Thursday, March 16, 2017

Leverage

Jim Geraghty raises an interesting point: The GOP is offering the AHCA as "Phase 1" in a three-phrase process.  The second "phase" is President Trump's rewriting of the Obama administration's ACA regulations, and the third would be more market-oriented (and perhaps more popular) legislative reforms, such as selling insurance over state lines.

Geraghty, though, wonders whether there will be enough bipartisan energy to pass "Phase 3":
Assume the American Health Care Act passes the House, at least 50 Republicans in the Senate vote for it and Trump signs it into law.
For "Phase Three," will eight Senate Democrats be eager to vote with Republicans to make further reforms? If you’re a Democrat, after AHCA passes, Republicans "own" the status quo on the health care system. You can blame AHCA for anything any constituent doesn’t like about their insurance, their premiums, their co-pays, their deductibles, or their quality of care. It may or may not be accurate, but let’s face it, accuracy has never mattered much in attack ads.
Perhaps naively, I believe that there could be a chance getting at least 60 Senate votes--including at least 8 Democrats--to support broadly popular reforms that would increase efficiency in the health-care market.

However, there is a possibility that this chance gets slimmer after the passage of "Phase 1."  Currently, Republicans can still blame the many shortcomings of the current health-care system on the legacy of the Affordable Care Act.  They can try to use these shortcomings as a way of putting pressure on Democrats in swing and lean-Republican states: We're trying to fix the broken system left to us by Obamacare, and you're just obstructing.

That dynamic changes, however, if a major piece of health-care legislation (like the AHCA) is passed on a party-line vote.  Then, it gets much harder to blame a "broken system" on the ACA alone.  Passing the AHCA gives vulnerable Senate Democrats an obvious retort: Nuh-uh, you guys broke the system with Trumpcare.

With this political cover, Democrats would have the temptation to obstruct any further changes to the health-care system leading up to the 2018 elections.  The obvious strategy would be to attack (fairly or not) the AHCA for denying care to the poor and vulnerable in order to give tax-cuts to corporations and "the 1%".  Democrats saw how well attacking a major piece of health-care reform passed on a party-line vote worked for Republicans in 2010; they might try to repeat that in 2018.

The recent political cycle has laid to waste many predictions, so any predictions about the future political dynamic should be made in a hypothetical rather than categorical mode.  Nevertheless, it seems as though Republicans could lose some leverage over Senate Democrats if they pass a party-line major health-care reform.  That leverage may be crucial if they hope to pass later reforms to health-care law this Congress; these reforms would require 60 votes in the Senate and so would need some Democratic support.

If Republicans want to enact major changes in health-care regulations (not just government financing), they might have more political leverage before passing a party-line bill than after passing such a bill.

(Two related points: Some folks have raised a possible counterargument to this narrative of leverage: Once the ACA is reformed through a party-line vote on the AHCA, Democrats will have less incentive to defend the ACA in its entirety and will be more willing to compromise on other areas.  At that point, it will no longer be about defending President Obama's "legacy" and more about pragmatically working to improve national health-care.  In a less politically polarized time, this counterargument would have more force, but it could still be plausible.

Also, if something like the AHCA did pass in its current form, one possible bargaining chip to get Democrats to support a later wave of reform would be to offer to increase Medicaid subsidies.)

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