Saturday, March 25, 2017

Trump Learns the Hard Way That Policy Details Matter

By Jim Geraghty
Friday, March 24, 2017

The good news is no one can say President Trump didn’t try to persuade House Republicans that they should pass the American Health Care Act. He invited lawmakers to the White House, dispatched his key aides to Capitol Hill, worked the phones, cajoled, charmed, arm-twisted, threatened . . .

He did everything short of actually attempting to understand why House Republicans didn’t want to vote for it.

President Trump and Speaker Paul Ryan chose to cancel the vote on the AHCA late Friday afternoon. Earlier this week, the loudest argument from Trump was that if House Republicans didn’t pass the bill, it could cost the GOP their majority in 2018. This may or may not be true; it’s also possible that passing a disappointing replacement could cost the GOP their majority. Either way, Trump went so far as to threaten primary challenges to those who didn’t sign on.

It’s not that the House Republicans who refused to vote for the bill didn’t fear such a threat, or that they were nonchalant about keeping their majority. They held out not because they lacked motivation to replace Obamacare.

No, in the end, they simply didn’t like what was in the bill and didn’t have faith that the Senate would improve it, or that it would get better in conference committee. At least for now, a significant number of House Republicans fear the consequences of passing an insufficient bill more than the consequences of failing to pass a bill.

Some Republicans felt that the American Health Care Act wouldn’t do enough to lower premiums, which many consumers find too high. The CBO score said that the bill would reduce the costs of insurance eventually . . . but increase them in the first three years. It’s fair to ask whether voters would feel warm to Republicans in fall of 2018 if a GOP replacement plan passed and they still found themselves paying too much for too little care.

Some House Republicans want to repeal Obamacare’s requirement that insurance plans cover outpatient care, emergency-room visits, hospitalization, maternity and newborn care, mental-health and addiction treatment, prescription drugs, rehabilitative services, lab services, preventive care, and pediatric services. On the one hand, mandating so much coverage does add to the costs of insurers, raising premiums. On the other hand, consumers like being comprehensively covered.

Others contended that the replacement just worked too much like Obamacare to meet their standards. Mo Brooks of Alabama declared, “It doesn’t deliver on the promise I made to fully repeal Obamacare.” Representative Rick Crawford of Arkansas tweeted that “the bill currently maintains [Obamacare’s] overall structure/approach, an approach that cements the federal government’s role in health insurance.”

Conservative health-policy wonks, meanwhile, had their own objections. Avik Roy pointed out that the AHCA “would lead to significant spikes in net insurance premiums for lower-income participants in the individual insurance market, with particular problems for those in their fifties and sixties.”

These are thorny issues that involve trade-offs. You can try to to sweep away everything that’s bad about Obamacare, but there’s no way to do that without disrupting millions of voters’ lives. You can try to control costs, but that’s hard to do without limiting benefits. You can’t enact some of Republicans’ favorite proposals, such as tort reform and selling insurance across state lines, without either some support from Senate Democrats or the elimination of the filibuster. As House Freedom Caucus chair Mark Meadows put it, almost no one in his caucus wanted to vote no. They wanted to get to yes but simply didn’t see enough good in the bill to make voting for it worthwhile.

A strong leader can help sort out conflicting priorities, but there’s little sign that President Trump had any interest in that role. Throughout the last days of arm-twisting, there were ominous reports that he was quite passionately attempting to persuade House Republicans to pass the bill, without really understanding what was in the legislation that made them so reluctant to vote for it. An unnamed House GOP aide told CNN that when it came to the details of the legislation, Trump “either doesn’t know, doesn’t care or both.”

In the Los Angeles Times, Michael Steel, a former GOP leadership aide, offered a bizarre portrait of a president who’s somehow simultaneously eager and clueless:

Ryan has learned that his wonky style of communication is wasted on Trump ​given the president’s lack of interest in policy details, Steel said. But he has come to value Trump’s eagerness to exert pressure on wavering Republicans.

It appears President Trump cared a lot more about getting a win than about what, exactly, he would be winning. And that lack of focus on the details helped deny him the victory he wanted so badly.

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