In a January 2010 speech at Hillsdale College, Paul Ryan decried Barack Obama’s efforts to expand access to health care. The future House speaker declared in apocalyptic tones, “The national health care exchange created by this legislation, together with its massive subsidies for middle income earners, will be the greatest expansion of the welfare state in a generation and possibly in history.”
Then Ryan uttered the fateful words: “Our message must be, ‘We will repeal and replace this government takeover, masked as health care reform.’”
Two months later on the day that Obama signed the Affordable Care Act into law, Mitch McConnell emerged from a GOP strategy session to say, “I think the slogan will be ‘repeal and replace.’… No one I know in the Senate Republican Conference believes that no action is appropriate.”
The mantra of “repeal and replace” helped propel the Republicans to breakthrough victories in both the 2010 and 2014 congressional elections. But even the best political slogans eventually face a rendezvous with reality. Herbert Hoover’s promise of a “chicken in every pot and a car in every garage” didn’t survive the 1929 stock market crash. And now — after seven healthy years — it is looking like “repeal and replace” may not make it through the week.
Yes, it is possible that the Senate vote on the new health care bill will slide beyond the Fourth of July recess, especially since no one has ever gone broke betting that lawmakers might delay.
But, in all likelihood, the Republicans will either repeal and replace Obamacare with their own ill-considered and parsimonious plan or else they will demonstrate that they cannot legislate even with congressional majorities and a compliant president.
A safe bet?
Any Republican anticipating a tough race in either 2018 or 2020 should be rooting hard for legislative ineptitude.
For all the angry snarls from the conservative base over any failure to repeal Obamacare, it is hard to envision how any voter would be attracted to a health care plan that offers less coverage, higher deductibles and a real risk of exceeding a lifetime cap on benefits. And all this before $772 billion in planned cuts to Medicaid kick in.
In short, the only thing worse politically for the Republicans than keeping Obamacare is passing Ryan-McConnell-Trump-care.
With the possible exception of TARP, the Troubled Asset Relief Program, passed amid the immediate financial panic following the 2008 collapse of Lehman Brothers, it is impossible to recall a piece of major legislation this unpopular.
An NBC News/Wall Street Journal poll released last week found that only 16 percent of those surveyed support the health care bill that passed the House, which the Senate version closely resembles. In similar fashion, voters rejected the House bill by nearly a two-to-one margin in a recent CBS News poll.
Every tweak to the current Senate bill invites new problems. In their rushed and secret drafting sessions, Senate Republicans gleefully eliminated the legal mandate to have health insurance without offering anything to replace it. The self-destructive result: The proposed legislation inadvertently encouraged Americans to only buy health insurance after they became sick.
But the fix, announced Monday, illustrates the dictum that sometimes the cure can be worse than the disease. The GOP revision imposes a six-month waiting period on anyone who lacks insurance for two successive months.
Not only is there scant evidence that this threat will force people who feel economically strapped to buy health insurance, but also the way it would play out in reality would be mercilessly cruel.
Imagine heart-rending Democratic ads about people who lost their jobs and their employer-backed health insurance, were soon diagnosed with cancer or another life-threatening diseases — and then couldn’t afford treatment for six months because they were barred by the government from getting subsidized insurance.
Making matters worse for the Republicans were the Congressional Budget Office’s coverage estimates, released late Monday afternoon. The CBO estimates that 15 million fewer people would be insured in 2018 than under Obamacare and that number would swell to 19 million by 2020.
Recall the famous Ronald Reagan 1984 re-election question: “Are you better off than you were four years ago?” For 19 million Americans in 2020, according to the CBO, the answer would be a defiant “no.”
That little detail should not be lost on incumbent GOP senators on the ballot in 2020 from swing states: Susan Collins of Maine, Cory Gardner of Colorado, Thom Tillis of North Carolina and Joni Ernst of Iowa.
Buried on Page 16 of the CBO report is the calculation that the loss of insurance would “disproportionately” affect “older people with lower income — particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.”
These are the people raised with the belief, as Bill Clinton put it, “If you work hard and play by the rules, you’ll be rewarded with a good life for yourself.”
But not — under the Senate Republican bill — if they have the bad luck to ever get sick before they qualify for Medicare.
House Republicans who voted for the original bill out of party loyalty were rewarded by Donald Trump calling the legislation “mean.” In the view of the CBO, the Senate version is equally mean.
All it takes is three Republican votes to end the mean season for health care. For instead of “repeal and replace,” the slogan all along should have been “retain and reinforce.”
Roll Call columnist Walter Shapiro is a veteran of Politics Daily, USA Today, Time, Newsweek and The Washington Post. Follow him on Twitter @MrWalterShapiro.