Fallout from the health care debacle

U.S. House Speaker Paul Ryan, R-Wis., and Mick Mulvaney, Office of Management and Budget director, arrive for a March 23 meeting about the American Health Care Act in Washington. (CNS/Aaron P. Bernstein, Reuters)

Thank God for the Freedom Caucus.

I never imagined I would be writing those words. The libertarian archconservatives who constitute that caucus usually do not support anything that coheres with Catholic social doctrine. And, their opposition to the "repeal and replace Obamacare" bill, crafted by Speaker of the House Paul Ryan, was based on the premise that the bill did not go far enough, when Catholic social doctrine would require the opposite conclusion: It went too far in the wrong direction. Nonetheless, it was the Freedom Caucus, and their allies, that killed the bill.

Don't take my word for it. Yesterday morning, President Donald Trump tweeted, "Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club for Growth and Heritage, have saved Planned Parenthood & Ocare!" The circular firing squad within the ranks of the GOP has begun.

Of course, there is plenty of blame, or credit, to go around for the defeat of this bill. At the top of the list is the president himself. The man who wrote The Art of the Deal could not, in fact, seal the deal on his first major legislative battle. The man who told us during the campaign that "America doesn't win anymore" but if we elected him, we would win so much, "we will get tired of winning," has yet to put a “W” in his column. Turns out the leverage and the skills appropriate to a real estate transaction are not akin to those needed to overcome policy differences and ideological rigidity. Trump promised to shake things up. He "alone" could fix what was wrong with Washington. But, it was Washington, and his own party, that did the shaking.

A very close runner-up in the category "most at fault" is Speaker Paul Ryan. Trump said, "Nobody knew health care could be so complicated" but Ryan knew. And he knew, as well, that those complications could result in political turmoil as they had for Obama and the Democrats. I am sure he thought it would have been better to start with tax reform, but he needed the savings from repealing the Affordable Care Act to help make tax reform possible. And, he knew that Republicans had been promising to repeal the Affordable Care Act for seven years.

For several years now, Ryan has been assuring people that he had shed his devotion to Ayn Rand and libertarianism, that he was now more deeply influenced by Thomas Aquinas. Well, he must have had a relapse. In his effort to repeal the Affordable Care Act​, he was not deterred by the Congressional Budget Office estimate that 24 million fellow Americans, all of them poor and therefore of special concern for a Catholic, would lose their health insurance. He was convinced that the market would make everything right, or pretend to be so convinced. No, he was only deterred when he could not muster the votes for his proposal. Whatever else his performance was the past few weeks, it was no profile in Catholic courage.

Ryan is wounded as speaker, but likely to survive the fiasco. "Ryan's speakership remains secure," Matthew Green, a politics professor and congressional expert at Catholic University, told NCR. "Congress is not a parliamentary system, so if the speaker loses a vote it's not the same as a vote of no-confidence.  Plus, no one else in the House Republican Party seems to want his job. Having said that, the failure of the repeal bill does suggest that Speaker Ryan is going to continue to struggle with the same problem of a divided conference that his predecessor had."

The president and the speaker said they intend to set aside the health care overhaul for now, and turn their attention to tax reform, but that will not be a walk in the park either. "On the one hand, tax reform is a separate issue. Republicans may have very different views about it, and if Trump gets involved with a tax initiative earlier than he did with Obamacare repeal, he might be able to build a majority behind it," Green told me. "On the other hand, tax reform was always going to be tough, because practically every line in the tax code benefits some organized interest that will fight tooth and nail to protect it. If the failure to repeal Obamacare diminishes the reputation of Ryan and Trump as effective bargainers, that can only make it harder to pass something as complex and politically perilous as tax reform."   

The U.S. bishops' conference, which grew to hate the Affordable Care Act because of the contraception mandate that Obama issued during the law's implementation, was cool towards the GOP proposal. In a letter to members of Congress, Bishop Frank Dewane, chair of the Committee on Domestic Justice and Human Development, asked the Congress to address the "serious flaws" in the legislation, especially as it related to the poor. In response, Ryan consented to making the bill even worse for the poor in order to conciliate the Freedom Caucus, not the bishops.  

Very surprisingly, the official press arm of the bishops' conference, the Catholic News Service, published a video featuring Sr. Carol Keehan, president of the Catholic Health Association, and a strong supporter of the Affordable Care Act. Keehan said on the video, "This bill is catastrophic for Catholic social teaching and particularly for the people that we are called to serve." She also criticized the provision that would have given $15 billion in tax breaks to people making more than $1 million per year. And, she pointed out that every recent pope has insisted that health care is a "right." To be clear, Keehan is not here mimicking the Democrats. The Democrats are mimicking the Catholic Church's teaching. Here is the full video:



I want to commend the Catholic News Service for this video. I do have a question: Was the senior staff at the USCCB asleep when it was produced? They have not been kind to Sr. Carol over the years, and they have been anemic in their responses to Trump so far. This video was a delightful change from the norm.

I also want to commend the Democrats not only for sticking together in opposition to this bill, but for helping to reframe the issue. Almost every time I heard a Democratic member of Congress on this issue, they made the point: health care is not a commodity, it is a right. The Democrats need to do the same thing when they address tax reform and infrastructure spending, using the debate to reframe the issues in basic ways.

"I am not a member of any organized political party," Will Rogers famously said. "I'm a Democrat." Today, it is the Republicans who seemed unable to organize themselves around a set of ideas and policies that can be translated into effective governance. The Democrats, bereft of any real power, need to use this time to communicate their core values, and how those values shape policies. They are not going to be able to attach any winning amendments. Trump and Ryan are not going to start doing business with Minority Leader Nancy Pelosi. If Democrats remind themselves and the country what they believe in, and the GOP keeps shooting itself in the foot, 2018 is going to be a good year.

The Republicans like having one of their own in the White House, but they don't really have one of their own. They have Trump. There is a downside to working with a president who seems to live in a universe of alternate facts. In the wake of the debacle last week, he said he never promised he would get Obamacare repealed in his first 6​4 days in office. That is true. He said he would do it in his first week in office, maybe even in his first day. And, he said it over and over again. There is something admirable about a person who moves on after a bruising fight he has lost. There is nothing admirable about a person who so lives in the moment that he brings no sense of personal or national history to his job. The question for the Republicans is: Can they trust such a man? Will they risk their political careers on such a man? And, for those who care about the country and not just getting elected again, the more pointed question arises: How much damage can we prevent this man from doing?

[Michael Sean Winters is NCR Washington columnist and a visiting fellow at The Catholic University of America's Institute for Policy Research and Catholic Studies.]

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