Analysis: Should Republicans Slow Down and Not 'Rush' Their Healthcare Bill? It's Not That Simple.

Posted: Mar 09, 2017 10:30 AM

Go read Allahpundit's post on this, which essentially endorses Sen. Cotton's reasoning in a recent MSNBC interview as "insuperable" -- even as he acknowledges certain salient counterpoints.  Their message, stated succinctly: "If you’re taking on a project as momentous as reforming the U.S. health-care system, it’s more important to do it right than to do it fast." From a policy perspective, that's undoubtedly true. Railroading through bad legislation just for the sake of passing something, especially just to check a political box (albeit a big one), is inarguably inadvisable. But I'd contend that the wisdom of Republicans falling back on the "slow down" argument now isn't nearly as cut-and-dried as it may seem.  I'll get to my points below, but first, here's Cotton on Morning Joe:

“This is a big issue. This is not like the latest spending bill that gets released on a Monday night, [passed] on Wednesday and everybody goes home for Christmas, and we live with it for nine months...We’re going to live with health care reform that we pass forever, or until it’s changed in the far distant future. So I don’t think we need to introduce legislation on Monday and have one chance to amend it on Wednesday. I would much sooner get health care reform right than get it fast."

Four points, the last of which is procedurally imperative: (1) First and foremost (and, to his credit, AP prominently mentions this in his piece), Republicans have had seven years to formulate and rally around an Obamacare replacement package. To finally produce a long-awaited document, then turn around, shrug, and ask for a lot more time because you still can't get on the same page is embarrassing. It undermines confidence in the party's seriousness and capacity to govern.  Senior House officials also emphasize that this process has by no means rushed through, and that the content of the plan was not suddenly sprung on members.  The major pillars of the new proposal were posted online in June of 2016 as part of the House's "A Better Way" agenda; the conference has also consistently been kept up to date on the legislative drafting process, in great detail, ever since Trump won.  Plus, let's face it, the ideological cross-pressures among Congressional Republicans are extremely well-known by this point, as are the tactics of various factions that influence the process. Why should skeptical voters believe that these challenges would be resolved or overcome six months or a year from now?  That's why President Trump and House leaders appear to be on the same page, at least for the moment: The introduced framework is the heart of any viable plan with a chance at passage. Elements might get tweaked, and deals can be made to help build a broader consensus -- and I'm absolutely in favor of that, incidentally -- but going back to square one after so many months of work and consultations isn't an option. In fact, Trump himself reportedly made that point explicit in a meeting with conservative members earlier in the week: "We cannot toss this out and start all over. We are too far down the road for that," he said.

(2) There's another component to the politically-driven time pressures that AP rightly raises -- namely, the risk of pushing what will inevitably be a tough vote on a tough issue ever closer to an election. If some Republicans, especially the moderates, are queasy enough about the existing proposal as to air their concerns very publicly in March of an off-year, what are the chances that they'll be willing to edge out onto a limb and take a big vote many months closer to election day?  And let's say those squeaky-wheel centrists were to be placated with goodies or assurances, wouldn't the concessions they win only drive critical conservatives further away from voting 'yes' (and vice versa)?  To be fair to Cotton, it's not at all clear that he's calling for a lengthy delay here, only that he fears things are moving "a little" too hastily.  And despite cautioning against dropping a bill on a Monday and having "one change to amend it on Wednesday," the Senator rightly acknowledges later in his answer that the legislative process does not and will not work that way on this bill.  In fact, due to Senate rules on budgetary measures like a reconciliation package, Senators would be allowed to introduce an unlimited number of amendments to this bill (a so-called "vote-a-rama"), if it makes it to the floor.

(3) If there were a silver bullet that would be guaranteed to work perfectly while satisfying all the disparate elements of the party, Republicans would all be toasting each other's genius as they rapidly passed the bill in lockstep solidarity. The truth is that the public has a greater appetite for federal intervention and spending than many of us would like to admit, and Obamacare has set a baseline expectation of more federal help than was previously the case.  One doesn't need to like this reality to at least recognize it.  Therefore, rescinding as much of Democrats' failing program as possible will require trade-offs.  Such legislation must offer a better and more affordable alternative that is significantly more market- and state-driven than Obamacare is, but it also needs to provide sufficient protections and assistance as to satisfy members from moderate states and districts. And yes, of course there's a risk that Republican efforts to undo and replace the Obamacare Frankenstein will miss the mark in ways that could create a political backlash.  That's possible, and it should go without saying that crafting sound policy and not over-promising are political best practices. But the biggest difference between what the GOP is embarking upon now and Democrats' (extremely dishonest) Obamacare push is that Republicans have specifically and ostentatiously campaigned on uprooting the sputtering law over the course four national elections, winning three of them. If they squabble and punt when finally presented with the chance supplant some of Obamacare's worst failures with at least some of their own ideas, then what is the point of winning elections?  The fear that "maybe it won't work" is inherent in any new program that is passed; Republicans either have confidence that their ideas are better than Obamacare, or they don't. And if they don't, they've taken their voters for a ride.  Which would be unforgivable.

(4) Last but not least, there's another crucially important legislative factor at play here: Reconciliation sequencing.  Together with the White House, Republican leaders decided ahead of the president's inauguration that they would seek two major policy initiatives in 2017, each exploiting "reconciliation" (to deny Democrats a chance to filibuster) and therefore necessitating a complex sequence of maneuvers to get those legislative ducks in a row.  To heavily delay the first priority -- and keep in mind that mechanisms have already been set into motion to achieve that agreed-upon first goal -- would throw the entire plan off, and potentially imperil both major pieces (Obamacare and tax reform) of Trump's early agenda.  Calendar year 2017 is uniquely valuable in those pursuits because Republicans have two budget resolutions to work with, and thus two bites at the reconciliation apple.  They've assigned the first one to healthcare, and the second to tax reform.  The 'repeal and replace' reconciliation instructions (now in place) apply only to the FY 2017 budget package.  I'm told that skipping ahead to tax reform due to a healthcare stalemate would shift business onto the FY 2018 package, foregoing the "bonus" reconciliation opportunity this calendar year.  'Repeal and replace' (or tax reform) may therefore get pushed into next year (an election year), and the FY 2019 budget.  One might argue that pushing one big agenda item or the other into next year isn't the end of the world, but it would unquestionably be a missed opportunity.  And counting on any group of politicians to make big, bold moves in an election year is a...questionable proposition.

I should also add that top GOP aides tell me that Sen. McConnell has informed Speaker Ryan that the Senate leadership strongly prefers to get healthcare done by April recess, in order to protect their planned floor schedule (including the Gorsuch confirmation) for the remainder of the year.  The timing here is especially sensitive because Senate Democrats are using minority prerogatives to slow-walk much of the Republicans' agenda.  In other words, the healthcare bill getting pushed much further back on the calendar would derail carefully-choreographed plans that Republican leaders in each chamber have established in the interests of taking efficient and consequential advantage of the united government voters have given them.  If history is any guide, such arrangements rarely last very long.  Relatedly, if the public starts to lose confidence that one or both of these reforms will actually get accomplished (remember, GOP in-fighting is also an issue on tax reform), that could also have significant political and economic ramifications.  

Bottom line: An indefinite delay on resolving the Obamacare situation would throw a very disruptive wrench into a carefully-plotted legislative timeline (and all the moving parts that entails), and also undermine confidence in the president's ability to follow through on his word and implement his legislative agenda.  There's a reason why Trump is flexing his political muscles on behalf of the plan he and his HHS Secretary have endorsed.  The last thing Republicans at either end of Pennsylvania need are perceived crises of confidence and competence -- either among their base, or among independents who have helped sweep the party into power over the last eight years.  Trump and GOP leaders are right to offer ample opportunities for amendments and suggested improvements to the legislation.  This bill shouldn't be needlessly jammed down on an error-prone, accelerated timeline.  Worthwhile changes should be considered and given a fair hearing.  But the window for action is now.  If Republicans from across the center-right spectrum don't respect the need for fairly urgent and united action, that window will close, and Obamacare will be here to stay.  That would be a disaster for the millions of Americans being harmed by the collapsing law, and it would be a lasting political black eye to the entire Republican Party.

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