Republicans’ failed attempt to repeal and replace Obamacare is an enormous setback. Neither Speaker Paul Ryan nor President Donald Trump attempted to sugar coat their inability to collect enough votes on their endorsed plan.
“You’ve all heard me say this before,” Speaker Ryan said. “Moving from an opposition party to a governing party comes with growing pains. And well, we’re feeling those growing pains today.”
Even with those growing pains, and with no support from Democrats—who made the political calculation to refuse to work with Republicans on a plan—Republicans came close to passing a bill.
“We were very close, and it was a very, very tight margin,” President Trump said in remarks to the press. “We had not Democrat support. We had no votes from Democrats. They weren’t going to give us a single vote, so it’s a very difficult thing to do.”
Unsurprisingly, the press was quick to label this as a humiliating defeat for Speaker Ryan and President Trump.
“Republicans had seven years to figure out a replacement!”, they crow. “How can the author of ‘The Art of the Deal’ not be able to make a deal with members of his own party,” they ask. “The president and speaker’s prestige and power is surely diminished if they can’t even take on the Freedom Caucus and win,” they’ll say.
But these are heartless, if not incorrect, political analyses. Americans don’t (or at least, shouldn’t) care about whether Speaker Ryan has used up political capital in a failing effort. They care about their ability to purchase meaningful health insurance. They’re concerned about premiums and deductibles soaring. And they’re worried about what happens when they get sick, get hurt, and get old.
That’s why Republicans had to try, even if they knew there was a razor-thin margin for success. Democrats’ foolhardy attempt to inject more government into the healthcare market via Obamacare simply left Republicans no choice.
Simply put, Obamacare is slowly tipping into a death spiral that will lead to its destruction, and millions of people will be hurt along the way. A recent report from the Department of Health and Human Services on enrollment figures shows why. According to the report, enrollment in Obamacare plans fell by 500,000 over the last year. Worse, the population covered by the plans is trending the wrong way with a measly 27 percent of enrollees coming from young adults between the ages of 18 and 34.
As Megan McCardle explains for Bloomberg View, these numbers tell us a lot about the fate of Obamacare.
By the end of 2016, however, it looked as if the market had matured, without the deep pool of healthy consumers that insurers and regulators had been hoping for to keep costs down for everyone else. The administration had originally stated they needed about 40 percent of the market to be between the ages of 18-34; they got about 28 percent. Insurers reported widespread losses. The risk subsidy programs were less generous than insurers had been expecting after Republicans insisted they could not be topped off from the federal budget, and anyway, two out of the three expired at the end of 2016. And enrollment growth from 2015 to 2016 had been disappointingly slow, suggesting that the long-awaited flood of better-risk consumers into the marketplaces wasn’t happening.
So insurers raised premiums substantially in order to recoup their losses. Those increases were not invisible, and some people decided that they were no longer worth it. And who was most likely to stop buying insurance? People over 18 and under 55, the relatively cheap portion of the market to cover.
That’s the world that Democrats created. That’s the world that Republicans—despite all of the political obstacles working against them—attempted to fix. They shouldn’t be jeered for failing. They should be praised for trying.
One thing is for certain, this won’t be Republicans last bite at the apple.
“As you know, I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats and have one unified deal,” Trump said after the repeal and replace plan was pulled from the floor. “And they will come to us, we won’t have to come to them.”
That’s the worst possible outcome, and the blame for it lays squarely at the feet of Congressional Democrats.