The unexpected transition from a Washington defined by Republican opposition to President Barack Obama to a Washington in which the Republican Party is the sole shaper of the national agenda has served as a kind of natural experiment for identifying root sources of political dysfunction.
The through-line connecting the Obama and Trump eras is a presumption that only Republicans are entitled to maximal demonstrations of power. Norms are meant to constrict Democrats; rules are for them to follow. This double standard creates a number of jarring discontinuities, the most abrupt of which was an overnight whipsaw from the indiscriminate denial of Obama’s power to fill a Supreme Court vacancy to the scowling demand that President Donald Trump’s nominee receive a fair hearing.
But Supreme Court vacancies are relatively rare, and vacancies in the final year of a president’s second term are even more so. The most consequential upending of precedent lies in the contrast between how Democrats passed the Affordable Care Act and how Republicans are attempting to repeal it.
It isn’t too hard to imagine the give-and-take between the parties over Supreme Court vacancies returning to some kind of balanced order. Republicans, by contrast, are kidding themselves if they think the ACA-repeal rush job they’re trying to perpetrate won’t become a model Democrats use when they’re ultimately empowered to fix what the GOP is trying to break. Democrats remain committed to establishing a national health care guarantee in the United States; what will change if Republicans roll back that guarantee isn’t liberal principles, but Democrats’ concern for achieving liberal goals through normal means.
Amid the tortuous process that ended with Obamacare’s enactment, Republicans complained that Democrats were “ramming” or “jamming” health care reform down people’s throats, and they have never stopped complaining. Their procedural objections centered around mostly mythical midnight votes, and the Democrats’ belated adoption of a process called budget reconciliation to secure the law’s passage in spite of a GOP filibuster.
The truth, as honest brokers will admit, is that health care reform was unusually public and transparent for such a massive undertaking, and that Democrats only used reconciliation after health care reform had already passed to make modest fiscal changes to their completed bill. It was a creative, but by no means norm-shattering twist on the normal process of ironing out differences between House and Senate legislative texts.
Democrats had famously adopted a Republican universal health care scheme as a blueprint for Obamacare and wasted months after a landslide election soliciting Republican support for that plan. Republicans, by contrast, announced at the outset of their repeal-and-replace process that it would be “a Republicans-only exercise” and laid the groundwork to use budget reconciliation as a filibuster-proof vehicle for the entire endeavor—all after losing the popular vote. They are advancing their legislation ahead of Congressional Budget Office analysis of its impact on costs, spending, and coverage levels, through actual middle-of-the-night votes squeezed into a timeframe better measured in hours than months.
In anticipation of a CBO cost estimate projecting the American Health Care Act will reduce insurance rolls by millions, Republicans are attempting not to improve their legislation, but to preemptively discredit CBO as an able modeler of health policy.
These antics are by no means guaranteed to succeed, but they very well may. What happens if they do will be a national embarrassment and a humanitarian tragedy, but it will not be the end of the story. Critics rightly note that Republicans, in their determination not to get bogged down for a year like Democrats did in 2009, seem to have forgotten some of the biggest political lessons of that health care reform process: don’t over-promise, and don’t dismiss the public opposition. But the biggest lesson they may be forgetting is the one they’re in the midst of proving: What’s done can be undone, and swiftly.
Had Republicans won a large, majoritarian victory in November, positioning themselves to make enormous changes not just to Obamacare, but to Medicare, Social Security, and the rest of the safety net, there would be a real logic to pressing ahead like this, with overwhelming force. A conservative counterrevolution would be difficult to undo entirely, particularly within the small windows of time new majorities typically have to implement their agendas. Even if conservatives paid a massive political price for it in subsequent elections, the dividends for the right would be massive.
What Republicans are attempting at the moment, by contrast, is a kamikaze mission not to repeal Obamacare, but to make Obamacare cruel and unworkable, while validating its underlying premises (such as that people who don’t have insurance through their employers should get subsidies from the government to buy their own). This is a curious thing to waste their once-in-a-generation majority trying to do.
If they succeed, they will cause tremendous suffering; but they won’t have settled the debate over the government’s role in health care once and for all. To the contrary, they will have traced the path by which a future Democratic majority dispenses with all the pleasantries and enacts a simple, and truly universal plan, like Medicare for all:
1. Demonize Trumpcare relentlessly (and, this time, with good reason);
2. Make a pledge to re-cement a true coverage guarantee the cornerstone of Democratic messaging;
3. Win control of the government by any margin;
4. Reduce the Medicare eligibility age to zero (or eliminate Medicaid income limits, or otherwise extend government programs to cover people without insurance) through the reconciliation process, immediately, without proper CBO cost estimates. Pay for it with largely progressive tax increases.
5. Apologize to no one.
This would be a heavily disruptive way to reestablish a strong health care guarantee, particularly for people who already have insurance through their jobs, but the guarantee would be much firmer than it is under Obamacare, and unlike the AHCA, it would leave everyone who loses a plan they like with real coverage, automatically.
There are good reasons, other than respect for norms and comity, why Democrats didn’t do this in 2009, but if Republicans succeed at undoing most of that work in a matter of weeks, the arguments for moving incrementally will largely disappear.
It would thus behoove Democrats interested in saving the ACA to appeal not just to Republicans, but to the interest groups that joined the Obamacare coalition eight years ago, to both kill the AHCA, and demand that Republicans administer the ACA in good faith. If doctors, hospitals, pharmaceutical manufacturers, insurers, and others sit on their hands now, and allow Republicans to repeal or sabotage Obamacare, they will destroy the value liberals saw in appeasing industry stakeholders back when they had Congressional supermajorities.
A maximal strategy like this would tempt some on the left to hope Republicans succeed anyhow—magnifying as many contradictions as possible along the way—to hasten the creation of a truly universal health care system in America. But that would be a particularly inhumane way to bring about more progressive health policy.
There’s no reason for millions of people to suffer for four years or more simply so Republicans can satisfy their lust for revenge. The key to stopping it is to make them realize their triumph would be fleeting, and that their subsequent defeat would be far more complete than it was when Obama signed the ACA into law.