Opinion: A GOP Guide to Running for Cover on Health Care

Three ways to overcome troubling diagnosis from the CBO

Cheered on by President Donald Trump, it was easy for House Republicans to believe that the CBO would find that their health care bill provided quality affordable health insurance for every single American while saving the Treasury trillions of dollars,  Walter Shapiro writes. (Mark Wilson/Getty Images file photo)

Long ago (that is, back in the days when James Comey was still FBI director), House Republicans rushed their health care bill through by a two-vote margin without waiting for the verdict of the Congressional Budget Office. That early May, haste was understandable since the victorious House Republicans were due at the White House for an Oval Office celebration of a bill that (“Whoops, we forgot about the Senate”) had not actually become a law.

There appeared to be no need for House Republicans to fret about the CBO score since, after all, Donald Trump had already promised in a tweet that “healthcare is coming along great … and it will end in a beautiful picture!” So it was easy for GOP legislators to imagine that the nonpartisan experts at the CBO would find that their bill provided quality affordable health insurance for every single American while saving the Treasury trillions of dollars.

Instead, what the CBO offered late Wednesday afternoon was a bitter pill, harsh medicine and a troubling diagnosis of the House Republican effort to “repeal and replace” Obamacare.

Most of the news coverage highlighted the CBO’s estimate that 23 million fewer Americans would have health coverage in 2026 under the bill. But in 2026, most current House Republicans will be lobbyists and strategic consultants — and some future Congress would get the blame. In political terms, the scariest CBO number was that 14 million fewer Americans would be without health insurance next year. And many of these suddenly uninsured people just might remember whom to blame when they cast their 2018 ballots.

A HuffPost/YouGov poll released Thursday, but conducted before the CBO report was issued, underscored how unpopular the House legislation already has become with just 26 percent of the electorate supporting it. Even Trump voters have muted enthusiasm for the bill with just 15 percent strongly favoring it.

So what should vulnerable GOP House incumbents do after marching off the cliff under the leadership of Trump and Paul Ryan?

Here are a few defensive options that the “yes” voters in the House might contemplate as they wonder whether it is dignified for a member of Congress to search for a future job in the private sector on LinkedIn.

  • The “What Do Auditors Know About Health Care?” Defense:

Many Trump loyalists have long been suspicious of such establishmentarian government entities as the CBO. So if the president were not off making new friends with our NATO allies in Europe, he probably would have unleashed a tweetstorm about the “losers” at the CBO who couldn’t get a job counting silver teaspoons at a Trump hotel.

New Jersey Republican Tom MacArthur, who helped deliver moderate votes for the House bill, complained Wednesday about the accuracy of the CBO’s projections. As he put it, “That’s somebody’s opinion at the CBO. I have a different opinion.”

The problem with this aggressive approach is that the CBO, like the filibuster, is a major nuisance — until you need it.

Given the current political mood, it is not too hard to imagine a Democratic president and Congress in 2021 trying to pass a version of Bernie Sanders’ “Medicare for all” legislation. Then, suddenly, Republicans would worship at the shrine of the CBO to show that such a massive health care bill would be unaffordable and unworkable.

  • The “Maybe It Will Go Away” Fantasy:

This certainly seems to be Mitch McConnell’s approach. Asked about health care in a Wednesday interview with Reuters, the Senate majority leader sounded like a man watching his car being towed as he said, “I don’t know how we get to 50 [votes] at the moment. … And exactly what the composition of that [bill] is I’m not going to speculate about.”

The 217 House Republicans on record as voting for the bill, of course, do not have McConnell’s luxury of avoiding responsibility as the legislation disappears beneath the still waters of multiple Senate committees. But there is always the hope that health care will fade as an issue in 2018 — especially if Republicans stop talking about it.

Many House Republicans came to Washington as part of the 2010 voter uprising against the Democrats. What is often lost in the mists of memory is that a cap-and-trade energy bill that passed the House in 2009 but died in the Senate proved to be as much of a political albatross for the Democrats as Obamacare. Make no mistake — no congressional vote is ever forgotten as long as there are campaign consultants skilled with voice-of-doom attack ads.

  • The “Put On a Happy Face” Defense:

Ryan attempted this gambit in his Thursday press conference as he said, “I’m actually comforted by the CBO report because it shows we’re going to lower premiums.”

The CBO did acknowledge that health care costs might decline for younger and healthier Americans who choose plans with minimal benefits. But the report also suggested that — especially in states that dramatically trimmed coverage requirements — “it would become more difficult for less healthy (including people with preexisting medical conditions) … to purchase insurance because their premiums would continue to increase rapidly.”

The problem with the “Let a Smile Be Your Umbrella” strategy is that Republicans can’t even brag about their vast budgetary savings. The CBO estimates that Trumpcare will only reduce costs by about $12 billion a year for the next decade. Put in perspective, that is about as much as Mark Zuckerberg’s wealth goes up annually.

Maybe, in the end, the safest stance for beleaguered House Republicans would be emulate the aggressive truth-defying approach of Trump himself: “What health care bill? I didn’t vote for any health care bill. And what about Hillary’s emails?”

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