact is seen. We have to depend on the ideologically committed members of congress to keep this out in front, even as we depend on more realistic members to sand off the rough edges of ideology.

    ““Zerangi” in Persian can be loosely translated as “cleverness” and to be “zerang” is to be “clever”. Most, if not all the time in Iranian culture and society, a zerang person is seen in a positive light for he or she is intelligent, resourceful and independent/autonomous and is thus what most Iranians strive to be. To be a zerang person can be applied in many situations, both positive and sinister. For example, a person who knows how the American legal system works and is able to work it to his or her advantage is zerang. A person who is resourceful in business and has made something of himself/herself is zerang. However, a person who is able to cleverly cheat his taxes and screw the system and government is also zerang. It does not stop here; a person who is able to wittingly cheat people, companies, businesses, governments of money is zerang and an idol for many Iranians.”

    https://iranian.com/main/2008/zerangi.html

  26. Whoops, I posted before reading neoneocon’s 2015 blog post. The proposal mentioned by Cassidy was a start for repeal, and a plan by Sasse was mentioned in the comments section.

    Would these proposals had any more chance of passing? I don’t think so, since Cassidy’s plan was one that allowed states to keep their exchanges. I think that proposal was mentioned during the run-up to the AHCA, but was rejected.

    In reality, the pressure the FC placed on a complete repeal, probably would have made these proposals non-starters as well.

  27. “It does not stop here; a person who is able to wittingly cheat people, companies, businesses, governments of money is zerang and an idol for many Iranians.” – DirtyJobsGuy

    That’s funny. I immediately thought of the Persian character in the musical Oklahoma, Ali Hakim.

    Ali Hakim: I wanted to marry her when I saw the moonlight shining on the barrel of her father’s shotgun.

    Will Parker: I don’t know what to make of you! You’re too purty to be a skunk! Too thin to be a snake! To little to be a man, and too big to be a mouse! I reckon you’re a rat!
    Ali Hakim: That’s logical.

  28. Brian E:

    Good point. Reconciliation was certainly a factor.

    But didn’t they know it would probably have to be done that way, even back when they were hatching those plans? They at least knew it was a good possibility it would need to be done that way.

  29. expat,

    I argee with you about Trump lacking a depth of knowledge on many important issues. And, like you I doubt he is wiling to do any homework. He has made some excellent appointments and some that IMO are questionable. In this particular instance I put much of the blame for this fiasco on Ryan. Something as complex as a healthcare overhaul of the ACA should not have beeen such a rushed affair.

    I am sure djt pushed hard for a swift replacement, and as Speaker, Ryan should have pushed back and informed POTUS that the legislative process is a bit more complicated than writing a check to his favorite charity. And sending Bannon to strongarm the FC was a very stupid idea.

  30. Ryan’s bill was vital to the process of repeal and replace. There is a war on for control of the Republican Party between the moneyed interests and the Tea Party. As Steve Bannon said, the Ryan bill was written by the insurance industry. The categorical rejection of the bill was a graphic illustration to the moneyed interests that they are no longer wagging the dog and had better get on board to salvage what they can.

  31. Just to set the record straight, I was aware that Trump consistently said repeal and replace. I was just pointing out to IGotBupkis that Trump didn’t campaign on merely repealing it, fully intending to MHCGA (Make Health Care Great Again).

    An error of omission.

  32. Brian E:

    Didn’t mean to pick on you. I was pretty sure you were looking at the bigger picture. But it did occur to me that a lot of people were ignoring the fact that Trump the campaigner was definitely pushing for repeal/replace and for doing it quickly.

  33. Hey, any press is good press, right?

    I enjoy reading your thorough analysis or issues.

  34. Roy Lofquist,

    So Ryan is not the gope, but is the gope, and the FC is the problem, but Bannon told them to get in line because they are not the problem in Bannon’s mind? Which is it? Or might be I am just stupid and you a genius? Matter meets anti-matter? Simpleton that I am it is highly likely I am wrong, or not.

  35. I’m no genius. It’s just that I have been watching the Washington Kabuki for more than 60 years.

  36. Something to keep in mind about passage of the ACA vs. AHCA.

    Democrats enjoyed a majority of 257-178 in the house and a near filibuster proof majority in the senate of 59-41.

    Republicans obviously don’t have that plurality. If they did now, the AHCA would likely have passed.

  37. If your master tells you to do something, you do it. That is what many Americans now find themselves in (the so called home of the brave and free), after appointing Trum as their King and Savior.

    That’s what you get when you trust in humans, and it is also what Trum gets when he tries to move the might of DC, the capital of evil, using merely his own will.

  38. As Steve Bannon said, the Ryan bill was written by the insurance industry.

    If Bannon told Roy to wipe his butt with his other hand, that it would support the fight against the moneyed interests of this toilet paper company…

    The categorical truth that isn’t mentioned is that humans deceive and lie. It’s not just the “moneyed interests” that do so.

  39. This was a couple comments on an article about the AHCA that are very informative.

    —————-

    Lynn Burgess: “COBRA is your employer insurance plan and when on COBRA coverage, you continue to be on their billing statement and you remain a part of their group. The premium is paid to the former employer not to the insurance company and it is the same price they were paying for you when employed plus a small fee they can add to cover their administrative costs. So to make COBRA available indefinitely would make the former employer liable to service you indefinitely and that does not work.”

    “The problem is not just continuity of coverage but when you start a new job even if you’ve had continuity of coverage if you have a pre-x condition the new insurance company will not cover that ailment for one year and thus the need for portable insurance that belongs to you and does not change when your employer changes. To be fully functional it would require everyone to buy into the same idea even employers who presently provide coverage who would instead deposit untaxed money to your HSA and you would buy your own insurance. I wrote about it more above if you’re interested in my further explanation.”

    tobybrut: “It’s actually even more complicated than that. The premiums don’t actually go to the employer. They go to the employer’s plan administrator, which then distributes the premium to the insurance carrier, so there’s even more red tape than what you indicated. However, a concept similar to this can be proposed that looks the same from an employee’s point of view but may be vastly different behind the scenes.

    Portability itself has problems. Even if you passed a mandate that said an individual could leave a company and be guaranteed the right to immediately buy a new policy regardless of pre-existing conditions, how fair is that to the second insurance company? It would make more sense if portability allowed you to buy the same policy from the same insurance carrier. But portability as everyone is talking about permits a newly-unemployed person to buy a policy from any carrier regardless of pre-existing conditions as long as that policy is bought relatively soon. Why does the second carrier have to support pre-existing conditions if that person had never had a policy with them before?

    Portability is no longer just portability. It’s now a subsidy for pre-existing conditions, something that so many here abhor, yet those same people strongly support portability.

    The only way to truly make it a non-pre-existing conditions mandate would be if employer-provided insurance was not permitted, but that kind of mandate should also be abhorrent to any conservative because it’s an interference in the free market.

    One thing I came to like about AHCA was the provision inserted for the Patient and State Stability Fund (PSSF) that removed pre-existing conditions from the general individual insurance market. The problem with ObamaCare was that pre-existing conditions polluted the individual market, pushing up everyone’s premiums. The individual mandate was intended to make up for that by spreading out the risks among more people, but it failed because people simply paid the tax penalty rather than buy insurance they didn’t need or couldn’t use because it was too expensive.

    The PSSF removed the risk from the individual market, so that the roughly 500,000 people with pre-existing conditions who did not have employer-provided insurance could be placed into a high-risk pool financed by the federal government. If a person loses his job and needs to buy insurance, that person could then be guaranteed the opportunity to buy a policy that’s subsidized by the PSSF. Nobody else’s premiums would be affected, completely eliminating ObamaCare’s biggest cost driver.

    The second biggest cost driver was the EHB mandates, which were also eliminated by AHCA. With both of the biggest cost drivers of ObamaCare neutralized, premiums were certain to come down.”

    _________________

    If what these folks are saying is true, and it sounds like they know what they’re talking about, the FC really needs to rethink their opposition to the AHCA.

    If the AHCA dealt with two of the largest drivers of premiums– guaranteed issue and EHB, I’m not sure they are going to get a lot of additional concessions. Yes, they oppose the Medicaid expansion– but moving it more to the states through block grants is probably as conservative as you’re going to get.

    The thrust of this article was re-visiting the Ted Cruz proposal to deal with ACA repeal.

    http://www.redstate.com/patterico/2017/03/27/next-step-repealing-obamacare-ted-cruz-answer/

  40. The Other Chuck – not many people put the name Trump in the same sentence as ‘long held beliefs’! My take on him is that he wants the win, and would prefer it to be what he wants, but will take what he can get. And he’s probably shrugging off this debacle and will come back to it later.

    Perhaps long held inclinations would be a better phrase? And who knows how long ‘long’ is. 2000 was a long time ago.
    ~~
    That said, I think that most people (the normal kind who think about politics 10 minutes a week, not us) would see this either as a Republican eff up / gridlock as normal, or even Republican obstructionism rather than it all being Trump’s fault.

    I’d say it was all of the above, personally.

  41. Julia, your points are well taken. My thinking is that Trump didn’t really care if it passed. And, its failure would give him an opportunity to use a contentious issue that can’t be resolved within the Republican congress for his own broader agenda.

    If Trump wants to accomplish the revitalization of the American economy and needs bipartisan support for it, what better bargaining chip does he have than the carrot of single payer healthcare? That he opened to door to Democrat involvement immediately after ACHA bombed only confirms this belief.

  42. Neo’s main point is entirely correct, of course. Trump made these promises. (And he has a history in conflict with these promises.)

    If Starbucks’ CEO says he plans to hire thousands of refugees, do you assume that he really wants more refugees accepted into the USA; or do you assume that he simply wants those hipsters that hang out in coffee shops all day, to now hang out in a Starbucks. CEO’s say things for two primary reasons, to boost sales, and to boost the stock price directly. And Trump was a CEO.

    Maybe Trump really believes in universal healthcare. Maybe he grew up since he wrote that book. Maybe he was just being a CEO.

    Do people remember that quaint notion that politician’s voting records should be scrutinized prior to re-electing them? I for one, would really like to see the total repeal of Obamacare passed through the House. Because I would like to see who in the Senate and Whitehouse takes a stand in support of it. Who would switch their vote in the Senate? Who were the phony supporters of repeal in the past?

    I know, reality intrudes. McConnell would let the bill twist in the wind, and it would go down because of a filibuster or cloture vote. I say do it anyway.

  43. “Trump’s “deals” are in this mode and they benefited him and not his business partners. But successful politics requires relationship building and at least the appearance of trust.

    We have to depend on the ideologically committed members of congress to keep this out in front, even as we depend on more realistic members to sand off the rough edges of ideology.”
    – DirtyJobsGuy

    Very zerang and interesting point!

    It helps that these members of Congress come from “safe” districts.

    But, what makes those districts “safe” to begin with?

    Either the members were able to sell their ideology to the folks in their districts, and on their ability to represent that while in office, or the district was predisposed to someone of their ideology (i.e. they were convinced by prior members, or by action at the state and federal party levels). Probably a mix of both.

    Bottom Line: It all circles back to the choices people make, as Congressional elections do a reasonable job of representing an “average” of what the folks in the district are looking for.
    .

    Certainly hear much less about how other billionaires “screwed” people in the process of running their empires vs trump – much of which predates his run for the presidency.

    trump also has some of the weakest arm’s length arrangements one could imagine. It MAY be enough to be legal, but it is very debatable whether it follows the spirit and ethics of what is needed.
    .

    Zerangi (the sound, and the connotations) reminds me of “Ferengi” from Star Trek – which could arguably be a left biased representation of Capitalism gone wrong.

  44. @TommyJay – yes, rather disappointing that trump didn’t use his megaphone to reach the public directly (instead of using it to talk about issues that distract).

    Also rather disappointing that the GOP didn’t have a plan already in hand that was more true to the principles they ran on, and that they didn’t seem quite as willing to go to bat to build support for it (perhaps because they were still debate what should be in the thing!).

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