The passage of the American Health Care Act in the House on Thursday is a major legislative breakthrough for Republicans, who are carrying the heavy load of repealing and replacing Obamacare with no help from the minority Democrats.
What started as a messy process with plenty of dissent has led to productive legislating, where individual House members, like Rep. Mark Meadows of the Freedom Caucus and centrist Representative Fred Upton, improved the bill with their changes. The successful outcome was also a lesson for the Trump administration that the White House, rather than the GOP leadership in the House, should take the lead on such core priorities for the president.
The drama surrounding the House vote on the AHCA is just a warm-up act for the complexities and stress in store when the Senate takes up the bill. The current divide among many conservative and centrist Republicans shows how these two different groups play by their own rules and are not necessarily willing to stand with President Trump when their own political interests are at stake.
Moderate Republicans could see the challenge of “selling” the new legislation to their constituents, especially in those districts that favored Democrat Hillary Clinton in November.
The goal of the GOP: lower health care premiums while providing more free-market options and competition. Americans should not feel that they have been left out to dry.
But it’s tricky because every transition comes with challenges, and voters will be expecting immediate and effective changes to their health care. But there are real selling points in the House bill. John Desser, vice president of public policy and government affairs at eHealth, says that under the House GOP bill “the middle class wins, unlike in Obamacare where they were left behind.”
While the Democrats are content to sit back and let Republicans bicker among themselves, the GOP majorities on Capitol Hill are dealing with the reality that something must be done even if the bill is imperfect. But lawmakers right now are functioning in a fog — the Congressional Budget Office has yet to “score” the impact on costs and coverage from the amended House bill that passed Thursday. The CBO review of the original bill was brutal, giving Democrats ammunition and putting Republicans on the defensive through much of the debate.
The White House is having a difficult time keeping Republican lawmakers in line, but Mr. Trump has made it clear that any repeal-and-replace bill must ensure that those with pre-existing health problems should not pay more for their insurance.
Mr. Trump’s dealmaker skills helped swing the deal that brought reluctant moderates like Mr. Upton on board, providing the crucial votes for a very narrow victory. He has kept the lines open to both conservatives and centrists GOP members, in hopes that they can find common ground.
But the president’s greatest challenges still lie ahead. Many GOP senators are not on the ballot in the next election cycle or worried about a two-year cycle like the House, and they are likely to have their own ideas about what should be in the bill. Any attempts to move the bill closer to the center or closer to the conservative side risks losing key votes. The president and the Senate GOP leadership can only afford to lose two Republican senators if they want the bill to pass.
Momentum is on the Republicans’ side right now, but may be slowed down by skeptics in the Senate. Centrists GOP senators may want to strengthen pre-existing conditions protections. The key is that Republicans will need to prove that premiums will decrease and everyone will have more choices. Both Mr. Trump and congressional Republicans campaigned heavily on a promise to replace Obamacare with something better, and very much rely on this essential victory.
Republicans need to prove that not only they can govern, but that they can unite and find a better way forward for dealing with the crumbling Obamacare law.
• Mercedes Schlapp is a Fox News contributor, co-founder of Cove Strategies and former White House director of specialty media under President George W. Bush.