Published March 22, 2017
Mark Trahant / Trahant Reports
President Donald J. Trump makes a pitch to Republicans who are reluctant votes for the speaker’s Affordable Care Act replacement. The House vote is scheduled for Thursday. (Photo via Speaker Paul Ryan’s official page.)
It’s hard to think of a more make or break moment for the Speaker of the House of Representatives than what happens over the next two days. Well, sort of.
The Speaker needs 216 votes to move his health care reform proposal on to the Senate. If he loses, then Paul Ryan will have a difficult time rounding up the votes for the next tough vote (which is supposed to be tax reform).
And, if he wins, that’s the odd part. Then the bill moves to the Senate where the most likely outcome is a major rewrite. And if that works, then it’s back to the House where the same division between conservatives and leadership surface again. In the Republican Party there are three factions: Conservatives, Moderates, and those who fit into either camp but yet are inclined to support leadership. (That would be the majority of members in both the House and Senate).
I think I’ve told this story before, but here goes again, many years ago when I was at The Seattle Post-Intelligencer we had an editorial board meeting with Rep. Jim McDermott. A tough vote was coming up in the House about the war in Iraq. We knew where McDermott stood. His inclination would be to vote no. But, he told us, “I will not do that to my speaker.” A “no” would have undermined Nancy Pelosi.
That’s not the way Congress works now. House conservatives do not fear the consequences of voting against their speaker (even though in the past it’s resulted in loss of committee assignments and the perks). The thing is that they represent districts that are not competitive. So there is little the speaker can do to punish them. (This is not new. These are exactly the same dynamics that resulted in the end of John Boehner’s speakership.)
So the leadership challenge over the next two days is to make sure there are 216 votes to pass the American Health Care Act (after making minor changes). There are only three options: Make sure the votes are there. Pull the bill back and rewrite it again. Or, least likely, lose the vote and use that as a mechanism to try and punish the members who would not play along.
President Trump has his reputation (such that it is) on the line, too. He went to Capitol Hill trying to close the deal. According to Politico: “Trump entered the meeting to loud cheers. ‘We have a chance to do something fantastic, to do something amazing,’ Trump told the lawmakers, according to sources in the room. He later added: ‘Many of you came in on the pledge to repeal and replace Obamacare. I honestly think many of you will lose your seats in 2018 if you don’t get this done.’ ”
Once again, though, the polls show a different story. “A strong plurality of voters think congressional Republicans are moving too quickly to overhaul the nation’s health care system,” according to a new Morning Consult/POLITICO poll. This is the big reveal: The poll shows that Obamacare is more popular than the GOP alternative.
This is not a prescription for winning the next election.
It makes it easier for any member of Congress who votes no to tell voters that they stuck up for their interests, instead of following the speaker’s command.
Today the president will meet with the Congressional Black Caucus. He’s likely to make the case there, too. But Trump will have a tough time getting any votes from Democrats unless this health care bill changes into something quite different. The more I read about the legislation, and the review by the Congressional Budget Office, it’s clear that this bill is more of a Medicaid repeal than a repeal of the Affordable Care Act. That’s where most of the “savings” in the bill is found.
There is a notion in the Republican reform, one that I find deeply troubling, that Medicaid is only another word for welfare. In this logic, people who are “able-bodied” are only gaming the system when they have this insurance. Nonsense. Health care is health care. Period. I think we should be expanding access to basic insurance, and Medicaid is a cost-effective program that works. (A tack I took in a recent piece for Yes! Magazine.) I’d like to see Medicaid expanded, perhaps to 300 percent of the federal poverty level.
Again, back to my Seattle days. We had an editorial board meeting on health care reform and at that time the single largest source of Medicaid “customers” was people who worked at Wal-Mart. Fact is they had access to health insurance but could not afford it. And their incomes were so low that they qualified for Medicaid.
An increase in Medicaid eligibility would be a huge gain for Indian Country. That 300 percent number I cited would cover most of the people who use the Indian Health System. If you then add the people who have employer-based insurance, I would bet you would be awfully close to universal coverage. And that ought to be the goal. (Working or not.)
Of course the House plan goes in the other direction. The New York Times reported today that this bill is so bad that even a straight up repeal of the Affordable Care Act would be better. “Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report,” The Times said. “In other words, one million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.”
That little nugget is not going to help the Speaker reach 216 votes on Thursday. If there is a vote.
Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports