If House Republicans enact their health-care bill, they're screwed. They'll have lost the critical initial dialogue and left opponents salivating. If they fail to pass it, they're screwed, too, having broken a commitment of the past four elections.
The Trumpcare debacle confirms the wisdom of the late Republican pollster Bob Teeter, who predicted a couple of decades ago that health care would be a loser for whichever political party owns it.
There's another lesson in the Republicans' angst, but this one's for both parties: It's almost impossible for Congress to succeed in something big on a partisan basis. President Barack Obama was rebuffed by Republicans on the Affordable Care Act eight years ago and paid a heavy price; now House Speaker Paul Ryan, R-Wisconsin, and his colleagues are the ones likely to bear the political cost.
It's hard to reverse the terms of debate set in the early stages of a big legislative battle. Remember, in 2009, the charges that Obamacare would set up death panels to decide whether grandmothers should live or die? It was false, but it resonated.
Now Ryan and the White House are on the defensive after an analysis by the nonpartisan Congressional Budget Office forecast that their plan would result in the loss of health insurance coverage by 24 million Americans over the coming decade.
Democrats are drawing blood with charges that the plan cuts care for the poor to finance big tax cuts for the wealthy. Conservatives are complaining that proposed tax credits to help people buy insurance amount to too much government. Moderate Republican governors are saying it's bad for their states because it cuts back on Medicaid financing that added millions of people to the insurance rolls.
Think of those arguments as raw material for an anti-Trumpcare ad campaign reminiscent of the "Harry and Louise" commercials that helped dash President Bill Clinton's hopes for comprehensive health-care reform in 1994.
In those 30-second spots, a fictional American couple invented by insurance-industry lobbyists fretted at a suburban kitchen table about losing trusted doctors and control of their medical destinies. (That was before they re-emerged briefly in 2009 in support of Obamacare.)
Imagine some of today's Harrys and Louises: a 62-year-old man echoing complaints of the AARP that he would have to pay more while younger, healthier people pay less; a cancer patient who worries that she'll lose access to treatments that were covered under Obamacare; a struggling lower-income couple who would be threatened with losing Medicaid coverage; perhaps a handful of working-class citizens griping around a coffee table about how rich people were spending the tax cuts paid for by their vanished insurance subsidies.
Another lesson to be learned is the danger of hyperbole or careless language. Republicans, more than six years after the enactment of the Affordable Care Act, still were reprising Obama's broken promise, "If you like your health care plan, you can keep it."
They, then, should be cognizant of the danger lurking in the campaign promise of their current leader, the man now in the White House, when he declared, "I'm not going to cut Medicare or Medicaid." In truth, Trumpcare reduces federal Medicaid spending by $880 billion over a decade. To Ryan, that may be reform; to the poor or those with disabilities, it's just less health care.
Then there's Rep. Jason Chaffetz, R-Utah, who suggested that the GOP plan might encourage lower-income Americans to make necessary choices between health insurance and "getting that new iPhone." And Rep. Ron DeSantis, R-Florida, who said that a cancer patient didn't really need Obamacare coverage subsidies because even without insurance she could "show up to the emergency room."
Vermont Sen. Bernie Sanders, who gave Hillary Clinton a scare from the Democrats' left flank during the presidential primary season, got a good reception this week when he took an anti-Trumpcare case to the heart of Trump country, West Virginia. Along with Kentucky and Arkansas, it is one of the three states with the sharpest reductions in uninsured rates over the past three years, largely as a result of Obamacare. These culturally conservative states voted overwhelmingly for Trump last November. The beneficiaries of expanding health-insurance coverage in these states aren't primarily immigrants or people of color; they are white, working-class voters, Trump supporters who bought into his campaign rhetoric.
But if passage of their Obamacare-replacement plan would expose Republicans to political peril, failure to pass it would be as bad, maybe worse. In 2010, 2012, 2014 and last fall, the vast majority of Republican congressional candidates promised to repeal and replace the Affordable Care Act. It was a promise they weren't expected to keep as long as they lacked both a congressional majority and the White House. Now that they have both, there are no excuses.
Trump, who probably cares little and knows less about the specifics of his party's legislation, has said if it fails to pass then Republicans can blame the health-care mess on Obama and Obamacare. He may have forgotten that he promised voters he would produce a plan that would "cover everybody" and be "much better." Voters may overlook some of his reckless vows, but they won't forget this one.