The “skinny repeal” debacle reveals in miniature why Republicans have continued to struggle in passing health-care reform. For months now, many Republicans in Congress have treated voting on health-care reform like a suicide run into opposing fire. It would be painful, and it would be unpopular — and politicians have a Darwinian aversion to pain and unpopularity. Last night’s vote on “skinny repeal” was almost a parody of this dynamic: GOP senators were supposed to vote for a bill even as they denounced it and sought assurances from the House that this bill would never become law. Voting for a bill you secretly hope will fail is a long-standing Washington tradition, but voting for a bill you openly hope will fail might have been a bridge too far.
In 2010, Democrats made that suicide run in passing the Affordable Care Act, and have paid a huge price for it. But at least they got a major public-policy goal accomplished in exchange for that electoral evisceration. A pseudo-repeal of the Affordable Care Act doesn’t have the same cost-benefit ratio.
Avik Roy is right that Republicans have an obligation to try to redress the many shortcomings of the American health-care system, but doing so will take a more substantial rethinking of not just public rhetoric but also of policy strategy. So far, trying to pass big-picture Affordable Care Act reform on a party-line basis has been a doomed proposition in the Senate. Going forward, Republicans might have first to try to do some smaller reforms of the ACA (think of them as policy training wheels) and/or collaborate with centrist Democrats to pass slightly more ambitious but broadly popular efforts at reform. The bipartisan rewriting of the No Child Left Behind Act in 2015 offers an example of that kind of model of reform.
Successful smaller approaches to health-care reform could increase public trust in the ability of Republicans to manage health-care policy, which in turn could give the GOP new political opportunities in the future. Moving beyond a reconciliation-centric strategy of health-care reform could also allow the GOP to move on to other policy areas. Republicans cannot afford to have the whole of the 115th Congress be dominated by a health-care stalemate.
Successful legislating usually isn’t a sprint to disaster; a slower, more judicious walk can be more sustainable in terms of both politics and policy.