Opinion

Opinion: What the Vote on Health Care Means — Republicans Now Own It

Even low-information voters know that the GOP controls the levers of government

Speaker Paul D. Ryan and House Republicans passed an ungainly piece of legislation that will deprive maybe 20 million Americans of health care, Walter Shapiro writes. (Mark Wilson/Getty Images)

Now that the buses have returned from the White House victory-lap rally and House Republicans have headed home for what undoubtedly will be ticker-tape parades, it is time to step back from the partisan talking points to try to realistically gauge the meaning of Thursday’s health care vote.

It is no exaggeration to say that Thursday may have been Paul Ryan’s best day in politics since he was named Mitt Romney’s running mate in 2012. Especially since being elected House speaker brought Ryan so many heartaches and headaches that it doesn’t count.

But this is also grading the speaker on a steep curve.

Put another way, Ryan and the House Republicans passed on the third try by a two-vote margin an ungainly piece of legislation that will deprive maybe 20 million Americans of health care. Even though the GOP has been running against Obamacare for more than six years, the only hope for the new bill is if Senate Republicans perform a feat of legislative alchemy akin to turning a lead balloon into a golden coach.

She’ll be back

Meanwhile, Democrats have been celebrating as if the House vote all but guarantees that Nancy Pelosi will again be wielding the gavel as House speaker in 2019.

The House GOP leadership, in their Donald Trump-fueled desperation to pass anything that could qualify as “repeal and replace,” helped lift Democratic hopes. By rewriting the legislation to the specifications of the hard-right Freedom Caucus, Ryan and Company acted as if moderate conservatives were expendable. Small wonder that 15 desperate members of the center-right Tuesday Group voted “no” on a bill that could imperil coverage for those with pre-existing conditions.

No matter what your ideological persuasion, if you have been in politics since breakfast this morning, you are experienced enough to envision the Democratic paint-by-numbers 2018 attack ads. A heart-tugging story of the struggle to get health coverage with a pre-existing condition before the passage of Obamacare slides easily into the framework of a 30-second TV spot.

Now for a bit of pundit heresy: It is impossible right now to predict with certainty how anything will play in the November 2018 congressional elections.

The Trump presidency is too volatile — and the voter mood too sour — for glib forecasts about what will motivate voters in 18 months. Opinion-mongers should also feel a little humility after the 2016 elections. Recall the widespread certainty at this point in 2015 that the GOP primary race would come down to a battle between Jeb Bush and Marco Rubio with perhaps Ted Cruz or Scott Walker as long-shots.

So looking toward 2018, maybe the House GOP leadership was right in calculating that the most disastrous political course would have been failing to send a bill to the Senate. Or maybe the Senate bill will be so wondrous that a wave of amnesia will erase the House legislation from political memory. Or maybe 2018 is shaping up to be such a Democratic wave election that nothing matters — and Republicans in districts that Hillary Clinton carried were doomed anyway.

What we do know for sure, though, is that Senate Republicans will be responding to far different political cues than their counterparts in the House. With only two potentially vulnerable GOP incumbents on the ballot in 2018 (Dean Heller and Jeff Flake), Senate Republicans do not have to worry about the impatience from the Trump White House or obsessing over their bygone promises to repeal Obamacare.

Is that paint drying?

Those who equate the legislative process with an action-adventure movie featuring an explosion every 45 seconds are apt to be disappointed with the Senate’s approach to health care. For the next few months, Senate Republicans have an opportunity to rewrite the House bill virtually from scratch to increase subsidy levels, safeguard much of the Obamacare Medicaid expansion and deal compassionately with pre-existing conditions.

There is no guarantee that Mitch McConnell can pull this off or even really craves a kinder, gentler version of the House bill. But the Senate represents the last opportunity for serious Republicans to demonstrate that they have a better way than Obamacare to provide affordable health-care coverage to the uninsured and the under-insured.

Thursday’s House vote represented a historic moment — Trump and the Republicans now own the American health-care system.

Sure, the White House can still loudly claim, as it did in a Thursday press release, “OBAMACARE IS COLLAPSING: Across the country, Obamacare is failing the American people, delivering high costs, few options and broken promises.”

But whatever happens from here, the blame (or, possibly, the praise) rests with our reality-show president and his loyal acolytes in Congress.

If Trump gets a real White House signing ceremony this fall or early in 2018, then voters can judge whether they are better off than they were with Obamacare. And if the Republicans fail to fix the problems with Obamacare, even low-information voters will know that the GOP controls the levers of government and refused to act.

Everything may work out for the Republicans, as Washington becomes a land of rainbows and lollipops. Or else the GOP may start angrily searching for the political consultant who came up that pious promise “to repeal and replace” Obamacare.

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