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“It’s easier to rage against the machine when you’re not in control of the machine, No. 1. And the perception that we are in control of the machine is inaccurate,” said Sen. Tim Scott (R-S.C.). “Needing 50 out of 52 members on the same page in the Senate? I think that is not being in control of the machine.”
The failure of the plan to quickly repeal Obamacare earlier this year forced Republican leaders to start over and attempt the daunting task of crafting a more comprehensive health care plan that would unite all sides of a squabbling conference. And the Trump administration’s lack of sufficient staff and planning for that early effort helped lay the groundwork for the legislative chaos the GOP’s agenda is mired in today.
A senior administration aide said that although the White House didn’t expect health care to take so long, the blame game will dissipate if the president signs a health care bill by August.
“If, a week from now, we have completed the repeal of Obamacare, I don’t think people looking back on it will do the woulda, coulda, shoulda game,” the aide said.
Still, rank-and-file senators now say starting with tax reform could have done more to unify the party and avoid the GOP’s ongoing quagmire.
“I would have much preferred to start off with tax. But that wasn’t my decision,” said Sen. David Perdue (R-Ga.). “Tax is the heavy lift here. It’s not going to be easier than health care. And we’ve been doing this for seven months.”
Past administrations have also been hurt by health care. Democrats said after the passage of Obamacare that they wished they had delayed the topic until more of their agenda was underway — House Democrats lost their majority in 2010 shortly after the law passed.
First lady Hillary Clinton took flak in the early 1990s for her failed health care task force, and President George W. Bush faced tremendous opposition when his administration pushed through the Medicare Part D prescription drug benefit — even though the program has cost less than original estimates.
Still, after the November 2016 election, few in Trump world or Congress saw potential problems after Republicans campaigned on killing off the Affordable Care Act for seven years.
“We are probably all guilty of not being as creative as we needed to be,” said one former congressional leadership aide. “Every administration likes to check off an accomplishment.”
During the transition, the Trump administration never established a great deal of coordination with the Hill or a concrete game plan for health care, according to congressional aides and one former transition official.
The transition had just a handful of health policy people, who were also tasked with working on the confirmation processes for Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma. The administration official said the lengthy confirmation process, which he blamed on Democrats, hurt the White House because it meant the administration did not have two key health policy experts in place.
Helping sort through the process were Marc Short, now the White House legislative affairs director; Rick Dearborn, the White House deputy chief of staff; and Stephen Miller, a senior adviser for policy. All three had congressional experience, but several Republicans said Trump’s staff lacked experience negotiating or moving major legislation.
“I just don’t have confidence that the administration had the health care expertise and policy advice that they needed there,” said G. William Hoagland, former staff director for the Senate Budget Committee and former leadership aide to Senate Majority Leader Bill Frist. “The result is what we are seeing today.”
On the Hill leading up to the inauguration, one leading idea was to resurrect the 2015 House and Senate bills that repealed much of the law. Republicans were already on the books supporting the bills, which needed only 50 votes in the Senate instead of 60.
But when GOP leaders in January pitched the idea — which involved repealing the law and figuring out a replacement later — they were met with stern resistance from lawmakers worried about constituents who had gained insurance through the 2010 law and who could lose coverage if it were suddenly revoked.
“Health care looks much easier when you’re at the talking point level,” said Larry Leavitt, a senior vice president at the nonpartisan Kaiser Family Foundation and senior health policy adviser during the Clinton administration. “It always gets more difficult as you start filling in the details.”
This was the first hint of real trouble for the Republican health care efforts. Passing a bill they knew would be vetoed under Obama was easy; passing one that would thrust their constituents into uncertainty was riskier.
“When you’re six years into a program, to change it when people are relying on it, there’s a fear that it may affect their own policies or their own families,” said Sen. Jeff Flake (R-Ariz.). “This is tough; this is complex. We knew it would be, but it’s really tough.”
In late January, lawmakers at a closed-door session at a Republican retreat in Philadelphia raised a myriad of concerns about tackling Obamacare, from the contours of the replacement plan to ways to keep premiums affordable. One former Republican Senate aide later called that meeting with Andrew Bremberg, the head of the White House’s Domestic Policy Council, prescient, because lawmakers privately raised many of the concerns that have since dogged the bill.
At the same policy retreat, House Speaker Paul Ryan laid out a three-pronged approach to scrapping Obamacare. He wanted to repeal as much of the legislation as possible, eliminate more through deregulation, and then work with Democrats on a replacement, said one former Republican aide.
Many Republican lawmakers doubted Democrats would work with them on redoing the health care law.
The president and one of his former campaign rivals also unexpectedly helped undermine the GOP’s repeal plans. Sen. Rand Paul (R-Ky.) said on television the GOP needed a replacement plan if it was going to repeal the law. Then Trump
endorsed that requirement. Their comments caused GOP leaders to start from scratch.
Now that the Senate’s attempt to revamp the health care law has run into roadblocks — with moderates insisting on protecting coverage for their constituents, while conservatives focus on undoing as much of Obamacare as possible — both Paul and Trump have
suggested going back to a repeal-only bill. >
Many Republicans say that’s unworkable now.
“We’re not just trying to get rid of the law, we’re trying to replace it with something better. Getting rid of it is pretty straight-forward,” said Sen. Marco Rubio (R-Fla.). “Replacing it with something better is a significant undertaking, but it needs to be done.”
Now, Senate Majority Leader Mitch McConnell maintains that the Senate will vote soon, though he was forced to delay again while Sen. John McCain (R-Ariz.) recuperates from surgery.
With two Republicans saying they will definitely vote no, the bill could not pass without McCain present. Other senators are still undecided.
“They’re trying to turn around a massive piece of public policy that has been the law of the land for seven years,” said Lanhee Chen, policy director for the 2012 Romney-Ryan presidential campaign. “One cannot overstate the magnitude of what is being attempted. This is a totally unique experiment in some ways.”
In the meantime, neither the White House nor Congress wants to claim responsibility if it doesn’t work out. While lawmakers grumble that Trump should have started with an easier policy goal, White House aides say they assumed congressional Republicans had it under control.
Republicans had campaigned on undoing Obamacare since 2010, the senior administration official said: “That was not contingent on President Trump.”