Trumpcare Will Likely Pass. It Won’t Be Pretty.

Let’s start with tweets, then additional thoughts.

The Federalist’s co-founder Sean Davis:

I tend to agree with this.  It is basically how Obamacare was enacted.  But not exactly.

Pres. Obama began buying off “stakeholders” (affected industry groups) before there was draft legislation. This was a key difference from the way Hillary Clinton ran her failed healthcare task force in the1990s.

Also, while Obama did not submit a draft bill for Congress to consider, he had signaled his position on key issues, e.g., exchanges, acceptance of individual and employer mandates, and a possible “public option” competing with private insurers in the exchanges.

It does not appear that the House GOP consulted insurer or hospital groups, while a tweet from Pres. Trump panicked trading in pharma stocks.  The American Hospital Association issued a letter of opposition to the bill.

The AARP supported ObamaCare because it was trading off Medicare cuts for expanded coverage that was potentially quite lucrative for AARP.  The powerful seniors’ lobby is opposed to the House GOP proposal.

Meanwhile, the lack of coordination between the White House and Congress appears to extend to this first major legislative effort.  Indeed, on Monday, Trump claimed that “nobody knew that health care could be so complicated,” suggesting a certain lack of engagement with the subject.

VP Mike Pence told Congress that “this is the bill,” wile being “open to improvements.”  OMB Dir. Mike Mulvaney, otoh, is stressing the latter, though it seems as if he’s telling conservatives to propose amendments and daring them to vote against the bill if those amendments fail.  Unity!

There also seems to have been no outreach to conservative groups like Heritage, Americans For Prosperity, FreedomWorks, etc., who largely blasted the draft bill.  And the communications strategy seemed non-existent, as House leadership scrambled to explain that this proposal was only the first step or “phase.”

Absent these failures, the House GOP might not be in the position it is now.  Moreover, given Tuesday’s reaction, I would not assume the draft bill resembles an “okay final deal,” even if it might have been on Monday.

In addition, the general lack of White House guidance potentially distinguishes this effort from the Obamacare effort in another way.

With eight GOP Senators raising objections to various major provisions of the House proposal, there is the risk that the bill — or some disputed positions — will die in the Senate.  Some House members will be loath to climb out on a limb that may be sawed off.

This brings us to the unstated common denominator between Obamacare, which passed, and the BTU tax which died (and Hillarycare, and the 2009 cap-and-trade plan that died in the Senate).   Now that repeal/replace/repair/whatevs is on the table, Obamacare is finally sort of popular, albeit by only a few percent. In fairness, much depends on how you ask the question:

But even if you assume that support for O-care is rising in part because the Left now feels it can’t pout over not getting a single-payer system, some of it may also be from people fatigued with disruption of their healthcare arrangements, or those who don’t trust the government to make things better after falling for past promises.

It cannot have escaped the Congressional GOP’s notice that Congressional Dems once delivered on what they promised their base, ramming through a sweeping bill that altered a broad sector of our economy, only to be defenestrated by angry midterm voters.  It’s a big part of why many of those Republicans hold office today.

Running a similar game plan now has to be unnerving.  Arms will probably have to be twisted to the breaking point at the end of the process.  Getting the policy right, and the comms strategy right, and the coordination right would be helpful to those looking for nerve at the beginning.

UpdateThe AMA opposes the House bill.  There will be people who think that interest group opposition is a feature, not a bug.  It viscerally appeals to me as well.  But the White House and Congress aren’t making passing a bill any easier.  People generally trust their doctors, who will be hearing bad things from the AMA.  This is the sort of thing that helped doom Hllarycare.

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