Despite fractures within their party exposed by the failure to bring the American Health Care Act up for a vote in the House last week, Republicans have not abandoned their effort to reach an agreement on health insurance reform.
President Donald Trump has said he now wants to move on to tackle tax reform, but negotiations continue this week between the White House and Republican leadership on a path forward for repealing and replacing the Affordable Care Act.
“I’m optimistic about the process,” Rep. Darin LaHood, R-Ill., said Wednesday.
He was disappointed Republicans could not scrounge together enough votes to pass the AHCA on Friday, but he emphasized that the problems it was intended to solve remain.
“Remember, if we do nothing, Obamacare fails. It will collapse… We have an obligation to the American people and a responsibility to fix health care,” he said.
Democrats dispute the notion that Obamacare is collapsing, despite massive premium increases for the individual markets in some states for 2017. Most acknowledge, though, that the system is flawed and needs to be addressed.
“We don’t want to throw the baby out with the bathwater,” said Rep. Jim Costa, D-Cal. “We want to fix what’s broken and we can only do that if we work in a bipartisan fashion.”
The Congressional Budget Office estimated the AHCA would result in 24 million people losing insurance, either by choice or due to rising premiums. Critics warned that the changes the bill made would hit the elderly and low-income families hardest.
The Freedom Caucus, a faction of conservative and libertarian lawmakers who often present a united front on major votes, remained wary of the bill despite heavy pressure from the White House.
Caucus chairman Rep. Mark Meadows, R-N.C., recognized that the group may bear a “disproportionate” share of the responsibility for the inability to reach a consensus, but he insisted it is more important to get the legislation right than to get it passed.
“When I looked at the bill last week, too many of my constituents would have been adversely affected,” he said.
Meadows stood by his opposition to the bill Wednesday.
“We’ve been very consistent,” he said. “We need to see one thing, and that is premiums must come down.”
The AHCA did not repeal enough of Obamacare’s mandates for some caucus members and Meadows felt it did not do enough to preserve the safety net for the most vulnerable.
Some Freedom Caucus members were swayed by the president’s lobbying effort. Rep. Brian Babin said he was prepared to vote “yes” after Trump offered to eliminate essential health benefit provisions.
“The president moved our way and it was sufficient for me to be able to vote for this bill,” he said.
He hopes the legislation can still make it to the House floor with some additional changes.
“I want Americans to have a health care system that is market-driven,” he said.
Babin declined to comment on reports he is considering joining Rep. Ted Poe in leaving the caucus over its opposition to the AHCA.
“The Freedom Caucus has been very effective in the past and I disagreed with the majority of them on the health care bill,” he said.
Rep. Markwayne Mullin, R-Okla., said conservative lawmakers should have been satisfied with a bill that reduced taxes, cut the deficit, and shifted control of health care away from the federal government.
“I’m afraid we allowed the perfect to become the enemy of the good,” he said. “There’s never going to be a perfect bill.”
President Trump has indicated he may be more open to working with Democrats on health care after the Freedom Caucus helped sink the AHCA.
Though Democratic leaders have also signaled a desire to seek common ground, Rep. Thomas Massie, R-Ken., doubts they will agree to scaling back the ACA’s provisions as long as the law is in place.
“He’s going to have to help us repeal Obamacare before Democrats come to the table,” he said.
Massie also suggested breaking down the reforms Republicans are seeking into smaller bills and attempting to pass the measures that can get majority support on the floor.
“Maybe take a smaller bite of the apple instead of swallowing the whole thing at one time,” he said.
Whatever direction Republicans choose to take, their struggle to advance the AHCA illustrates one important lesson the GOP and the Freedom Caucus are quickly learning.
“It’s much easier to be an opposition party than it is to be a governing party,” LaHood said.