“Fixes” are coming to the American Health Care Act. Rejoice! “Fixes” would be useful, since all but a few dozen people in the world think it’s a bad bill. The problem is that each bloc of Republicans that thinks it’s a bad bill has dramatically different reasons for why. And there was no sign on Capitol Hill on Thursday that any neat “fixes” exist that can unite the conservative and moderate wings of the caucus. If this bill is to pass, one side will have to break and accede to “fixes” that move the bill in the other’s direction. If it doesn’t pass, each faction will be responsible for making the governing party a governing joke.
Who budges?
Conservatives, having viewed a Congressional Budget Office score that shows the bill eating fully a quarter of Medicaid funding in 2026 while separating north of 10 million poor people from their health coverage, are still up in righteous arms about how gingerly the bill treats lower-income Americans. It is not enough for them to give Medicaid enrollees a few years to get their papers in order and say their goodbyes. They demand an end to the expansion beginning in 2018. On top of that, they want to include more work requirements for “able-bodied” individuals to receive Medicaid, having seen the bounty of decent jobs available in, say, Appalachia. They also want to deprive those on the individual markets of the modest subsidies proposed to them. It really is something, and they feel no pressure to move from this hard-line position.
And why should they? It’s an astounding victory already that they’re speaking directly with the president about what can be done to earn their votes, even though the CBO score was a big, bright, flapping red flag against moving further rightward. Freedom Caucus members are confident enough in their leverage over House Speaker Paul Ryan that at least one of them now feels comfortable comparing him unfavorably with Nancy Pelosi.
“I have to be honest. Sometimes I give credit to Nancy Pelosi, that she knew what it meant to have a majority,” Rep. Raul Labrador said Thursday, speaking at a monthly “Conversations with Conservatives” press conference. “To her, having a majority was implementing the promises that she made to her constituents.”
“Maybe Paul Ryan needs to take a couple of lessons from Nancy Pelosi,” he said.
These conservatives laughed off threats leadership might try to use to get them in line.
“My staff just texted me, ‘The American Action Network robocall asking constituents to call our office has completely backfired again,’ ” Labrador said, referring to the leadership-aligned pressure group pushing Ryan’s bill. “‘Every person but one has called to oppose the bill.’”
Texas Rep. Louie Gohmert, a new member of the Freedom Caucus, brought up the leaked audio from last fall that Breitbart published this week in which Ryan dropped his campaign support for Trump.
“I believe it was 12 comments from people on that call, and all but one were absolutely adamant that we have to get in step, in support” of the president and his issues, Gohmert said. “That’s what I’ve seen from the rank and file. Leadership may try to go off like they did on that conversation—‘let’s save ourselves’—and the rank and file are going to be with the president. And I’ve found President Trump to be much more accommodating than our leadership has been so far.” It’s unclear if those accommodations from the president are making it into Ryan’s bill.
Either way, if Gohmert or Labrador were to vote for whatever bill Ryan put forward, they would be still be re-elected to Congress. They are not going to be beaten from the right in a primary, and their districts are safe in the general. Jamming Medicaid into the wood chipper is an ideological passion project for them.
This bill is life and death for Republican moderates. They’ve always been there for leadership when conservatives throw their fits over spending bills or the debt ceiling. Shouldn’t they be the beneficiaries of whatever “fix” is coming?
“Much of the focus thus far has been focused on the hard right and their concerns,” Pennsylvania Rep. Charlie Dent said Thursday. Dent co-chairs the moderate Tuesday Group, a caucus that also has the numbers to tank the bill if it votes as a bloc. “I think now, since the CBO report came out, some of that focus is starting to shift to the center-right members.”
“Many of the people in our group are in the governance wing of the party,” he continued. “We’re the ones who put up the votes to make sure the government functions and doesn’t default.”
Is this the vote where the Tuesday Group puts its foot down after the Freedom Caucus has dragged a bill further rightward?
“Well, we’ll see,” he told reporters.
I asked Dent if there was any possible trade out there between the Tuesday Group and the Freedom Caucus. Is there some ask moderates could make in exchange for, say, moving the end of the Medicaid expansion to 2018?
“That’s a nonstarter,” Dent said. Another reporter asked, Well, what about 2019?
“That’s a nonstarter too.”
Conservatives feel like they have the upper hand. Moderates, recognizing that this bill was seemingly designed in a laboratory to end their political careers, don’t look like they’ll just hand Ryan however many votes he asks of them this time—especially if the bill has a strong chance of dying in the Senate. (It has a better than strong chance.)
How does this get resolved? One very good option is that it doesn’t.
If it did, though, it might look something like the following: A package of modest fixes offering talking points for both moderates and conservatives is introduced. They all still complain. A few other last-minute tweaks are worked out—a provision for conservatives that institutes “work requirements” for poor children with leukemia before they can eat their dessert, some vacation vouchers for moderates to use once they’ve lost their jobs in Congress—and the bill is brought to the floor. If anything is going to move them, it’s still going to be the fear of being one of the members who killed the Obamacare “repeal and replace” effort and, with it, Republicans’ legislative agenda. But it’s not going to be a silver-bullet policy fix that unifies House Republicans. There is none.
