Republicans Can't Agree on How Much They Want to Destroy Our Health Care System, Delay Congressional Vote

No matter when the House votes on repealing Obamacare—it was scheduled for Thursday but abruptly postponed—President Trump and the House GOP have shown the nation that the Republican Party’s most extreme elements are in the driver’s seat.


Absent anything resembling political discipline or party unity, the arch-right-wing House Freedom Caucus has demanded a series of increasingly draconian measures to be put in the Obamacare repeal legislation in order to secure their yes votes. Whenever Speaker Paul Ryan brings a repeal bill forward with enough votes to pass it, it’s likely to be a hollow victory for Trump and the House GOP. That’s because its details will be so harsh that even more GOP senators will likely side with Democrats and vote no.

“There are at least a dozen skeptics of the bill among Senate Republicans, who maintain a slim 52-to-48 advantage, and many of them want to maintain some of the current law’s more generous spending components,” the Washington Post reported midday Thursday, before Ryan postponed the vote. “If Republicans fail this initial test of their ability to govern, Trump and Capitol Hill Republicans may face a harder time advancing high-priority initiatives on infrastructure, tax reform and immigration. They might also find themselves navigating strained relationships among themselves.”

The White House and House Republicans know they have to pass something to save face, as they have gotten off to the least-productive start of any recent presidency. However, beyond the question of whether any legislation that suffices in the House is doomed in the Senate, is the emerging reality that the House’s most ideological Republicans now know they have power to hold that body hostage to their bottomless whims.

As of late Thursday, it appears the Freedom Caucus is on a rampage that neither Ryan nor Trump can satisfy or defuse. The nation is seeing a primetime display of boundless extremists who, once given concessions, keep demanding more. Millions of Americans who value Obamacare can only hope that these Republicans continue their stampede sufficiently to derail any repeal. 

Look at how the week began. On Monday, Ryan, responding to this hard-right flank, revised his legislation that would strip health care coverage from 14 million people in 2018 and grow to 24 million in a decade, according to the Congressional Budget Office. Ryan added a punitive work requirement for poor Medicaid recipients. It hardly mattered that the Affordable Care Act’s expansion of Medicaid has helped people return to work and that the new requirement would make it harder for many people to hold jobs, as economists have said. Somehow this right-wing cadre sees that as spreading freedom.

By Thursday, the Freedom Caucus had met with Trump and were said to extract more concessions, namely a pledge to repeal Obamacare’s “essential health benefits,” which require insurers to cover services including emergency-room visits and hospital stays, mental health, maternity, preventive care and prescription drugs. The Freedom Caucus’ rationale was that not everyone uses these, so why should they be included in all health plans and premiums? This section of the law also bars insurers from setting premiums based on a person’s sex, medical condition, genetics or other factors. Yanking these standards would be a bonanza for insurers, while pushing those lacking coverage into financial ruin when crises strike. But that, too, is more freedom.

Exactly how the essential benefits revocation would be legislatively handled was one of the reasons the vote was postponed. A pledge by Ryan and Trump that it would be kept out of the House bill but added by Senate GOP leadership wasn’t sufficient for some Freedom Caucus members. They wanted it in the House bill and didn’t believe its inclusion would procedurally kill the bill in the Senate. (A spokesman for the Senate Democratic leadership said doing do would invoke rules requiring 60 votes to pass; there are 52 Republican senators.) Other Freedom Caucus members said they didn’t trust the Senate to add it as an amendment, while others, such Rep. Justin Amash, R-MI, remained unsatisfied because Ryan’s repeal didn’t revoke every line of Obamacare.

The House Republicans and the White House said they expect to bring an Obamacare repeal bill to the floor as early as Friday. Whether the elements of that legislation will doom its passage in the Senate is an open question. But for now Americans have seen who holds the power in the House. It’s not Ryan, and it’s not Trump. It’s the most extreme right-wing Republicans. The lunatics have taken over the asylum.

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