How the Republicans Botched The Trumpcare Rollout & Why Trump Won't Just Repeal Without Replacement

The truth of the matter is that this healthcare rollout was botched from the beginning.  What they should have done, in my opinion, was the following:

1) Get everyone together from the various conservative groups, the various caucuses in the House, and representatives from the Trump Administration.  Have each of the caucuses beforehand write down exactly what they expect out of this bill.  Have the Trump Administration set guidelines as to what they want out of this bill.  Also have Senators there for an idea as to what will pass the Senate.  Invite doctors and people from the private sector who offer solutions for great, free market health care at a lower cost.  Hammer it out. 

2) Write the bill and get everyone together again to go over it.  Don't release the bill to the public until  you are confident in it.

3) Promote the bill to the American public so they really understand it.  Now that you have the various conservative factions involved, have them running ads, sending out updates, and encouraging supporters to contact their representatives.  Have these representatives and Trump out there doing town halls and rallies promoting this.  At the same time, Trump and said representatives and groups need to be feeding a daily stream of news and stories to the public of the negative affects of Obamacare to counter the media narrative.

4) Now vote on the bill, and hopefully it will pass and go through the Senate. 

This is going to take longer than 3 weeks, and that is okay.  This is a change, and you want people to be comfortable with it.

Now obviously none of this occurred with the bill presented before the House.  They did it backwards.  Paul Ryan wrote the bill secretly enough where Rand Paul took reporters on a treasure hunt searching for it, and they fought over what should be in it after it was written.  It was rushed to the point that no one knew what was in it.  A lot of people were confused about the three phases and how a lot of the things people wanted were in phase 3.  No one promoted the bill except for Ryan and Price - that includes Trump who seemed lukewarm on the whole thing until he tried to get representatives to sign on for the vote.  It was to the point that people questioned whether or not Trump liked the bill.  He didn't do any rallies specifically for it.  I think that Trump is new to this, and he counted on Paul Ryan who has been wanting this for seven years and his team to know how to do this.  Paul Ryan did not.

As far as the Freedom Caucus goes, if you read articles in the media, Trump offered them concessions such as getting rid of the essential benefits (shifting them to states) which caused moderates to pull away from the bill and outrage among the media which was pumping said outrage out over the airways and into their newspapers.  The Freedom Caucus felt that they weren't getting enough of what they wanted, although I read a quote by one member who remarked it was better than Obamacare - just not good enough.

The thinking with the bill is that it would be a three stage approach.  A full repeal would be filibustered in the Senate, so this part would go through reconciliation and would be filibuster proof, but a lot of what excited conservatives, like purchasing across state lines, would come in the third stage - which some were skeptical they would ever be able to get through.  Because of that, the CBO only scored phase one, and without the entirety of everything taken into account, the CBO numbers were terrible.  The media blasted them out consistently.  This plus the absolute disaster of a rollout gave the bill a dismal 17% approval rating.  The left hated it for the obvious reason that it undid Obamacare.  The moderate wing thought it went too far and many on the right thought it didn't go far enough - some wanting a plain repeal and other wanted a repeal and replace with a bill similar to that of Rand Paul's. 

Ultimately, the Freedom Caucus tanked the bill, but some moderates aided in their efforts:

After all, it wasn’t just conservatives who sank the AHCA. The Freedom Caucus remains a stubborn problem for GOP leadership, but blaming—or crediting—its members for Friday’s defeat ignores the fact that some two dozen moderate and centrist members were also opposed. "There's no natural constituency for this bill," Raul Labrador, a Freedom Caucus co-founder, said throughout the week. He was right. Members care about policy and process, and between the two, there was no clear upside for many of Ryan's members: It left too many people without coverage and failed to drive down premiums; it also was re-written hastily to accommodate changes and felt rushed for no good reason. Ultimately, every concession made to win conservatives, like the amendment that left regulating essential health benefits up to states, was destined to result in the loss of moderates.

http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947

The Freedom Caucus made a wager that they weren't getting enough of what they wanted and in effect ended up with Obamacare in the end. 

Walking toward the tunnel that connects the House office buildings to the Capitol itself, I ran into Mark Walker, the chairman of the Republican Study Committee, a large caucus that was once home to the conservative movement in Congress before being eclipsed in recent years by the more ideologically pure Freedom Caucus. Walker had initially been against the bill, but came on board quickly after some changes, and in doing so validated the critiques of his group by those further to the right. A former minister, Walker is by nature relaxed and genteel, but his face was burning red and his voice trembled as we discussed the bill's defeat.

“I’m very bothered. I'm disappointed,” he said, measuring his words. “This was a chance to repeal all the Obamacare taxes. It was a chance to take off the burdensome mandate we've stuck on our employers and individuals who have begged for help. It [has] additional pro-life provisions. It destroys the chance to do the biggest Medicaid revision that we've had in what, 51, 52 years? Yeah, I'm bothered by it.”

http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947

A full repeal would not be possible, but at least they would have gotten some of what they wanted as opposed to none.  Trump has now suggested he will work with the Democrats and won't need the Freedom Caucus.  The Freedom Caucus will get even less then and have less power to negotiation.  Trump himself called out the Freedom Caucus on Twitter.

March 26

Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare!

March 27

The Republican House Freedom Caucus was able to snatch defeat from the jaws of victory. After so many bad years they were ready for a win!

From Bob Costa of The Washington Post:

“I think they made a mistake, but that’s okay,” Trump said of the Freedom Caucus.

I asked: Would working on a bipartisan health-care deal a year from now be something he would find more agreeable than whipping the hard right?

“A lot of people might say that,” Trump said, laughing. “We’ll end up with a better health-care plan. A great plan. And you wouldn’t need the Freedom Caucus.”

https://www.washingtonpost.com/powerpost/president-trump-called-my-cellphone-to-say-that-the-health-care-bill-was-dead/2017/03/24/8282c3f6-10ce-11e7-9b0d-d27c98455440_story.html?utm_term=.aa30fd7b1f20

He Tweeted about this as well.

March 25

ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!

March 27

The Democrats will make a deal with me on healthcare as soon as ObamaCare folds - not long. Do not worry, we are in very good shape!

Reince Priebus and Sean Spicer also talked of working with the Democrats.

Now, I realize that among many conservatives, they were hoping that Trump would repeal Obamacare completely.   If Trump does that sans a good replacement, he will be a one term President, and the Democrats will come in next term and give you something more intrusive than Obamacare - socialized medicine.  He made a promise to the people he would repeal and replace, keep preexisting conditions, the 26 rule, and take care of those who can't afford it.  He said so in September 2015 long before the first primary:

Scott Pelley: What's your plan for Obamacare?

Donald Trump: Obamacare's going to be repealed and replaced. Obamacare is a disaster if you look at what's going on with premiums where they're up 45, 50, 55 percent.

Scott Pelley: How do you fix it?

Donald Trump: There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, "No, no, the lower 25 percent that can't afford private." But--

Scott Pelley: Universal health care?

Donald Trump: I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now.

Scott Pelley: The uninsured person is going to be taken care of how?

Donald Trump: They're going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably--

Scott Pelley: Make a deal? Who pays for it?

Donald Trump: --the government's gonna pay for it. But we're going to save so much money on the other side. But for the most it's going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.

http://www.cbsnews.com/news/donald-trump-60-minutes-scott-pelley/

He said who he was, and he didn't apologize.  He made himself clear throughout the campaign.  In doing so, he was not only able to win the Republican nomination, but he also won the election by cracking the blue wall and winning with working class voters, poor voters, and rural voters. Some of these voters are dependent on Obamacare.  If you wanted a candidate who was going to do a straight repeal or repeal and replace with something that did not include a safety net, Donald Trump was not the candidate to vote for.  You would have wanted Ted Cruz or Rand Paul.

He even reiterated again in an interview with The Washington Post right before he took office:

“We’re going to have insurance for everybody,” Trump said.

“There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?postshare=1231484529419268&tid=ss_tw&utm_term=.4e23ce91c858

Just some basic stats and polls:

Obamacare has a positive approval rating at this point (although not amongst most Trump voters I'm sure) - with 49% to 44%:

http://kff.org/interactive/kaiser-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable--Unfavorable&aRange=twoYear

Overall, only 19% of Republicans approve and a slight majority of Independents disapprove with 47% - 46%.  Obamacare's approval rating actually went up when people heard it might be taken away.  The media still wields some power.

A Rasmussen poll showed the following:

The Rasmussen survey ahead of the failed bill found that while a majority of voters wanted health care reform, 52 percent were concerned Trump and the GOP would change too much. Thirty-six percent worried they would change too little.

https://www.msn.com/en-us/news/politics/trumps-approval-rating-falls-as-trumpcare-flops/ar-BByT8jM

Of course the group worried they would change too little is obviously the conservative wing.

While there are conservative voters who want it all repealed, there are others who want some replacement like Rand Paul, but others yet who want to keep things in place like Trump promised.    If Trump violates his campaign promise and drops Obamacare with no replacement, he's in trouble.  The media will run story after story of not only how he's a conman and liar but of people negatively affected.  The people who voted for him and trusted him that are currently now using Obamacare and expect either a better system or the ability to get help if they are ill, will look elsewhere. Trump barely won in Democrat states with a total of 70,000 people COMBINED.  These people did not vote for Trump to repeal and not replace Obamacare.  They voted for him for a better healthcare system.  In order for Trump to win the next election, he will need to maintain his voter base, and some the portion that helped put him over the top will be voting Democrat if Obamacare is not replaced with a better system for them.  Also, exclude those voters for a minute and think how it will motivate Democrat voters to come out who otherwise stayed at home as they weren't motivated.

They should work to open up the markets and lower costs - making the system as free market as possible, but at the same time, he made a promise to help those who can't afford it.  If they are successful and prices go down, perhaps less people will need help as time goes on, and the goalposts can be moved as less people will need government healthcare (although the reality is that some always will).  The Democrats are aware of the fact that you can't get what you want right away, so they settle.  The far left settled for Obamacare because it was a step towards their goal of socialized medicine.  They didn't get everything they wanted then, but they knew it wasn't the endgame. 

My point is that people who are looking to flat repeal or repeal and replace without adhering to Trump's campaign promise will win the short term battle on this, but they will lose the war because the Democrats will come in and give you something to the left of Obamacare.  Republicans won't get a shot again.  Not only that, but then you will lose having a President who is pro-life, pro 2nd Amendment, who is willing to put conservatives on SCOTUS, enforce immigration laws, wants tougher vetting, helps business by easing regulations and lowering taxes, wants fair trade, eases climate regulations, is tough on ISIS, expects our NATO members to meet commitments, is pro-Israel, etc.  You'll lose all that and lose on healthcare too in the end. 

The above said about the need to compromise, while I state I think the Freedom Caucus will have to make concessions, I think it's likely good for Trump that this bill fell flat.  Complaints and disputes I read from both sides of the political spectrum is that this could negatively affect vets, seniors, debate over some losing Medicaid who need it, debate over essential health benefits, illegals could sneak in and get care (cause it was done under reconciliation), the 30% surcharge for lapsed coverage, whether or not the age based tax credits is a good system, and of course the horrific CBO numbers of those losing insurance.

The bottom line is that it had a 17% approval rating.  That is absolutely dismal, and Obamacare currently has a slight positive approval rating aided by media promotion.  If this bill went through and tanked, they would own it.  It would be a dire setback electorally.  Trump mentioned the best thing they could do politically is let Obamacare explode.  Once it does, the American people will be clamoring for a better plan.

I actually think Trump looked a bit relieved that it failed.  I think now he has lashed out a bit at the Freedom Caucus because Trump is a counterpuncher, and right now the narrative out there is that the dealmaker failed - was beaten by the Freedom Caucus who will now have power over him and have weakened him, that his loss is devastating to his Presidency, etc.  He sees the media and Dems celebrating, and from that stand point, he wants the win, but he could be better off without it.

Yes, there is a risk that if they move forward onto other things this session, save it for next session, and lose seats they've lost their chance to repeal Obamacare - meaning this is their best and only chance, but unless they get something done (and that would be risky without sufficient promotion and with Obamacare's rating) it's a risk they will have to take.  The Freedom Caucus also have taken a risk that if/when Obamacare explodes, Trump works with the Democrats and they are marginalized. 

It will be a gamble to see if people will blame the Republicans for Obamacare blowing up for not getting this healthcare bill done.  People will either blame the Republicans because they are in charge, it happened under their watch, and they failed to get something done, or they will blame the Democrats who passed and fought to keep it.  The Democrats did their victory laps in the short term but not necessarily in the long term will they be celebrating I believe.  The one thing the Republicans could have done, knowing they couldn't get 60 votes due to a filibuster in the Senate, is load a bill up with absolutely everything they wanted, let the Dems filibuster, and then the Dems really would have owned it.  They took a larger risk of blame by letting this thing flop miserably, but it its what it is.

The bill put forward in the future should have full backing, support, and promotion from conservative groups and isn't promoted by Trump and Congress so the American people understand it in the future - especially if they are going the non-bipartisan route.  If they are going the bipartisan route, Trump has to remember he and the Republicans are in the majority and can't give the Democrats too much leeway.  I would prefer to see the Republicans get something good done themselves if/when Obamacare explodes.

To conclude, I realize my opinion may not be popular among some conservatives, but reading what Trump has said, his comments were not comments that would make the conservative base completely happy.  Ironically, that is probably what helped him win.  I see some conservatives turning on Trump for this, and I don't think it's wise.  He's somebody who is willing to fight to give you most of what you want and is willing to stand up to the press.  Don't give up on him over this because I think adhering to his campaign promise will keep him in office to do all the other things we want.

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