Not many people envy House Speaker Paul Ryan’s life these days. You might recall that he was begged to take over as Speaker of the House after conservatives were tired of John Boehner. Ryan was very reluctant. He knew the toll that role would take on his family and his own sanity. Yet he accepted. And, even still, amidst all of the Trump era chaos, I don’t think he regrets it. Ryan is a policy wonk. He might hate the politics but he loves the deep dive into fixing problems.
Let me take you into his world for a moment based on my own experience working on Capitol Hill years ago. Given that today is the seventh anniversary of Obamacare, let’s just focus on its repeal and replacement. Again, you might recall that not long ago I predicted Obamacare would NOT be repealed – a prediction I stand by still. So here is why I say that and the heavy lift faced by Speaker Ryan. Let’s piece together all of the forces in play.
First, he has his own ideas about what should happen and, though he represents the entire House body in his role as Speaker, as the House leader it’s hard not to subordinate what you believe to be good policy. Knowing him the little bit I do, I know he would love to see Obamacare erased from the history books. Ryan believes in free markets. Best I can tell, agreeing with most conservatives, he does not believe health care is a right. He believes in old-fashioned insurance markets and individual plans, designed by the customer, that reward health but cover sickness. That’s the health insurance market Americans will never see again, in my opinion – and my gut tells me Paul Ryan knows that too.
Second, Ryan faces a very limiting legislative procedural obstacle. It’s called reconciliation. Reconciliation is a process to handle budgetary items requiring only a simple majority vote in the Senate. If non-budgetary issues arise for the Senate, such as a House repeal bill that guts “essential benefits” currently covered by Obamacare, any vote would require at least 60 senators – a bridge much too far to reach these days. For any repeal and replace bill to pass the Senate, it needs to be careful not to overstep the rules governing reconciliation. Just to be clear, I’m saying that no repeal of Obamacare will happen if that bill requires 60 votes in the Senate. Ryan is all too aware of this fact.
Third, the House Freedom Caucus, full of conservative spitfires, will not support a repeal plan that doesn’t actually repeal the key components of Obamacare. That’s Ryan’s biggest stumbling block right now in the House and why President Trump has scheduled so many meetings with the caucus members. The House Freedom Caucus is key at this point. They have approximately 36 “no” votes right now and all they need to block an unsatisfactory repeal bill is about 30. So Ryan, with Trump’s help, will try to peel off six or seven of those caucus members. That won’t be easy in that group – the last thing those guys want to be accused of is selling out. Not selling out is why the caucus was created in the first place.
Fourth, conservative senators, such as our own Mike Lee, will stand firm on a full repeal bill. The GOP majority in the Senate is 52 to 48 – a three-vote margin when you include tie-breakers by the Vice President. Senate conservatives only need three “no” votes to stop an unacceptable repeal bill. That’s Senators Lee, Cruz and Paul. Done. It’s dead without them.
Fifth, even if Paul Ryan manages to console House and Senate conservatives and give them what they want, there is a whole Congress filled with moderate Republicans who probably would kill that bill. Moderate GOP members in both chambers want to keep all of the essential components of Obamacare, mostly for political reasons. Even though Speaker Ryan and Trump have assured everyone that a repeal bill will not get rid of pre-existing conditions and adult dependent coverage, moderates love other features of Obamacare and may pull support if those aspects are excluded.
Paul Ryan has procedure going against him, House and Senate hard-liners against him and potentially moderates against him. His one constant is the Democratic minority and they, too, are against him. Who the hell outside of Ryan and Trump are for this thing? And if Trump is your only friend, you stand alone.
So how does Speaker Ryan get out of this fix? One way is to force rules changes that give him more flexibility inside the process. But that requires a heavy hand on par with LBJ-type insider games and Ryan, though smart enough, does not have the temperament to do that. He could try to piecemeal the repeal of Obamacare, offering up one component at a time for a vote. Conservatives would love that to hold every legislator accountable but the two party structures would hate it – and, in political timing, it would take forever. He and the president could start the arm-twisting and vote manipulations, such as offering individual legislators specific deals that would make the representatives look good back in their districts. Some of that will occur. It always does. But not enough to make a difference.
That leaves Paul Ryan with one option and one option alone to deal with this mess – simply to deal with the mess. And this is why I stand by my prediction that Obamacare will not be repealed.
I’m Paul Mero. Thanks for listening.
