The
defeat of the House of Representatives attempt to repeal and replace
the Affordable Care Act provided great civics lessons.
Its
most important student turned out to be President Trump. “We
learned a lot about the vote-getting process,” he said.
“Certainly, for me, it was a very interesting experience.”
The
first lesson is there’s a big gap between promise and performance.
Many voters believe politicians lie. That’s because they
overpromise and then cannot produce.
Candidate
Trump promised his health care reform would do more than the ACA but
cost less. Yet the White House offered no specific proposal. The
president simply endorsed Speaker Paul Ryan’s bill as if it were
what he had promised. When it failed, he failed.
The
second civics lesson is that on major issues, the president proposes
and Congress disposes. That’s called the separation of powers.
Trump
expected that, because he won the presidential election,
congressional Republicans would fall in line behind him. This time,
it did not work that way. As much as he wanted to dominate the
process and paste the Trump name on it, he depended on an independent
Congress.
This
piece of legislation had to begin in the House, because the
Constitution requires “money” bills to start there. While
passage of the ACA, done with only Democratic votes, had taken more
than a year, Ryan allowed his bill only 18 days.
The
president made a series of assumptions about the House. He made no
effort to attract Democratic votes, expecting virtually all of the
majority Republicans, out of loyalty to him, would support the bill.
But
the bill ran into the Freedom Caucus, an extreme conservative GOP
group, which wanted outright ACA repeal without replacement.
Desperate to pass the bill, Trump and Ryan agreed to delete coverage
for such essential services as emergency and maternity coverage,
trying to reduce costs to gain conservative votes.
By
cutting health services and Planned Parenthood funding, Trump and
Ryan lost the support of some moderate Republicans, who risked
election defeat if they opposed their constituents’ interests on
these matters. And the leaders still could not pick up some Freedom
Caucus members.
Maine
Second District Rep. Bruce Poliquin, while worrying about Ryan’s
rushed efforts at passage, was not among the bill’s GOP opponents.
Ryan
could not afford to lose more than 21 GOP votes, but 33 opposed his
modified bill. Trump, always the salesman, urged them to change, but
they refused. The president was learning that loyalty to him does
not overcome the separation of powers.
Here
is another civics lesson. The bigger a party’s legislative
majority, the less unified it will be. More members means more
diversity of outlook. That explains the GOP opposition.
Even
if the House passed the bill, the matter would not be settled,
despite the impression Trump gave. The key part of this civics
lesson ignored by Trump was the independent role of the Senate. It
would not have simply accepted whatever the House passed.
Affecting
previously approved spending, the bill needed only 51 senators,
avoiding the 60-vote threshold to end a filibuster. But, with just
52 Republican senators, only a handful of opponents were needed to
block the bill. A sufficient number of conservatives and moderates
had already made clear their opposition.
While
the ACA may not be “collapsing,” as Trump and the Republicans
claim, it needs to be fixed. Competition is lacking in some markets
and costs are rising. It cannot work indefinitely under its current
rules or management by Health and Human Services Secretary Tom Price,
who would abolish it if he could.
The
lesson is that ACA reform, which must come eventually, should be the
result of negotiations between Republicans and Democrats. Ryan
worries about cooperating with Democrats, because he will lose some
Republicans simply for doing that.
Ryan
and Trump should try to get enough votes for a bipartisan deal and
worry less about inevitable Republican defectors. And they should
drop the idea of using health care reform to cut taxes on the
wealthiest, the real conservative strategy.
If
the Democrats accept the need for changes in ACA operation including
markets, while insisting on preserving ACA coverage, they should get
off the sidelines if invited by Trump or Ryan.
To
win votes, Trump overpromises. Trump needs to be less of a salesman
and more of a statesman. Is that possible?
A
friend of Trump’s has said: “On future legislation, he won’t
make the same mistakes.” If so, he must better understand Congress
and be more realistic about making promises he can’t keep.