Health reform is dead, but Trump makes Republicans pretend it's alive

Josh Barro
U.S. President Donald Trump honors the Super Bowl champion New England Patriots at the White House in Washington, U.S., April 19, 2017. REUTERS/Joshua Roberts

Thomson Reuters

The Republican healthcare bill is supposedly coming back from the dead, again. Some senior officials in the White House are expressing optimism for a vote by midweek next week, Politico reports — meaning such a bill could pass the House within President Donald Trump's first 100 days in office.

And yet, as a senior GOP aide told Business Insider's Bob Bryan: "The question is whether it can get 216 votes in the House and the answer isn't clear at this time. There is no legislative text and therefore no agreement to do a whip count on."

I think it is best to understand the periodic reemergence of the American Health Care Act as similar to the periodic searches for evidence that President Barack Obama really did "tapp" Trump's phones.

Trump says he was wiretapped, so he sets off a frenzy as Republicans seek to substantiate that claim, even though they will never be able to. Trump says Republicans are still making great progress on a healthcare deal, so he also sets off frenzies among Republicans to substantiate that claim, even though they'll never be able to.

Trump forces his staff and Republicans in Congress to spend energy trying to construct in the real world the alternate reality that exists in his head, even when their energies would be best directed elsewhere — for example, toward trying to reach an agreement on a bill to prevent the government shutdown that will occur, absent legislation, on April 29.

Nothing has changed

The problems that prevent Republicans from passing a health care bill remain the same as they ever were.

A substantial number of members of the Republican House conference have maximalist ideas about Obamacare repeal, and can't abide leaving a lot of the law's spending and (especially) insurance regulations in place.

A substantial number of other members of the Republican conference have ideological or political objections (or both) to changes that would take away health insurance from many of their constituents, and/or make it difficult for people to get health insurance coverage that addresses their actual medical needs.

Fixing the first group's objections will only deepen the second group's objections. The spending the Freedom Caucus hates is what keeps coverage levels high. The regulations they hate are what make sure coverage actually addresses people's healthcare needs, including pre-existing conditions.

Healthcare is more complicated than Trump realized, but it's not so complicated that you can creatively slice and dice the legislation to address the objections from both the right and the center. It's impossible to write a bill that gives 216 Republicans in the House something they consider to be politically and substantively acceptable.

Meanwhile, the healthcare bill keeps getting less popular, congressional Republicans keep getting berated about the bill by constituents at town halls, and more members keep responding to that beratement by making promises to ensure the law protects coverage and holds people with preexisting conditions harmless — promises they will break if they vote for a revived version of the bill.

This bill is dead. Dead, dead, dead, dead, dead, dead, dead. But Republicans will prop up its stinking corpse, Weekend-at-Bernie's style, until the president allows them to stop.

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