President Trump and his advisers ought to study the collapse of the American Health Care Act. It’s a case study in how Beltway institutions—the so-called Swamp Trump pledged to drain—can herd a president and his party toward unpopular legislation and political defeat.
Begin with this question: Why the rush to repeal and replace Obamacare? Yes, repealing the law has been a Republican priority since 2010. But Democrats had spent decades laying the groundwork for universal health care before finding themselves in control of the government in 2009. And even then, it took a year for the Affordable Care Act to be signed into law. Republican leadership unveiled a plan and gave the caucus very little time to influence it before calling for a vote. They did so because repealing and replacing Obamacare would give them more leeway to cut tax rates down the line. The legislative schedule determined policy. Not a good idea.
The objective of the American Health Care Act was not to write into law the best possible conservative reform of health care. While I happen to think the bill had plenty of good stuff in it, its main purpose was to overcome a Democratic filibuster in the Senate. That’s why the bill failed to overturn Obamacare’s regulatory structure: House leadership didn’t believe such reforms could pass the watchful eye of the Senate Parliamentarian. And when, late in the process, Senator Mike Lee of Utah suggested that the parliamentarian would allow deregulation in the bill, the situation became even more confusing.