As Republican senators craft their healthcare plan, they should bear in mind their record and the promises they made the voters. The American Health Care Act is a positive step forward in the repeal process, but Republicans in the Senate must build on the reforms begun in the House, not tear them away.
In 2013, Republicans unsuccessfully attempted to defund ObamaCare in the appropriations process. The effort was scuttled in the Democrat-controlled Senate (a problem voters resolved in 2014).
In 2015, Republicans unsuccessfully attempted to repeal ObamaCare through the reconciliation process. This effort made it all to the way to President Obama’s desk, but was vetoed. The threat of a veto is gone as of Jan. 20, 2017.
In the seven years since ObamaCare was enacted, Republican candidates for offices from dog-catcher to the presidency have vowed to repeal ObamaCare. In 2013 and 2015, Republicans in Congress made full repeal an official part of their voting record. Those Republicans successfully ran on this record in 2016, effectively promising their constituents that they support full repeal of ObamaCare.
In 2012, 2014 and 2016, Republicans universally made perhaps the clearest, most emphatic campaign promise in modern history. And they were rewarded for it with unified control of both chambers of Congress and the White House.
Their target, ObamaCare, can be explained in a few basic parts.
The first is a mandate that every American retain health insurance, whether purchased by their employer or on their own. The American Health Care Act repeals this mandate.
The second is a subsidy scheme for low-income Americans who purchase their own health insurance. The American Health Care Act repeals this subsidy scheme and replaces it with a tax credit that increases with age.
The third is a regulatory scheme that places all sorts of requirements on health insurance companies. The American Health Care Act largely leaves these regulations in place, but sets up an opportunity for states to apply for a waiver for a few of the most damaging regulations. The states that do obtain a waiver will ultimately prove that repealing these regulations will drive down the price of premiums, and more states will choose to follow.
The fourth is an expansion of the population of people eligible for Medicaid and an increase in the share of the cost the federal government will bear. The American Health Care Act steps down the expansion over time.
A group of 13 Republican senators is currently working through each of these topics, negotiating a consensus agreement that they believe will get the 51 votes required to pass. Admittedly, this is no easy task, as the views of these 13 senators are as varied as possible on each of these four topics. However, this disagreement is a brand new phenomenon unique to 2017. No such disagreement existed the last time the Senate considered ObamaCare repeal.
All 13 of those senators voted for the 2015 repeal bill, which looked dramatically different than the changes some of those Senators are vying for in 2017. To be clear, the 2015 repeal effort did not include any plan to replace ObamaCare, so all of the replacement aspects of the AHCA are brand new territory. However, even those topics explicitly covered in the 2015 repeal bill are up for grabs in this year’s negotiation.
In one sense, 2015 was a dry run just to refine the difficult parliamentary requirements of the reconciliation process and was always doomed to a veto. In a more significant sense, however, the 2015 process represented a specific, detailed promise to the voters who exercised their choice in 2016.
Shouldn’t senators be expected to be consistent? Shouldn’t their voting record before a major election match their behavior immediately after that election? Let’s hope this negotiation reflects that kind of admirable consistency.
This piece originally appeared in The Hill on 5/23/17