Responsibility for the failure to undo Obamacare extends far beyond the late Arizona senator.
President Trump has been engaged in an increasingly gross and weird feud with John McCain, the deceased Arizona senator and war hero, this week. At a rally in Ohio on Wednesday, the president complained that last August he gave McCain “the funeral he wanted, and I didn’t get ‘thank you.’”
In addition to the bizarre complaint about McCain’s funeral, Trump has continued to attack the late senator for allegedly being the reason that Republicans failed to repeal and replace Obamacare.
“[McCain] said two hours before he was voting to repeal and replace [Obamacare], and then he voted thumbs-down, badly hurting the Republican party, badly hurting our nation, and hurting many sick people who desperately wanted good affordable health care,” President Trump said at an Ohio rally on Wednesday.
A former McCain aide tells National Review that McCain never pledged to vote for the so-called skinny-repeal bill in July 2017. But many people were indeed surprised by McCain’s vote against the bill because he had indicated at a press conference that he’d vote for it if Arizona governor Doug Ducey supported it and if congressional leadership gave assurances it wasn’t a final product but simply a means of keeping the legislative process alive.
Both conditions were met; McCain voted “no” anyway. Does that mean he bears responsibility for the GOP failure to repeal and replace Obamacare? Not quite. The truth, as Ramesh Ponnuru has written, is that McCain makes for a poor scapegoat.
The skinny-repeal bill that McCain helped kill would not have seriously repealed and replaced Obamacare. If enacted, it would have eliminated Obamacare’s fine on individuals without insurance, temporarily suspended the law’s medical-device tax and the fine on employers who don’t provide their employees insurance, and provided some greater flexibility to states granted waivers from some of Obamacare’s regulations. It also would have defunded Planned Parenthood for a year. (Republicans, with John McCain’s vote, ended up repealing the fine on individuals without insurance in their December 2017 tax-reform bill.)
From a conservative perspective, chipping away at a few additional parts of Obamacare via skinny repeal would have been better than simply repealing the individual mandate. But it wouldn’t have replaced Obamacare. It would have allowed Republicans to claim that they had repealed Obamacare when they really hadn’t solved the law’s central problem: skyrocketing premiums for Americans who purchase insurance on the individual market.
It’s also important to remember that enacting skinny repeal outright was never seriously considered. Senator Lindsey Graham, for example, said the plan was a “fraud” and voted for it only after receiving an ironclad promise that it would serve only as a vehicle to get the process to a conference committee with the House, which would theoretically produce a new bill. So a majority of Republicans were far from reaching a consensus on Obamacare when McCain voted “no.”
This isn’t to say that McCain’s actions during the Obamacare debate can’t be criticized. He was on solid ground when he objected to the legislative process: The skinny-repeal bill was released to the public two hours before a midnight vote was scheduled. But with his insistence that Republicans gain Democratic support for any health-care bill, McCain effectively abandoned his 2016 campaign pledge to repeal Obamacare. There was no way Republicans could have gotten significant Democratic support for a bill that even touched Obamacare, let alone one that cut off the law’s subsidies for elective abortion and defunded Planned Parenthood.
That said, McCain bears no more responsibility for the GOP’s failure here than do Susan Collins and Lisa Murkowski, who also voted to kill the skinny-repeal bill, not to mention Rand Paul, who joined McCain in September 2017 to kill off a last-ditch effort to block-grant Obamacare’s funding to the states.
If President Trump were really so upset about Obamacare, you’d hear him attacking Murkowski, Collins, and Paul with equal vigor. But his longstanding feud with McCain, which weirdly continues seven months after the senator passed away, isn’t really about health-care policy, as Commentary‘s Noah Rothman has pointed out. It’s something far more personal.
In reality, repealing and replacing Obamacare would have been an extremely difficult task regardless. Any substantial reform of the health-care system was always going to meet public resistance, and Republicans were restricted in what they could do by complex legislative rules governing the process that would allow the Senate to evade a Democratic filibuster. It was very late in the game until anyone in Congress came up with a bill approaching coherence.
And Trump didn’t help matters: He lacked any serious understanding of health-care policy and urged House Republicans to pass one version of “repeal and replace” only to later call the bill “mean,” which was quite the use of the bully pulpit. The truth is that Obamacare repeal was a collective failure of the GOP, but one for which leaders in Congress and the White House bear more responsibility than the rank and file, because that is the very nature of leadership.