Here’s why House moderates voted for a more unpopular, right-wing version of a bill that was too unpopular and right-wing for them just weeks ago.
In March, House Republicans tried to pass a health-care bill that slashed Medicaid by $880 billion to finance a tax cut for the rich; radically increased the cost of insurance for old people in rural America (a.k.a., the Republican base) , so as to make it slightly cheaper for upper-middle-class young people in cities (a.k.a., the Democratic base) ; and established a system of subsidies for insurance so poorly designed it would have actually left more people uninsured than if you eliminated the entire Medicaid expansion — and every other part of Obamacare — and replaced it with nothing at all .
These ideas proved so unpopular with non-millionaire voters and health-care-industry stakeholders that the House’s GOP moderate wing had enough votes to kill the bill, even without the help of the Freedom Caucus conservative purists for whom it wasn’ t punitive enough.
Six weeks later, House Republicans tweaked their bill to allow states to waive the requirement that health insurers cover preexisting conditions and put a fig-leaf amount of backup funding over the massive increase in health-care costs for, say, nonaffluent cancer patients that would ensue. The bill’s most regressive aspects were left almost entirely in place. And on Thursday, Trumpcare passed the House with a vote to spare.
Here are seven reasons Republicans were able to make that happen.
1. Donald Trump made Reince Priebus’s life a living hell.
The president is not an artful deal-maker. Trump lacks a remedial understanding of health-care policy, legislative procedure, or the ideological disputes within his own party. He is also a deeply lazy man whose favorite (only?) negotiating tactic is to make extraordinary ultimatums — and then back down at the first sign of resistance.
It’s not surprising then that GOP insiders are (anonymously) downplaying Trump’s role in yesterday’s victory. And it’s true that Trump contributed far less to yesterday’s win than did a handful of key players in Congress. But it’s still hard to dismiss the notion that the House vote was, in part, a triumph of Trump’s will. The president may not be invested in the details of health-care reform. But he is deeply invested in being perceived as a winner. So, when Trumpcare’s failure produced a flood of headlines suggesting the very opposite, Trump’s wounded ego took out its rage on the White House chief of staff.
Trump took to mocking Reince Priebus for his “too-cozy” relationship with Speaker Paul Ryan, “merging the two men’s names into one long ‘Ryan-ce,’ ” and reminding Reince of his health-care failure whenever the obsessive-compulsive Wisconsinite stood idle, as the New York Times reports:
Priebus responded to this bullying — and the omnipresent murmurs than another health-care failure would be his doom — by ringing House Republicans’ phones with all the manic persistence of a newly jilted ex-lover. Politico offers details on Ryan-ce’s relentlessness.
House GOP sources were eager to paint Priebus’s efforts as irrelevant or counterproductive. But given the myriad reasons to believe that Trumpcare was better off dead — not least the immense liability the bill’s revival posed to vulnerable Republican House members — Priebus’s drive to save his own job by any means necessary probably played a part in forcing Thursday’s vote.
2. Tom MacArthur decided to spend his beach vacation helping the far right produce a politically tenable plan to make health-care unaffordable for people with preexisting conditions.
Trumpcare’s revival began with negotiations between Mark Meadows of the Freedom Caucus and Tom MacArthur of the moderate Tuesday Group. The purpose of these talks was difficult for outside observers to comprehend. After all, Trumpcare had been too moderate for Meadows’s team and too right-wing for MacArthur’s. There simply was not any happy middle ground between their two positions.
But what outside observers missed was that the Tuesday Group was, itself, a bunch of outside observers. Acting against the wishes of the moderates he ostensibly represented, MacArthur helped the House’s reactionaries make their deeply unpopular plans more politically tenable through the magic of federalism — and then allowed them to brand the resulting proposal as a magnanimous compromise.
The day after Trumpcare failed, MacArthur “couldn’ t stop thinking about how close conservatives and GOP leaders had come to an agreement at a late-night meeting with Vice President Mike Pence a few days earlier, ” according to Politico .
And so, during a beach vacation with his family over the Easter recess, MacArthur sketched out a plan to allow states to choose to nullify two of Obamacare’s most popular provisions — protections for people with preexisting conditions, and regulations requiring all health insurers to cover a set of basic services, including mental-health and maternity care.
The resulting amendment did not make the health-care bill any more appealing to moderates. But the fact that it was drafted by a self-identified centrist made it more politically difficult for the House’s other “squishes” to maintain the courage of their convictions.
3. Fred Upton got moderates the Michigan Morsel.
If only one self-styled “reasonable Republican” agreed to put lipstick on the far-right’s pig, that swine might still have been slaughtered. MacArthur’s amendment may have marginalized the other moderates, but as of early this week, the Tuesday Group seemed more in the mood for excommunicating its turncoat than accepting Trumpcare 2.0.
And then Fred Upton debuted the year’s most effective bit of political theater. The Michigan representative was known as a reliable vote for the GOP’s leadership — one who had been instrumental in getting the original health-care bill out of committee. So, when Upton declared his opposition to the new bill Tuesday morning, Trumpcare was once again pronounced dead.
But this climactic crisis only served to heighten the catharsis of the House GOP’s happy ending. On Wednesday morning, the president and Upton agreed on a game-changing compromise: The new bill would set aside $8 billion — over five years — to fund high-risk pools for people with preexisting conditions in states that opted to abolish their protections.
As with the MacArthur Amendment, this proposal didn’ t actually offer moderates anything of substance. The conservative American Enterprise Institute estimates that such high-risk pools can only be maintained with outlays of $15 to $20 billion a year. And the bill already included a $130 billion slush fund for states to use to ameliorate various problems the legislation might create.
But if the Michigan Morsel changed nothing substantively, it did change things politically, creating a sense of “momentum” that House moderates proved ill-equipped to resist.
4. Mike Pence has credibility with the Koch brothers.
One of the many obstacles to Trumpcare’s passage in March was the opposition of conservative outside groups. The White House may not have won over any of the health-care sector’s actual stakeholders, but the vice-president was able to sell the new bill to the far-right-funding billionaires.
