DOMEocracy

hardline political news and analysis

Month: March, 2017

Happy to Be Proven Wrong!

Sometimes, when you go out on a limb, you’re going to have a rough landing.  In the last DOMEocracy, I predicted that “the House will pass something [on health care] that the President will define as ‘amazing.’” I have never been as pleased to say: “I was wrong! Mea culpa!” I have never been happier to have been proven a faulty seer.

I should have known better. First, congressional behavior is always tough to predict, and the current band of wayward miscreants who control the House are fixated on defying all historical antecedents. After all, this is the same crowd that gleefully pleaded with John Boehner (who surely is somewhere with an enormous grin on his face and a merlot in his hand) to shut down the government. The same crowd that proclaimed how wonderful it would be to default on the national debt: who refused to vote for continuing resolutions or stimulus bills or any other urgent legislation because they worship at the shrine of chaos, not to mention practice the dark art of ineptitude.

Since the Republicans bulldozed their way to the majority in 2010, I have described their behavior as bizarrely Orwellian. Failure=success: allowing (even encouraging) government to fail is an achievement, because it promotes the broader objective: to destroy peoples’ confidence in government. Now, with the collapse of the “repeal and replace” (snicker) ACA movement, it is they, not government, who look indescribably incompetent, not because they failed to pass a bill, but because their inability to translate 7 years of buffaloing the public into real legislation has exposed them as a bunch of hyperbolic windbags.

I mean, if you can’t kill off the law you’ve spent a solid 7 years trashing, with your governors refusing to create exchanges or accept Medicaid expansion dollars; if you’ve spend billions on political campaigns begging the American people to elect a unified Republican government to end the “abomination of Obamacare”; if you’ve had a narcissistic blowhard waving his Executive wand for two months pretending to be King Donald I – you’ve got all that going for you and you still crash and burn – and I mean, spectacularly crash and burn – on your first serious legislative outing: well, what else can you say except, “You’ve been exposed as frauds.” Not to mention, amateurs.

Give them credit, they did achieve something Barack Obama never could: they made people appreciate the Affordable Care Act. Perversely, their focus on the law’s protections and benefits reversed the public hostility to the law. Now, the public wants ACA left as it is by a 3-1 margin. Even Republican politicians can count those numbers, not that they weren’t tempted to make them even worse. The photograph of a large group of white men sitting around the table in the White House Cabinet Room dissecting the ACA and removing maternity benefits: come on!

Now this little band of wounded warriors can turn their attention to what always was the first goal of Republican politicians: cutting taxes for rich people and bumping up the national debt in order to create a rationale for additional cuts in domestic programs. But they may have done themselves in by exposing their meanspiritedness and mendacity. When they begin writing the budget resolution and appropriations bills, they will have not only the health care fiasco as a burden to carry, but also Trump’s egregiously stupid idea to slash Meals on Wheels, which uses religious charities, among others, to deliver nutritious food to homebound senior citizens. The inclusion of so malevolent an idea can easily obliterate every other message in a multi-trillion dollar budget simply because it gives you the keyhole to look into the values and morality of those composing the plan, and in this case, those values are contemptible. The annual budget to feel a home-bound senior through Meals on Wheels is probably less than a really nice Trumpian feast at Mar-a-Largo.

Perhaps the most serious political fallout will affect the relationship between Trump and Republicans in Congress, who are unlikely to grovel before his golden throne after this week’s demonstration of incompetence. His bluster surely did not help build a trusting relationship, particularly his threat to support primary opponents against those who dared to defy his edict.

The other big loser is Paul Ryan who learned the hard way that nothing has changed since the Freedom Caucus drop-kicked John Boehner out of the Speaker’s chair. Ryan made the mistake of trying to ride the tiger which, as John Kennedy once warned us, often consumes those who take such chances. The Senate Republicans are doubtless delighted with the outcome: Ryan’s stature is lowered, and they do not have to upset the base by tempering the House’s loony legislation (which the House probably wouldn’t have passed when it arrived back on the south side of the Capitol, unrecognizable, in a few months).

All in all, quite a good week. The Republicans can rest up a bit before the forthcoming April recess, which will bring a new round of harrowing town hall meetings with outraged constituents. At least the GOP representatives won’t have to explain why they voted to slash health benefits to women seeking mammograms or pregnant women seeking prenatal care. A silver lining in an otherwise grim forecast.

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It’s Showtime for the Health Care Battle

The biggest legislative day for the 115th Congress and President Donald Trump – without much competition – is lining up to be this Thursday, when the House is scheduled to vote on the mutating American Health Care Act, the secretively conceived and widely disparaged “replacement” for the Patient Protection and Affordable Care Act. Written without the input of most of the House Republicans, affected health care industry groups, impacted patient organizations or senators who will have to respond to a House-passed bill, the road forward proves to be rocky. However, when the dust settles (and it may not be on Thursday), I will go out on a limb and predict the House will pass something that the President will define as “amazing.”

My willingness to make a prediction has less to do with the details of the AHCA than the politics. After years of horsing around with make-believe “ACA repeal” bills, the House Republicans have had to put a real legislative plan on the table. Let’s stipulate it is a stinker: there is no more sophisticated term for a bill that throws 26 million people off health care, undermines the economics of the health care industry, and showers hundreds of billions in tax relief on the wealthiest Americans. It wasn’t that long ago (1993 to be precise) that it was Democrats who united groups like the American Medical Association, the pharmaceutical industry and insurance companies to denounce health care legislation. Now, all those groups are condemning RyanCare, or TrumpCare, or whatever name will ultimately be stenciled on this abomination.

A terrible process creates a terrible bill. Not only did Republican leaders hide their cards from their own members and Democrats alike, but they insisted on proceeding without a word of testimony, a day of open hearings or the sina qua non standard for serious policymaking, a score of the cost and impact from the Congressional Budget Office. When CBO delivered the bad news, after two committees had already marked up the bill, the GOP leadership naturally trashed the non-partisan office. That kind of high-handedness doesn’t sit well with serious policy people or many Members, for that matter. There is a reason CBO, not the President’s Office of Management and Budget, has long provided the definitive analysis of the impact of proposed legislation: it is nonpartisan and unusually accurate which aggravates Democratic as well as Republican majorities.

Republican myth makers like to assert that the Democratic health bill was similarly developed in secret and foisted upon an unsuspecting and uninformed Congress in 2009, except that the GOP’s characterization is utterly untrue. Three House Committees spent 100 hours in hearings, listening to 181 witnesses; they held well-publicized mark-ups at which 239 amendments – Democratic and Republican – were offered and 121 were accepted. In the Senate, the bill received 53 hearings and 8 days of mark-up during which they considered 135 amendments. There were bipartisan discussions in Committee and at the White House. There were extensive consultations with medical, patient, hospital, drug and other impacted groups. And there was a CBO score before floor action (which predicted a trillion dollars in budget savings). Any comparison of the ACA process to the stealth AHCA is as phony as the Trump Tower wiretaps.

Republicans, commentators and those who are taken in by them also love to rationalize their secrecy by quoting Speaker Nancy Pelosi’s statement – one line in a long speech about health care – that “we have to pass the bill so that you can find out what is in it,” conveniently leaving out the remainder of the sentence, “away from the fog of controversy.” Pelosi was perhaps overly optimistic to imagine that Republicans would ever allow the ACA to be “away from the fog of controversy,” but she certainly was not suggesting no one knew what was in a bill that had been the subject of such detailed and prolonged discussion and negotiation. Rather, she was admitting the obvious about the legislative process: as legislation undergoes repeated amendments and ping pongs back and forth between the House and Senate, one can never say what the “final” version of a law is until the last stage in its creation. We can’t say what the final score in a baseball game is in the 7th inning either but that doesn’t make the game illegitimate.

Lacking much commitment to sound policy, Speaker Paul Ryan is feverishly offering up amendments to buy much-needed conservative votes. Not surprisingly, some House Republicans are uneasy with a bill that could deprive thousands of constituents of their health insurance – many of them Trump voters who hate ObamaCare but sure love that ACA that covers their unemployed spouse or their special needs kid. And there are the Freedom Caucus zealots, always happy to impose parliamentary chaos with Cat-in-the-Hat irreverence, who are harrumphing they will never support a bill they have denounced as “ObamaCare 2.0.”

Despite these observations, however, Ryan is likely to cobble together the 216 votes he needs to pass whatever concoction the AHCA has morphed into by Thursday, for the simple reason that he does not want ACA repeal to die on his watch. And this argument, more so than the details of the bill, is what will doubtless find resonance among 216 Republicans, though perhaps not many more. House members reflexively gag at arguments that their bills must be tempered to accommodate the whims of senators, who can drag out the filibuster rule or the rulings of the Senate parliamentarian when needed to muscle the House into submission. The House often anticipates such Senate obstinate behavior by passing legislation that satisfies the House’s internal politics, recognizing that a reckoning with reality lies somewhere down the road.

The atmospherics are different in the Senate. Where Ryan can afford to lose a couple of dozen Republicans and still pass a bill, the Senate margin is far tighter, only 2 votes. While a significant number of House members can vote “no” because their particular district demands it (as was the case with Democrats in 2009), a senator has to confront the impact across an entire state — a broader view of reality that causes grief to people like Lisa Murkowski, Susan Collins, Rand Paul and Rob Portman. A “yes” vote from these senators has draconian impacts on hundreds of thousands of constituents who have health insurance for the first time thanks to the ACA. The House hardliners are right: the Senate will alter whatever the House sends over in order to accommodate Senate realities. Then will come the moment of truth: can Paul Ryan cobble together the 216 votes needed to pass a Senate version that, for example, might retain Medicaid until 2020 (when everyone undoubtedly hopes cooler heads will prevail and the phase-out is scrapped)? Unless circumstances change dramatically (and they won’t), Ryan will not be able to count on Democratic votes to pass the Senate bill, so a displeased Freedom Caucus could still sink a more moderate Senate work product.

For the moment, such a scenario is down the road and a far more immediate test awaits Ryan.   President Trump lumbered over to the Hill today for a pep rally in support of the AHCA and predictably put his foot into it, musing that any Republicans who voted against the bill on Thursday might lose their seats in 2018. (The translation of the not very subtle dog whistle, in the words of a Republican inside the room, “If you don’t get behind this … it looks like you’d be ripe for a primary.”) Things may have changed since my departure from the Hill four years ago, but in my experience, presidents secure more votes when they exude charm rather than venom, and that is undoubtedly true for a president who is likely less popular in most districts than the members of Congress he was threatening. Yet Trump, utterly unschooled in Hill deference, not only issued the broad threat but singled out Freedom Caucus Chairman Mark Meadows with a promise, “I’m gonna come after you” if the North Carolinian doesn’t swallow his pride and embrace Ryan’s bill. Meadows has not responded favorably, advising that such warnings “don’t bring us closer to ‘yes.’ If anything, they have an opposite reaction.”

Time will tell how the politics and the policy play out, surrounded by the continuing chaos that is the Trump Administration. It is important to remember that today’s Republican Conference has been unable to enact any complex legislation without Democratic votes since assuming the majority in 2011. Believing they can succeed on something so convoluted as health care, with the entire health industry opposing them, is difficult to fathom. As former Speaker John Boehner noted last month, “Republicans never, ever, one time agreed on what a health care proposal should look like. Not once.” Will they have done so when the fight over AHCA is over? Maybe, but negotiating the policy and political labyrinth is going to be awfully confounding for an unproven and inexperienced majority.

Rewriting History (and the Affordable Care Act!)

 

Deep in the bowels of the Capitol, Republican staff members (and perhaps some Members and outside policy wonks) are furiously fashioning a brand new national health bill that House leaders pledge will be passed by the end of March. It is an unconventional way to draft legislation that, if enacted, would not only unravel health insurance coverage for millions who have gained it under the Affordable Care Act (ACA) of 2010, but would have sweeping impacts on an industry that affects one-sixth of the nation’s economy.

However Republican leaders spin this secretive process over the coming weeks, there is no question that such “legislating in the dark,” as an account of the 2009 stimulus legislation termed the process, is the wrong way to approach so contentious and significant an issue as health policy.

Over the past several days, several legislators of both parties have endeavored to secure a copy of the much-vaunted “replace” component of the Republicans’ “repeal and replace” prescription for ACA. GOP Sen. Rand Paul and Democratic Whip Rep. Steny Hoyer both conducted futile missions to find the furtive bill drafters. Instead, Hoyer was informed by Majority Leader Kevin McCarthy, “You can look it up when we mark it up.”

How’s that? Does McCarthy mean to say that House Democrats will not see a bill that impacts millions of their constituents until the committees “mark it up”? For those who have not spent their lives in and around legislators, “mark up” is the amendatory process conducted by committees on legislation before it is passed (reported) and sent to the full House or Senate membership “on the floor” for amendment (sometimes) and final passage (usually). It is difficult to draft amendments to legislation you have not seen. It is even more difficult to vote on legislation that has never been the subject of scrutiny – not by the minority, by the press, by affected constituents, by the health care industry. Even the basic parameters of the law, let alone how much it would cost and whether it would deprive Americans of affordable care they posses under ACA, are unknown.

Speaker Ryan seems to disagree with his own Majority Leader, pledging that “This bill will go through the committee process. It will go under regular order.” But Ryan was unclear whether “regular order” would include open (or any) hearings, a full vetting of the bill, and unrestricted mark-ups – all processes used en route to passage of the ACA.

In an indication of how Ryan and Republicans are attempting to alter history, the Speaker asserted that regular order was the “opposite of what Democrats did in 2009.” But Ryan has his history wrong, and such assertions are little more than an effort to revise the record to impugn Democrats and sanction secret lawmaking.

House Democrats held hearings on the health care proposal in 2009 in three committees, providing an open forum to hear from an exhaustive list of supporters and critics. In the Senate, the hearings were among the longest on record, causing much consternation among House Members who feared the same kind of effort to run out the clock that had doomed a child health bill in 2008. Mark-ups occurred after a thorough public airing, and contrary to the revisionist versions of the ACA legislative process, many Republican amendments were accepted in an effort to secure bipartisan support that ultimately proved elusive. Republicans might not have liked the outcome – although the ACA, as is widely known, is based more on the Heritage Foundation/Mitt Romney Massachusetts model than the single payer/Medicare expansion many Democrats would have vastly preferred – but they were not denied an ability to review, discuss or amend the underlying bills.

Critics often point to Speaker Nancy Pelosi’s much ballyhooed statement that she could not know the provisions of the ACA until it was passed as evidence of the secret nature of the bill on which Members were compelled to vote. But this history, too, has been cynically misrepresented by those seeking to ridicule Pelosi and taint the ACA. Pelosi’s statement merely acknowledged that the final version of the bill could not be known until the House and Senate had completed their revisions to each other’s versions of the bills. For the uninitiated, it is called “the legislative process,” and Pelosi’s much maligned statement merely acknowledged the back-and-forth inherent in reaching a complex measure’s final provisions.

ACA critics certainly have every right to criticize the law’s impact, although they would do well also to acknowledge how severely their obstructive efforts have complicated implementation. Complex statutes always require amendment in the years following enactment, but instead of a good faith effort to address the inevitable problems in implementing a nationwide health law, Republicans have spent years wasting time on over four dozen futile efforts to repeal it with no idea how to substitute a program that matches ACA’s impressive achievements. Now, with majorities in the House and Senate and a Republican President, they have their chance, not as a symbolic sideshow but as substantive policy, and hopefully in the light of day and using regular order.

Managing the Modern Speakership: Pelosi and Boehner

My article on the two most recent former Speakers of the House had just been published in “Extensions,” the journal of the Carl Albert Congressional Research and Studies Center at the University of Oklahoma (Winter, 2017).  The paper is based on the talk I gave at the June, 2016 Congress and History Conference in Norman, OK.

The article is on pp. 20-25 of the journal, which can be found at the following web site for the Carl Albert Center: http://www.ou.edu/carlalbertcenter.html