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.