Health Care

The Meaning of the G.O.P.’s Health-Care Fiasco

Illustration by Tom Bachtell

Anyone still inclined to pity the Senate Republicans might pause to examine Donald Trump’s taunting of them, at a meeting last Wednesday at the White House, for their failure to blow up the American health-care system. A range of Trump’s traits were on display: lying (he wildly misrepresented the terms of the most recent Senate bill); an obsession with betrayal (he complained that senators who were his friends “might not be very much longer”); hinting at retribution (he said of Dean Heller, who had helped stall an earlier version of the bill, “He wants to remain a senator, doesn’t he?”); and inconsistency (he can’t seem to decide whether he wants to replace the bill or just repeal it). The one plausible notion Trump presented at the meeting was that, under President Obama, congressional Republicans had “an easy route: we’ll repeal, we’ll replace, and he’s never going to sign it.” Trump added, “But I’m signing it.” In other words, Trump had turned the Republicans into people with a real job—a hard job—and revealed their inability to perform it.

Yet, at the meeting, when Trump said that Obamacare is “gone, it’s failed—it’s not going to be around,” he was just repeating what Senate Majority Leader Mitch McConnell and his colleagues have said any number of times. The bill got as far as it has in the Senate the same way that a similar one was passed in the House, with lies told in public and callousness dealt in private. Republican legislators peddled conspiracy theories about Obamacare being part of a scheme to strip Americans of their freedoms. The Senate version was drafted in secret and reflected an almost complete indifference to the needs of any Americans, really, apart from the wealthiest. McConnell, for his part, greeted Trump’s White House rant as a welcome act of statesmanship, portraying the President as a latter-day Lyndon Johnson “totally engaged,” behind the scenes, in the effort to round up votes.

In acting as though the bill still has a chance, McConnell may be undertaking another Trump-like maneuver: reducing matters of state to the level of farce. The Republicans have fifty-two Senate seats—fifty-one, for the moment, given the absence of John McCain, who last week received a diagnosis of brain cancer. This means that, with Vice-President Mike Pence as a tiebreaker, McConnell can lose only one vote. Every configuration of the bill so far has been unacceptable to more than one senator, for reasons both good and bad.

As the senators skittered between plans that would result in the loss of insurance coverage for as many as twenty-two or maybe thirty-two million Americans, some of them, including Heller and Susan Collins, expressed genuine concern about the devastating effect the bill would have on their constituents. Others, notably Jerry Moran, Rand Paul, and Mike Lee, insisted that the bill didn’t do enough to scrub Obamacare, and much of the Medicaid system, from the landscape. The damage that a repeal-without-replace plan would inflict was too much for Collins, Shelley Moore Capito, and Lisa Murkowski, who said that they would vote against bringing any such bill to the floor. For that, they were called traitors to their party, and threatened with primary challengers. Meanwhile, Ted Cruz slipped in an amendment that made the bill even worse, by opening a door to “junk” insurance plans and exorbitant premiums for people with preëxisting conditions.

All of this might suggest either that the G.O.P. was a party stumbling away in shame from a self-inflicted defeat or one that was narrowly saved by the obstinacy of a few of its members, who prevented it from doing something truly harmful to the lives of Americans. But to say that the divisions in the Republican caucus represent a coherent ideological debate between well-defined factions—business, populist, Freedom Caucus, libertarian—would be to assign to the process a dignity it doesn’t merit. The Republican leadership’s argument of last resort, when whipping votes, has been that the Party has to do something dramatic about Obamacare simply because, for the past seven years, it has said that it would. That is an explanation of a quagmire, not a call to arms. Capito, in defending her dissent, said, “I did not come to Washington to hurt people,” but it is far from clear what the Republicans did come to Congress to do. No one seems to have had an Obamacare-replacement plan at hand that makes even mathematical sense.

Still, McConnell has said that he will delay the Senate’s August recess, if necessary, to try for another vote on something: repeal, replace, or a thrown-together bill to be named later; his zigzagging mirrors that of the President. If this attempt fails, the backup plan seems to be to turn the matter over to the executive branch and let it commit whatever acts of regulatory, budgetary, and administrative vandalism it can, to break the system bit by bit. For example, it could withhold crucial cost-sharing subsidies, or decline to defend Obamacare against various lawsuits that its opponents, including the House Republicans, have brought against it. Uncertainty on such points is a major reason that some of the Obamacare exchanges are in a state of disarray. As with the primaries last year, the Party, with no center or true direction, may end up just leaving it to Trump.

The final drive to pass the bill will be another measure of how Trumpist the G.O.P. has become—and more tests of its character are on the way. This week, Donald Trump, Jr., will testify before the Senate Judiciary Committee about his meeting with various Russians; Jared Kushner, the President’s son-in-law, will appear before the Senate Intelligence Committee, though in closed session. The Republicans will have to decide how they will conduct those hearings and whether they are willing to insure that the investigation into Russia’s involvement in the Presidential election remains intact.

That question, too, just became more difficult. On the same day that Trump chastised the senators, he also humiliated one of their former colleagues, Attorney General Jeff Sessions, by saying, in an interview with the Times, that he would never have chosen Sessions if he’d known that he would recuse himself from the proceedings. Trump also seemed to confirm reports that his lawyers are investigating Robert Mueller, the special counsel on the case, in a search for excuses to get rid of him.

At this point, it will look like negligence if the Republicans don’t have a plan for what they will do if the President pushes Sessions out or orders the firing of Mueller. According to the Washington Post, Trump has asked his lawyers about the extent of his power to pardon his associates and family members, which would also serve to scuttle the investigation. He reportedly even asked about pardoning himself. The Senate Republicans may be wishing they had that option, too. ♦


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