On March 24, House Speaker Paul Ryan (R-Wis.) pulled the American Health Care Act (AHCA), the Republicans’ first attempt at replacing the Affordable Care Act (ACA), from the floor. Ryan told reporters, “I don’t know what else to say other than, Obamacare is the law of the land” and “We’re going to be living with Obamacare for the foreseeable future.”
Thus ended two and a half weeks of political machinations, including marathon sessions by two House committees—which resulted in party-line votes—and a quickly produced score of the bill by the Congressional Budget Office, which estimated that the uninsured population would increase by 24 million people in a decade under the AHCA, though the federal deficit would decline by $337 billion over the same period.
The Fragmentation of America’s Political Parties
Political pundits were quick to name winners and losers in this stalled race to replace. Most of these assessments were conducted using the standard two-party lens, concluding that the Democrats were the winners and the Republicans were the losers.
But two developments that occurred soon after the AHCA’s defeat may suggest the need for a different kind of political lens—one that considers not just two monolithic parties, but four or five political camps.
First, President Donald Trump blamed the AHCA’s failure not on the Democrats, but on certain members of his own party, the House Freedom Caucus, the furthest-right grouping within the GOP, who opposed the bill as soon as it was announced. According to a March 27 article in the Los Angeles Times, Trump tweeted on March 27, “The Republican House Freedom Caucus was able to snatch defeat from the jaws of victory.”
Second, less than 24 hours after the AHCA’s demise, Sen. Bernie Sanders (I-Vt.), who caucuses with the Democrats, told constituents at a town hall meeting in Hardwick, Vt., that he would soon introduce a single-payer healthcare bill in Congress (at press time, he had not yet introduced the bill). Although such a bill is unlikely to pass, given Republican majorities in both chambers of Congress, it does reflect the views of the more left-leaning part of the Democratic Party.
Thus, factionalism permeates both political parties. The Republican House majority includes the centrist Republican Main Street Partnership, moderates, and the conservative Freedom Caucus. On the other side of the aisle, the Democratic House minority includes the centrist Blue Dogs and the more leftist Progressive Caucus.
The Pragmatic Appeal of Compromise
In like manner, Trump has indicated—in his own inimitable way—an intent to work with moderate Democrats to reform health care in some way. On March 27, the previously cited Los Angeles Times article reported the following additional tweet from Trump: “The Democrats will make a deal with me on health care as soon as Obamacare folds—not long.” Such a deal will require a tacking to the center and, realistically, some compromise and coalition building.
However, even if President Trump moves in that direction, Democrats may not meet him there. After the election, when Senate Minority Leader Chuck Schumer (D-N.Y.) raised the idea of working with Trump on certain issues, such as infrastructure, he drew sharp rebukes from the left and quickly changed his tune.
The Blame Game
Sadly, health care is being treated as a political football, with both political parties seeking to avoid at all costs being blamed by the public. After the AHCA’s failure, Trump wants the Democrats to take the blame for the ACA’s shortcomings, while Democrats want the Republicans to be blamed for not doing what’s needed to fix the ACA.
What It Will Take to Compromise
To rise above the blame game that characterizes the debate on healthcare reform will require statesmanship and courageous leadership. Fortunately, there are historical precedents of strong leaders from the two parties who were able to achieve compromises on major issues in spite of withering criticism by members of their own respective parties.
For example, as related by Chris Matthews in Tip and the Gipper: When Politics Worked, the historic 1986 tax reform bill that was President Ronald Reagan’s major second-term triumph would not have passed without the support of then House Speaker Tip O’Neill (D-Mass.). O’Neill explained, “After the vote, I was struck by how much could be accomplished when the president and the speaker, coming from opposing parties but working together, could agree on specific legislation.” f
That is precisely the important task at hand for Trump and Democratic congressional leaders as they deal with a healthcare system that is clearly still a work in progress.
Ken Perez is vice president of healthcare policy, Omnicell, Inc., Mountain View, Calif., and a member of HFMA’s Northern California Chapter.