For many, the failure of the GOP to repeal and replace Obamacare came as a surprise. Most Americans had never heard of the House Freedom Caucus prior to last week; nor did they realize that a group that makes up less than 10 percent of Congress could have so profound an influence over the future of our health care system.
Personally, I not was surprised that a solid block of House members revolted against Speaker Paul Ryan’s leadership last week. For months, House Freedom Caucus members have both privately and publicly chastised Ryan for being part of the dreaded establishment, an accusation that to them is akin to treason. Ryan’s Obamacare replacement plan — which they quickly labeled as Ryancare — was taken as a Benedict-Arnold-level betrayal of principle. Ryan’s plan had absolutely no chance.
I personally know a dozen or so House Freedom Caucus members. I’ve dined with them, laughed with them, debated with them and have agreed with them more often than not. I believe them to be genuinely good, patriotic, principled people who are trying to do their best to preserve and defend the country they love. In short, I admire and respect my House Freedom Caucus friends.
Unfortunately, while trying to stand on principle and keep their campaign commitments to fully and immediately repeal Obamacare, the House Freedom Caucus members have virtually ensured the enshrinement of Obamacare as the permanent law of the land. Are they entirely to blame for the debacle? Of course not. But the total unanimity of the Democrat opposition to any Obamacare changes put the House Freedom Caucus in a position of extraordinary power. Instead of using that leverage to make Speaker Ryan’s bill better, they insisted on an all-or-nothing repeal strategy that had no chance of passing.
So why did the House Freedom Caucus take such a position on Obamacare repeal when they could have helped unwind most of it, all while achieving groundbreaking Medicaid reforms in the same legislation? I can think of only one possible explanation. I think the House Freedom Caucus is counting on Obamacare to collapse, believing that its collapse will result in so much political heat that all House Republicans will be eager to vote for a straight repeal. I don’t expect this scenario to materialize.
There is no way that the Trump administration or House Republicans can stand by and let the health care insurance market collapse. A collapse would dump tens of millions of Americans into the ranks of the uninsured overnight; it would bankrupt hospitals and clinics who depend on commercial insurance payments to keep operating; it would also likely drive our economy into a steep recession. Most importantly, a collapse would cost some people their lives as they lose their access to live-saving care.
When the crisis moment for Obamacare comes — and it will come — Nancy Pelosi and the House Democrats will step up to the table with all of the leverage in the world. They will agree to make the necessary tweaks to shore up Obamacare, but will agree to nothing more, knowing that Trump and Republicans will own all of the political fallout if people get hurt. Last week, Trump began preparing for this eventuality by publicly inviting Democrats to work with him to fix the problems with Obamacare. At the point of crisis, of course, the Democrats will be only too happy to oblige.
I have never subscribed to all-or-nothing approaches to public policy, realizing that 100 percent of nothing is still nothing. I’m afraid that the House Freedom Caucus will realize, after it is too late, that sometimes the antonym of “Compromise” is “Complicity.”