How Washington Handed Trump His First Defeat

Column: Health legislation failed because Republicans put procedure ahead of policy

Trump Oval Office
President Donald Trump, with Vice President Mike Pence and Health and Human Services Secretary Tom Price, pauses as he speaks from the Oval Office / Getty Images
March 24, 2017

President Trump and his advisers ought to study the collapse of the American Health Care Act. It's a case study in how Beltway institutions—the so-called Swamp Trump pledged to drain—can herd a president and his party toward unpopular legislation and political defeat.

Begin with this question: Why the rush to repeal and replace Obamacare? Yes, repealing the law has been a Republican priority since 2010. But Democrats had spent decades laying the groundwork for universal health care before finding themselves in control of the government in 2009. And even then, it took a year for the Affordable Care Act to be signed into law. Republican leadership unveiled a plan and gave the caucus very little time to influence it before calling for a vote. They did so because repealing and replacing Obamacare would give them more leeway to cut tax rates down the line. The legislative schedule determined policy. Not a good idea.

The objective of the American Health Care Act was not to write into law the best possible conservative reform of health care. While I happen to think the bill had plenty of good stuff in it, its main purpose was to overcome a Democratic filibuster in the Senate. That's why the bill failed to overturn Obamacare's regulatory structure: House leadership didn't believe such reforms could pass the watchful eye of the Senate Parliamentarian. And when, late in the process, Senator Mike Lee of Utah suggested that the parliamentarian would allow deregulation in the bill, the situation became even more confusing.

The legislation was unpopular with the House Freedom Caucus and outside conservative groups when another D.C. institution, the Congressional Budget Office, began to scare moderates. The coverage losses predicted by CBO forced Republican congressmen to face up to the fact that universal coverage has never been a goal of the conservative movement or the GOP. The potential blowback from reductions in Medicaid rolls worried Republican legislators from Medicaid-heavy districts while the conservatives from safe seats argued that the bill did not go far enough. The parliamentarian and CBO were a left-right combination that knocked the American Health Care Act to the ground. It never recovered.

President Trump seems determined not to slow down, to move on to other issues such as tax reform. But if the GOP House leadership makes the same mistakes with tax legislation that it did with health care, Washington is likely to defeat Trump a second time. The wiser course of action might be for the Congress to take its time, allow the relevant committees to write legislation with the input of all the various factions, and not to rush to meet some arbitrary August deadline. Don't write laws for the Senate parliamentarian, write them for your constituents. And if the Democrats obstruct these proposals, then be prepared to make the case for them not on procedural grounds but on policy ones.

In his remarks after the bill was pulled from the House floor, President Trump said he's learned from this experience. Anyone who went from punchline to president in a little over a year is a quick study. Conservatives and Republicans hope that what he took away from this experience is not to rush, to let the committees do their work, and to keep the denizens of Trump country foremost in his mind.