Much of the commentary following the disastrous failure of “TrumpCare” focuses on the role of the ideological fissures in the Republican Party, the failure of Paul Ryan to understand the dynamics of his caucus, or the lack of policy expertise of Trump and the White house.
All of these factors played a minor role, but they ignore the three truly important factors that made it impossible for the GOP to cram “TrumpCare” – or “RyanCare” – or ACA “repeal and replace” — down the throats of Congress and the American people.
Factor #1. First and foremost, their bill was politically toxic. Before the vote, the Quinnipiac Poll found it was opposed by 56% of the voters and supported by only 17%. People didn’t just find it distasteful. It became politically radioactive. Politico reported that:
…when voters are told their Republican member of Congress supports the plan, they move from approving of their congressperson by 12 points (46% approve, 34% disapprove) to disapproving by 21 points (35% approve, 56% disapprove) – a net shift of 33 percentage points. The voters also move from saying they would reelect their congressman, 44-38, to saying they will elect a Democratic challenger, 45-38. That is a net 13-point swing away from the Republicans in the vote for Congress.
If “TrumpCare” had been popular, the supposed “divisions” in the GOP wouldn’t have mattered at all. Everyone would have lined up, saluted, and supported their party’s leader in the White House.
Why was the bill so unpopular? First and foremost it’s because most people hate the underlying Republican philosophy pertaining to health care. And they hate it for good reason: it doesn’t work.
We tried the GOP philosophy of allowing the “competitive” market to provide the “most wonderful health care plan in the world” and it produced a system that resulted in per person health care costs twice as high as the rest of the industrial world and outcomes that were worse. That was the world of pre-ACA health care.
The “unfettered market” allowed insurance companies to discriminate against people with pre-existing conditions – and to define one of those “pre-existing conditions” as simply being a woman. It allowed them to enforce lifetime caps on coverage – so if you got really sick you were simply out of luck.
Recall that the pre-“ObamaCare” world priced the old and sick out of the market, and allowed insurance companies to sell policies that covered so little that they weren’t really true insurance policies at all. Health costs became the chief cause of personal bankruptcy, and number of people who were uninsured skyrocketed.
When the ACA or “ObamaCare” passed, the GOP spent billions of dollars tarnishing the “ObamaCare” brand. So the brand itself became mildly unpopular. And they made it an emblem of Obama’s supposed dictatorial overreach and “big government” rallying cry for their base.
It turns out that ordinary people get much angrier if someone wants to take away something they have, than they do when they are denied something to which they aspire.
But most Americans really do consider access to health care a right: not just access to buy insurance if you can afford it, but real access to real health care.
As a result, people always liked the actual contents of “ObamaCare” – and the law directly benefited many in the GOP base who didn’t like the brand.
So the moment Donald Trump’s election allowed the GOP to credibly threaten to actually take those benefits away, and people began to connect the benefits with the brand, the brand itself also became popular. And ordinary people got really furious that the Republicans were trying to take their personal health care benefits away.
The CBO Report laid bare the true effect of “TrumpCare” – taking health care from 24 million Americans to give a tax cut of $600 billion to the wealthy. That pretty much put the final nails in the coffin of “TrumpCare”. Meanwhile the bill was also going to defund Planned Parenthood – one of the most popular organizations in the country.
It turns out that ordinary people get much angrier if someone wants to take away something they have, than they do when they are denied something to which they aspire. That’s especially true if the motive is to benefit a tiny fraction of the richest, most powerful people in the country. The GOP got a taste of that fury.
Factor #2. That brings us to factor two: The Resistance.
Trump’s election spawned the greatest upsurge of progressive mobilization in the last fifty years. People turned out in droves – to the Women’s March and other protests, and to scores of Republican Town meetings.
They formed new organizations like Indivisible and the Town hall Project. They swelled the ranks of older organizations like MoveOn, Organizing for Action (OFA), Planned Parenthood, People for the American Way, Ultraviolet, and People’s Action. Together these groups joined with unions, community organizations, immigrant’s rights organizations, the Center for American Progress (CAP), the Center for Popular Democracy, the Democratic National Committee, and with a multitude of social media sites to coordinate their efforts. Add to the mix the revival of the coalitions that had originally passed the Affordable Care Act – Health Care for America Now (HCAN) and Save Our Care.
Together these organizations created a title wave of palpable opposition to “TrumpCare”. Thousands turned out to Republican Town Hall meetings to demand that the GOP drop its efforts to “take away our health care”. They had “stake outs” at Congressional offices. They marched through the Capitol. They sat in Congressional offices. And they generated literally hundreds of thousands of calls to Congress – targeting their calls especially to the most politically vulnerable GOP Members.
The last day of the battle, they virtually shut down the incoming phone lines in the offices of GOP Members whose votes were in play.
That real, intense, up-close-and-personal stuff made it perfectly clear to [members of Congress] that voting for the “TrumpCare” bill could mean political suicide.
So GOP Members of Congress weren’t just seeing analyses from staff, or reading editorials or looking at poll numbers. They were forced to look thousands of their constituents in the eye. They were forced to watch the local news coverage of confrontations between themselves and voters who were explaining how “ObamaCare” had saved their lives – and others who were desperately afraid that “TrumpCare” would cost them their financial security, or cause them to be unable to take their cancer drug.
That real, intense, up-close-and-personal stuff made it perfectly clear to many of them that voting for the “TrumpCare” bill could mean political suicide. Whether they explained their position in terms of their commitment to conservative ideology, or compassion and concern didn’t matter. They refused to be dragged into supporting a bill that – like a dead fish – smelled worse every day it sat on the political dock. They put their hand on the stove and it was very hot. Nothing any leader or negotiator could do was going to change their personal observation of the bill’s unpopularity – no matter what faction of the House GOP they called home.
Factor #3. Third, Donald Trump was right about one thing: Democrats were partially to “blame” for “TrumpCare’s” defeat. They get a big share of the credit for its demise because they directly aligned themselves with the Resistance and their own voters. They stood up straight and said no way, no how. House Democratic Leader Nancy Pelosi and Senate Leader Chuck Schumer were magnificent.
And Democrats were unified. Democrats joined arms and stood up together. For instance, many of the Members of the Senate who are sometimes most prone to vote with Republicans were not tempted at all on “TrumpCare.” Just try cutting Medicaid in West Virginia – a state that has one of the highest rates of usage of Medicaid in the country. If you were the Senator from North Dakota, why in the world would you want to vote to support a bill that would penalize the oldest and most rural consumers? North Dakota is after all, one of the oldest most rural states.
Democrats joined arms and stood up together. For instance, many of the Members of the Senate who are sometimes most prone to vote with Republicans were not tempted at all on “TrumpCare.”
It was that Democratic unity that forced Ryan and Trump to negotiate with the so-called “Freedom Caucus” in the first place. They couldn’t afford to loose more than 22 votes in the House since they would get zero votes from Democrats. And in the Senate they only had a margin of three – they could have lost a dozen.
There are definitely some problems with the ACA. Most importantly some individual insurance market places only have one major insurance company offering plans. No competition, means higher rates and deductibles.
But there is a simple solution. Just create a Public Option – make available Medicare to anyone who wants to buy into the plan and let that plan compete against the private insurance companies. That would drive down rates in a second, since Medicare is the most efficient health insurer in the country. Of course some private insurance companies say that would be “unfair” competition since Medicare has such a huge enrollment base it’s overhead is very low – and it doesn’t have to pay profits to Wall Street.
Of course many people think that’s why it would make sense for everyone in America to be covered by Medicare and to do away with private insurance companies entirely, except for “Medicare Supplemental policies”, since that would really drive down the costs of health insurance. That’s especially true if Medicare could negotiate with drug companies to lower prices like they can in the rest of the industrial world.
So in summary, let’s be clear that once the Resistance Movement organized, and Democrats took a hard line, “TrumpCare” was likely a doomed effort from day one. No amount of clever coalition building by Ryan, or brilliant “negotiating” by Trump would ultimately have won the day. That, by the way, is how out of touch many of the beltway pundits are who blathered on about how inevitable it was that the ACA would be repealed. They need to get out more.
And if by some miracle, “TrumpCare” had actually passed the House and Senate and become law, it could easily have sunk any hope the GOP has of hanging onto the House in 2018. If progressives to our job right over the next year and a half, it still will.