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The Politics of the AHCA

Damon Linker [1] and I each have columns at The Week [2] today about the politics of the AHCA. Linker sees a great opportunity for the Democrats [1] that he fears they will blow:

If the Democrats can’t transform this monstrosity of a bill into fuel to power them to victories in the 2018 midterms and beyond, then they should just pack it up and go home.

Could they screw it up? You bet they could. This is the party, after all, that just a few months ago lost the presidency [3] to the most unsuitable, unfit, unappealing major-party candidate in American history, and has spent most of the time since then blaming Russia for its own ineptitude.

So yes, the Democrats could blow it. But they shouldn’t. Especially when the path to victory is so clear.

The primary thing they need to do is follow the example of Bernie Sanders. Have you heard about his town hall in rural West Virginia [4] on Monday night? A 70-something socialist with a thick Brooklyn accent won over a crowd of Trump supporters with his earnest, straight talk about health insurance and the struggles faced by voters in coal country. I don’t often agree with Glenn Greenwald, but he was surely right to plug the event with this tweet:

Precisely. Sanders has a message that resonates with large numbers of Democrats — and like Trump, it’s a message with potential appeal among members of the other party as well. This is a moment of realignment, both in the U.S. and Europe. Neoliberal, managerial, centrist globalism is being challenged by populists of the anti-liberal right and left. Right now, the right-wing variant holds power in Washington. If Trump had the guts to combine his populist-nationalist appeals with support for a single-payer health-care system, he just might succeed in realigning both major American parties by scrambling their policy commitments. But despite his occasional words of support for covering “everybody [5],” Trump shows no sign of actually doing this.

That leaves the field wide open for the Democrats to act boldly. And Sanders is showing how to do it: Call the AHCA the social calamity [6] that it is. Talk about how trade deals have enriched some but impoverished many others. Propose bold policies that could make things better, and do so with confidence, daring the Republicans to denounce them. And make the case for all of it in terms of citizenship.

I agree that the bill is a monstrosity — but I’m less convinced that it’s guaranteed to do serious damage to Trump [2]:

[One] possibility is that Trump thinks the game works differently for him than it did for Obama. Obama’s large majority in the Senate in 2008 was built on the back of two successive wave elections, each of which explicitly involved reaching beyond the Democratic core. He had a lot of room to fall. Trump himself certainly altered the shape of the electoral map — but by accelerating polarization [7], not decreasing it. And his legislative majority in both houses of Congress is thin and dominated by the right.

Because of this, Trump may well think it makes sense to govern as if Democrats just don’t matter. If Democrats overwhelmingly oppose anything he does, that may just convince the voters who elected him that he’s on the right track. Those people losing insurance? Maybe they’re mostly poorer, or non-white, or are happy to avoid paying for insurance that they don’t want. Maybe he’s gambling that for the bulk of his voters, making sure they aren’t paying for insurance for the “undeserving” is precisely the point. Particularly given the shape of the 2018 electoral map, Trump and the GOP may rationally conclude that the more polarized the political environment, the better for them — and the AHCA will certainly be polarizing if it passes. Meanwhile, by 2020 the state of the economy and job growth is what will really matter to voters, or at least an electoral college majority thereof.

Paul Ryan is another story:

The AHCA was announced to furious condemnation by many Tea Party-type Republicans for not completelyeviscerating the ACA, but instead being “ObamaCare light.” Since then, it’s shored up its support on the right in the House, but come under fire [8] from less-doctrinaire Republicans in the Senate without having won back Cruz and Paul. What are the odds that a bill with that kind of opposition can even pass? Maybe not high. It’s possible that this is fine with the Trump administration, and that in fact they would prefer for the bill to fail.

It would normally be strange for a Republican president to want his own party’s majority to suffer a major black eye like that. But this is Ryan’s bill, and Trump has no love for Ryan. Moreover, inasmuch as Bannon is in competition with Ryan-ally and Chief of Staff Reince Priebus for influence over the White House’s agenda, it’s very much in his interest specifically for Ryan to fail [9]. The collapse of the AHCA would be a massive failure — and would likely invite a leadership challenge.

And if it failed quickly, it would be easy for Trump to blame Ryan for getting it wrong, tinker with ObamaCare around the edges (particularly in ways that could be done without even passing legislation), and then when the exchanges don’t collapse claim he fixed them. After all, the same CBO report that said the AHCA would cost 24 million people their insurance said that the much-heralded death spiral isn’t coming all that soon. Trump could yell at a bunch of insurance executives, watch premiums stabilize, and claim victory.

The most exotic possibility is that Trump not only wants the bill to fail and Ryan to take the blame, but that he wouldn’t be too upset to see the Freedom Caucus defanged, opening the door to more creative possibilities. There are certainly people in Trump’s inner circle [10] who see the big problem with ObamaCare as being its support of private insurers, and who would prefer a relatively stingy single-payer plan to either ObamaCare or ObamaCare light. Trump doesn’t have a legislative majority for a reform like that — but maybe after some strategic losses in 2018 he would?

Personally, I think those kinds of hopes are misplaced, and that Trump ultimately just doesn’t care that much about the subject of health care. But it is important to recognize that Trump’s position is far less exposed than Ryan’s is.

This, from my perspective, is the dominant political fact about the Trump presidency. He won by attacking his own party’s leadership. He can’t win again without retaining the support of the Republican base — which means he has to be supportive of any effort to repeal ObamaCare, because the base has demanded that for years. But he will take every opportunity to convince that same base that they should be more loyal to him than to a GOP leadership for which they have already demonstrated mistrust. Which means failures by that leadership can be turned to his advantage. Whereas apart from individual leaders who have their own personal following (as, in their different ways, Cruz and Paul and McCain do), the traditional GOP leadership has a much harder time doing the opposite and triangulating against Trump.

So Ryan’s taking a huge gamble with the AHCA, and he’s taking that gamble because it actually matters to him as a policy priority. Trump is taking a much more modest one.

That’s the way I see it, anyway.

15 Comments (Open | Close)

15 Comments To "The Politics of the AHCA"

#1 Comment By JonF On March 15, 2017 @ 8:11 pm

RE: He can’t win again without retaining the support of the Republican base — which means he has to be supportive of any effort to repeal ObamaCare, because the base has demanded that for years.

The base or the donor class? It’s the latter I think. The working class base may have taught to hate something called “Obamacare”– but they do not want to lose their ACA coverage.

#2 Comment By The Other Eric On March 15, 2017 @ 8:53 pm

While I tend to agree, if Ryan goes down, it will probably include Democrats taking the house. If the Democrats take the house Trump can expect at least as many investigations as the Republicans have done on the Clintons. I cannot imagine him looking forward to that.

#3 Comment By Joe the Plutocrat On March 15, 2017 @ 8:54 pm

“This is the party, after all, that just a few months ago lost the presidency to the most unsuitable, unfit, unappealing major-party candidate in American history, and has spent most of the time since then blaming Russia for its own ineptitude”
First things first. The “blame Russia” argument is more a fabrication or creation of the alt-right/GOP. A de facto false flag operation which actually originates on the right. The profound and “unpresidented” (pun intended) implosion of the Dems, and the as yet undetermined extent of Russian “participation” in the election are mutually exclusive. This is why the word “collusion” is counter-productive. Russians snoop on Americans and Americans snoop on Russians. This is not news. What IS news is; the contact/conversations Manafort, Stone, Flynn, Sessions did or did not have with Russian agents/operative s (and of course and business relationships the 45th POTUS had with Russia). But again, whether or not these ‘relationships’ or Russian ‘hacks’ influenced the election (intended, or not), is, as the saying goes, another kettle of fish.
Which brings us to the essence of this thread. For all his faults (and there are many), this “policy move” will determine of if the 45th POTUS is the Populist/Nationalist he campaigned to be (for better or worse), or just a patsy/Trojan horse who is being manipulated by the very establishment (bureaucracy) he (and Steve Bannon) seeks to “dismantle”.

#4 Comment By Alex (the one that likes Ike) On March 15, 2017 @ 10:20 pm

Quite possible that Trump’s been playing against Ryan all along. Can’t blame him for that.

#5 Comment By CharleyCarp On March 15, 2017 @ 11:16 pm

I’ve been saying for months that if Trump enacts universal single payer, he goes on Mount Rushmore. Unfortunately, he’s too self-deprecating to pursue that course.

I’m not sure exactly what it is that Mr. Linker thinks Democrats should do. Introduce a universal bill and have a press conference and then, what, wait for committee hearings that never come?

Have a press conference every week, that’s never covered by Fox or even anyone else, since the minority can’t make law?

Certainly universal coverage ought to be a 2018 theme. But that’s more than a year away . . .

Unless you count the specials: our Montana democratic nominee is a proponent of universal coverage.

#6 Comment By William Dalton On March 15, 2017 @ 11:32 pm

A Republican Congress put an Obamacare repeal bill on Obama’s desk before he vetoed it. There is no excuse for this Congress to produce at least the same bill to put on Trump’s desk. At least, Republican voters won’t see any excuse. And those who would lose by Obamacare’s repeal were not voting to vote for Trump or Republicans in the first place.

Once the old law is gone, Democrats will have all the incentive they need to agree to something Republicans will be willing to pass to replace it. If not, Republicans will simply busy themselves with repealing more of the regulations which drive up insurance costs and prompted the move to pass Federalized health insurance in the first place.

#7 Comment By Joseph K On March 16, 2017 @ 11:03 am

“Once the old law is gone, Democrats will have all the incentive they need to agree to something Republicans will be willing to pass to replace it.”

So, the Democrats would have a choice between:

A) Devising something acceptable to the Republicans, which means it will do very little, and the Republicans will take credit for whatever benefit it achieves, or

B) Do nothing, let the Republican party trumpet how the Democrats did nothing to support the GOP’s health care initiative, and wait for people to start dying due to lack of coverage. Folks might be a smidge less like to vote Republican when Republican legislation killed Grandma.

#8 Comment By peanut On March 16, 2017 @ 12:05 pm

“A Republican Congress put an Obamacare repeal bill on Obama’s desk before he vetoed it. There is no excuse for this Congress to produce at least the same bill to put on Trump’s desk. At least, Republican voters won’t see any excuse.

Messaging bills are much easier to vote for than bills that might actually get enacted. News at 5.

“And those who would lose by Obamacare’s repeal were not voting to vote for Trump or Republicans in the first place.”

Since the AHCA transfers wealth from Trump voters (older, rural) to Clinton voters (urban, young), I daresay that you are deeply wrong here.

“Once the old law is gone, Democrats will have all the incentive they need to agree to something Republicans will be willing to pass to replace it.”

The thing about the Blazing Saddles strategy of pointing the gun to one’s own head and threatening to pull the trigger is that it doesn’t work in real life.

“If not, Republicans will simply busy themselves with repealing more of the regulations which drive up insurance costs and prompted the move to pass Federalized health insurance in the first place.”

First, the Republicans need Democratic votes to go after regulations. Second, outside the local Ron Paul fans club, federal regulations on insurance are rather popular.

#9 Comment By EliteCommInc. On March 16, 2017 @ 12:22 pm

I have bee reading through this legislation.

it supports via financial aide or tax credits/deductions the killing children in the womb. Whatever doubts I may had at not giving the legislation a fear hearing are removed.

Absolutely not.
are removed.

#10 Comment By collin On March 16, 2017 @ 4:11 pm

I am with Noah as:

1) A relatively quick killing of the bill will have minimal damage by 2018.
2) In reality the nation may continue to be in fairly good shape by 2018 and Trump’s ratings stay in the consistent 40 – 45% range. And the Senate is beyond terrible.
3) The big question for Democrats is: Do we focus on the WWC or the Sun Belt voters? 2018 Midterms are not exactly a choice but we do need to realize the Joe Machin are the reality for WV. Anyway, HRC ran a helluva of a campaign for the 2024 swing states and this will need to be asked in 2020 and the answer is not good. (Although Steve King is making it easier!)
4) I was not a big fan of Sanders but his consistent leadership on healthcare has been amazing.

#11 Comment By JonF On March 16, 2017 @ 4:18 pm

EliteCommInc.

Current insurance laws and regulations do the exact same thing– and have since Roe vs Wade became legal. While I detest this piece of legislation, it does not in any way later the status quo of many years on abortion. (Neither did the ACA)

#12 Comment By EliteCommInc. On March 17, 2017 @ 3:45 pm

“Current insurance laws and regulations do the exact same thing– and have since Roe vs Wade became legal.”

And my position was, is and remains, not a single dime of tax payer funds should be used to, facilitate or support killing/murdering children in the womb.

What a private insurer does with someone else’s private money is another matter.

#13 Comment By EliteCommInc. On March 17, 2017 @ 6:59 pm

“What a private insurer does with someone else’s private money is another matter.”

Not to be taken as any manner of support for killing children in or out of the womb. But my comments are speaking to this legislation, apparently designed by a man who claims that such acts should be verboten.

More than disappointing.

#14 Comment By Alex (the one that likes Ike) On March 18, 2017 @ 3:41 am

I was not a big fan of Sanders but his consistent leadership on healthcare has been amazing.

If Dems keep on barring Sanders-like candidates from getting the nomination, the GOP has already won both 2020 and 2024.

#15 Comment By Bette On March 18, 2017 @ 12:14 pm

Daniel Horowitz is covering this issue at ‘conservative review’ in the best way. There are ways of returning this issue to the private sector with new and creative insurance plans. Republicans and Democrats are to married to special interests to change the paths they are on. They are two patheticly lead political parties. We need a leader to step forward from those ranks (Hey Ted) to clarify the issue until the masses of voters understand what is being done that is continuing to bankrupt this country. Little time is left to convince.