“Repeal and Replace” is Dead – What Does that Mean for Georgia?

Monday night at a dinner with select Senators, in his typical bombastic way, President Trump said they — presumably meaning Senate Republicans and not Republicans in general to include him — would look like “dopes,” and also “terrible” and “weak,” if they didn’t pass the Better Care Reconciliation Act. Almost simultaneously, two Senators not at the meeting, Jerry Moran of Kansas and Mike Lee of Utah, announced publicly that they would join Senators Rand Paul of Kentucky and Susan Collins of Maine to become the third and fourth Republicans who would vote “no.”

For those keeping score at home, this bill was named as it was because Republicans had planned to pass it through the budget reconciliation process, which requires only 51 votes to pass. Under normal process, the Senate requires 60 votes to end debate and bring a bill up for a vote.

Leader Mitch McConnell has been on a rather quixotic crusade with “repeal and replace,” mainly because the President and most Republicans have insisted on repealing the Patient Protection and Affordable Care Act, whereas no Democrats were willing to go along, given it’s one of the defining pieces of legislation of the Obama Administration.

However, several Democrats have been open to helping Republicans mend PPACA if they chose that route. That was not what Republicans wanted, so they opted to use the budget reconciliation process. For weeks, there was discussion of how Vice President Pence would need to be the tie-breaker in a 50-50 split vote. That, by design, created a way for Senate Republicans to pass BCRA without any help from Democrats.

I’ve been skeptical of the ability of “repeal and replace” to actually happen, and now here we are. But why? Republicans control both Houses of Congress and the Presidency, after all.

Actually, former Representative Phil Gingrey explained it well in a blog post for his lobbying firm:

While complete repeal and replacement may have made sense in 2010 —when the GOP first took back control of the Congress and the ACA was not yet implemented— too much time has passed and too much of our nation’s health care infrastructure has been altered to get all the toothpaste back into the tube. A solution today should focus on keeping what works, fixing what is broken and tweaking the areas that need refinement and revision. Perhaps a more accurate name than “repeal and replace” would be “retain/repair/revise.”

But yet, that’s still not where we are. The Senate instead will be voting next week on “repeal only.” The number of Senators who are planning to vote against this measure currently stands at three, but other Senators have said publicly in the past they were not supportive of “repeal without replace.” I don’t see how McConnell gets to 51 votes for repeal only.

I think that’s been the point since January, though.

And, really, for a good length of time before this year. At some point, Republicans gave up on trying to fix health care for Americans and started using the repeal votes to solely score points with the base. How do I know?

The last time the House and Senate passed a PPACA repeal bill, they did so knowing that President Obama would veto it and they didn’t have the votes to override the veto. Some Senators have been talking in “what ifs” for weeks, with McConnell himself discussing how to shore up the exchanges if “repeal and replace” failed.

Also, President Trump gets to blame Congress as it stands, so his base won’t fault him. In case you didn’t know how it had gone down in President Trump’s Twitterverse, it’s the Democrats, stupid. Never mind that the Democrats by design weren’t supposed to be part of the equation. It’s their fault for not being part of the equation.

Weird how this is all working out, right?

Where does this leave Georgia Senators Johnny Isakson and David Perdue? Perdue, I am thoroughly convinced, would jump in a lake if the President told him to do it, and to that point, he’s already come out as a yes vote for repeal only. Isakson negotiated a deal to help charity hospitals in Georgia and other states that was put in the second version of BCRA, meaning he would almost certainly have voted for that bill. I’m thinking he’ll vote for the repeal only bill this time because he voted for the 2015 bill and is a vote that Senate Leadership can count on in a pinch, though he’s noncommittal so far. He has recently said that it would be wrong to vote for repeal without something to replace it, so I could be wrong.

Some points to ponder: When did Isakson and Perdue realize the bill would fail? What was the point of expending all that political capital, particularly in Isakson’s case, if it was always going to fail? Will Isakson vote for the repeal only bill?

It doesn’t matter in a sense, as the bill doesn’t have the votes to pass. It does, though, in another: Do our Senators really want repeal only, or do they think Georgians don’t have the sophistication to understand that repealing without a replacement will throw us back into the system that nobody liked before nobody liked Obamacare? (This also applies to any House Members calling for repeal only. Looking at you, Buddy Carter.)

That’s a cynical question, but an important one.

A more important question, though, is why President Trump, supported by so many in his base for his promise to make great deals for the American people, would have agreed to the partisan approach in the first place? Democrats passed Obamacare with the help of merely one Republican in the House and no Republicans in the Senate in 2009. That has not served them well, as every problem with the legislation has been all Democrats’ fault up until now. One would think Republicans would have learned something from that experience, as in “thank goodness it wasn’t us.”

Also, given that just seventeen percent of Americans recently polled on the issue liked the contents of BCRA, wouldn’t this strongly signal to the Dealmaker-in-Chief that he and Congress could and should do better than that? There are ways to find bipartisan compromises to our big problems that have a real majority’s support, not just the (slim) majority of the Senate’s support.

The biggest question, of course, is what now?

Legislators in the Georgia General Assemby had been looking at expanding Medicaid in 2017, but decided not to move forward with that plan after the House of Representatives passed its version of “repeal and replace.” Congressional Republicans have refused to fund parts of the bill over the past seven years in hopes that the exchanges would fail. Now, of course, Georgia has an issue with Blue Cross Blue Shield trying to get a massive rate hike out of its exchange customers. I hope McConnell will give up on repeal only and move on quickly to the shoring up of the exchanges. However, that doesn’t seem to be the way the White House wishes to proceed, with President Trump saying he would “let Obamacare fail.”

The President doesn’t want to “own it,” meaning any current problems with PPACA. Sorry, buddy. You’re the one who wanted to be President, and now you are, not Obama.

Everything that has happened since January is President Trump’s and Republicans’ to own on every topic, including all things health care. How many times have you heard people complaining about that terrible Lyndon Johnson for the current problems with Medicaid? What about that awful Dwight Eisenhower every time an interstate needs to be repaired? What was the last complaint you heard about that rascally Jimmy Carter regarding common core? No one does that. They always blame the current occupant of the White House.

I’m sure 2009 doesn’t seem that long ago. In the political world, though, that’s a lifetime, and voters’ memories are notoriously short.

Furthermore, Republicans — including Trump — promised Americans that if they’d just vote for them, just put them in charge, they would find a better path forward. I can promise you that a better path forward isn’t either the House or Senate versions of “repeal and replace.” It definitely isn’t any version of repeal only.

It’s one thing for Republicans to hold repeal votes when in the minority, however much of a fruitless and hollow exercise it became. It’s quite another to do it as the majority, when votes have real consequences and affect real lives.

When I particiapted in the Health Care Caucus working group (something I’m told doesn’t even exist in the House anymore, sadly), we had disagreements on where to go with health care reform, but one of the core principles for all of us was “access for all, not just insurance for all.” Maybe House and Senate Republicans might start there again with their way forward, and I’ll bet they’d get a lot of support from their colleagues across the aisle if they use that approach.

Make no mistake, though: There has to be a way forward. “Letting Obamacare fail” would also be failing the American people, and we wouldn’t have to wait very long to find out who voters think should own that.