Did Paul Ryan intentionally sabotage his own health care plan?
Why the speaker of the House might have purposefully written a terrible bill no one likes
Speaker of the House Paul Ryan finally introduced his proposed replacement for ObamaCare late Monday. It did not go well.
Democrats were predictably appalled that the GOP proposal, called the American Health Care Act, would essentially take away health care from millions of people, many of them poor, in order to pay for upper-class tax cuts. Moderate Sen. Bob Casey (D-Penn.) summed up the feelings of the Democratic caucus when he declared that the bill's savage cuts to Medicaid were a "disgrace to our nation" and that "I will fight it with everything I have."
But there was never a chance that Democrats would support any major Republican changes to the Affordable Care Act. So what's really interesting is the amount of opposition that the bill has instantly generated among conservatives.
If Democrats see taking away poor people's health care to pay for things like tax breaks for health insurance CEOs as cruel, the American right sees it as not cruel enough. Sen. Rand Paul (R-Ky.) asserted that the bill was "dead on arrival." The far-right Freedom Caucus in the House was no more enthusiastic. Conservative health policy wonks attacked the bill. And major conservative think tanks like the Heritage Foundation, the Club For Growth, FreedomWorks, and the CATO Institute immediately came out swinging against "RINOCare."
What explains the depth of conservative opposition? One possibility is that we should, as Marco Rubio might put it, dispel with the myth that Paul Ryan knows what he's doing. While some grumbling from House conservatives was inevitable, it's odd that he couldn't get buy-in from conservative organizations for a replacement plan. On its face, everything about this botched rollout seems like gross political incompetence.
Another, and perhaps more plausible, answer is that Ryan couldn't possibly be this inept. He didn't get his allies on board for a simple reason: He doesn't actually want any major repeal plan to pass.
This isn't to say that Ryan would not, all things being equal, like to kill the Affordable Care Act. His entire political career has been devoted to attacking programs for the poor to pay for upper-class tax cuts. But now passing and maintaining tax cuts and achieving other crucial objectives means Republicans must keep control of Congress — and that's where ACA repeal becomes a major political liability.
Now that it's being seriously threatened, the ACA is popular. And as Greg Sargent of The Washington Post explains, passing RyanCare would almost certainly be a political disaster in the 2018 and 2020 elections. Marginal voters might favor "small government" and oppose the "government takeover of health care" in the abstract, but that doesn't mean they won't object to having their coverage taken away or made substantially worse.
Passing a health care bill that takes coverage away from voters would also complicate what will already be a difficult political situation for the Republicans. They've benefited from having the opposition control the White House during a time of gridlock, but now the shoe is on the other foot. The out party generally fares better in midterm elections to begin with. Even worse for Republicans, the popularity of the president is the best predictor of how the party will fare in congressional elections. And while Donald Trump was able to eke out an Electoral College win with a lot of help from an unpopular opponent and the FBI, he remains a very unpopular figure.
As Sargent says, because the gerrymandered House and the 2018 Senate map both favor Republicans, it's possible that the GOP could maintain control of both houses anyway, but there's only so much political damage they can sustain. (And remember that while gerrymandering helps you in a typical election, because it involves spreading out your supporters, it makes a party more vulnerable to major losses in a wave election.) Cutting their losses, letting ACA repeal die, and focusing on priorities that won't generate waves of intense opposition from all sides is probably the least bad political option for the GOP.
Consider the case of Rand Paul. Kentucky's very popular Medicaid program, Kynect, would be destroyed by the Republican bill. So attacking the bill from the nominal right while allowing Kynect to live would be the least bad option for Paul. Many of the other GOP senators from states that have accepted the ACA's Medicaid expansion probably feel similarly.
For many Republicans, cold political logic dictates that RyanCare should be allowed to die. And Paul Ryan might know it.