The Deplorable Care Act

March 27, 2017 4:07 pm by Jacob McAllister

The American Care Act Goes Down in Flames

healthcare system

It looks like they really were the “Party of No” after all.

In a truly epic fail, the Republican replacement for the Affordable Care Act went down in flames on Friday, raising the question whether or not the party was ever truly serious about coming up with a replacement plan at all. In a stunning admission of ineptitude, House Speaker Paul Ryan stated “Moving from an opposition party to a governing party comes with growing pains. Doing big things is hard.”

After 8 years of warning that the sky was falling if we didn’t “repeal and replace” immediately, the best Ryan and the House Republicans could come up with was this stinker of a bill, which would provide huge relief to wealthy individuals while leaving some 24 million Americans with no insurance, many of whom voted for Trump. From Politico:

The House speaker is more identified with AHCA than anyone else, and had greater control than anyone else of its moving parts. It was his bill, his plan, his preferred timing. But he produced one of the worst pieces of major legislation in memory—and his reputation as a policy professional and legislative tactician may never recover.

Ryan increasingly has the look of a defeated dog whose days are numbered. He is widely being cast as the fall guy for this disaster.

upward redistrubution

This chart shows the same old combination of tax cuts for top earners and benefit cuts for low earners that has become so familiar to Republican policy. Courtesy of The Washington Post

Winning Bigly

Candidate Trump tore through the campaign trail promising to “immediately” repeal Obamacare, so it is impossible to see this as a victory for him. Several first hand accounts have described Trump as disinterested in the details of both Healthcare and Congressional procedures. Again from Politico:

It was Thursday afternoon and members of the House Freedom Caucus were peppering the president with wonkish concerns about the American Health Care Act when Trump decided to cut them off.

“Forget about the little shit,” Trump said, according to multiple sources in the room. “Let’s focus on the big picture here.”

Trump wanted to emphasize the political ramifications of the bill’s defeat; specifically, he said, it would derail his first-term agenda and imperil his prospects for reelection in 2020. The lawmakers nodded and said they understood. And yet they were disturbed by his dismissiveness.

For many of the members, the “little shit” meant the policy details that could make or break their support for the bill—and have far-reaching implications for their constituents and the country.

The president was looking for a win here, and tried to take the quick and easy route. He wants to be able to say “I repealed Obamacare,” and couldn’t care less about the details of how he gets there. He pushed hard for the bills passage, lobbying and tweeting in support of it.

By all accounts it would seem he wanted it to pass.

And Just What the Hell is Bannon Up To?

And then there is Brietbart. The tabloid publication that Senior White House Adviser Steve Bannon left to run Trump’s campaign has been loud in its opposition to both the bill and speaker Ryan. Bannon is in fact, in his heart, a Tea Party/Freedom caucus ideologue. He is far to the right of the establishment of the Republican party, and has stated on numerous occasions his desire to “destroy the administrative state”, which presumably includes the bureaucracies created and enlarged by the Affordable Care Act. And yet, he was reportedly trying to whip House members in line behind the bill as late as Thursday.

Could this whole thing just be a ruse to throw Paul Ryan under the bus?

Ryan has long been the target of Bannon, whom he sees as not ideologically pure enough. Indeed, there would have been no compromise that went far enough for the Freedom Caucus, the fringe group of Representatives who have effectively functioned as an opposition party for the last 8 years. They believe fundamentally that the government has no place in the healthcare market. Seeking the repeal they screamed for, but having no interest in a replacement, they have convinced their constituents that the bill is tantamount to socialism, and must be defeated. They would love nothing more than for the government to get out of the healthcare business altogether.


By letting Ryan take the blame here, and doing nothing, they still have their boogeyman to lash out at in O-Care, and Bannon and his unofficial propaganda arm of the White House can hammer that message home to create maximum outrage.  Meanwhile they are in a perfect position to sabotage healthcare from within, choking off funding and killing the bill slowly.  This would be their preferred method, as it would allow them to escape the painful work of passing new legislation,  while still achieving their goal of destroying the ACA. It remains to be seen how effective that strategy will be.

It is important to note that the average Trump voter cares little about policy, and is far more likely to be swayed by cultural issues. Paradoxically, they would ultimately end up being the big losers from Trump’s policy decisions, and yet potentially still be receptive enough to Bannon’s “America First” message to ignore their personal decline in living standard.

Never underestimate the power of tribalism…

It is also plausible that Bannon and Trump favor some type of welfare for older and working class white men scheme which would require a well funded bureaucracy, and the preservation of Medicare and Medicaid. It would mean they would have to compromise on their free market ideology, but they would be spared the wrath of millions suddenly losing benefits they have grown accustomed to.

The Law of the Land, For Now

Burning it down is always easy, but building a consensus behind the bill is the challenge. The Washington punditry class is beside themselves at this administration’s inability to do so. But at every step of the way this has been the case, and every time they come out on top. To assume that there is no plan here, or that they are not playing a long game on healthcare is pompous and naive. Letting this bill fail, and then gutting Obamacare from within are in perfect alignment with the wrecking ball strategy that team Trump has employed with great success so far in its short term. This is what they are trying to achieve.

Addition by subtraction.

But as it turns out, it is a lot harder than advertised to remove an entrenched safety net program, especially one that is already established, which is why its popularity began to increase once the possibility that it was in danger became real. The backlash against this terrible policy was loud and fierce, and perhaps can send a message that a hard-right, pro big business agenda is not what voters wanted. Trump has said he will walk away from the replacement for now, but that does not mean the fight is over. Quite the contrary, the Republican assault on healthcare policy will continue.

The failure of the American Healthcare Act is the beginning, rather than the end, of the long battle to preserve healthcare for millions of Americans. Obamacare is an imperfect solution, but it is a start. Bernie Sanders today called for Medicare for all. This would not be possible had the path not been paved by the previous president.

The desire of those who adamantly oppose government involvement in healthcare to kill it off in all forms is strong, and will not go away. But, at least for now, they have been held at bay.


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