Last week, as the drama surrounding the attempted passing of the American Healthcare Act unfolded, Americans saw that even when you add control of the White House to your political recipe, a legislative flop can still be the result.
Despite having a significant majority in the House of Representatives, the Republican conference could not build a practical coalition to achieve their most well-known campaign promise: a repeal of the Affordable Care Act.
Despite having a president who repeatedly touted his negotiating skills during the past election, compromise could not be forged between the disparate factions of the GOP.
Despite having seven years to formulate a politically palatable healthcare alternative, the brainchild of Paul Ryan failed to truly win the hearts of his colleagues. While the defeat is unquestionably a tactical setback, the larger problem must now be faced. The Republican Party must return to the legislative drawing board, but can scarcely agree on what that drawing board looks like, let alone the solution meant to be drafted upon it.
Any attempt at healthcare reform that the party attempts must contain measures of decentralization, tax relief for those lacking comfortable employer-based coverage, some form of continuous coverage for the average American and significantly more flexibility at the state level.
Increased consumer choice, empowerment of patient-doctor decision making, and lowering the overall cost of care should be paramount.
These goals necessitate more discretion in price structuring for providers, along with restructuring of current provider tax subsidies that encourage expensive plans. The shift from strict federal control towards a restoration of state-level discretionary spending and the injection of market mechanisms should be enough to generate a united conservative front.
But it no longer is.
The unfortunate fate of the Trump Administration is to preside over a fractured party struggling to find its identity in the 21st Century. The dynamic of stubbornness that defined John Boehner’s tenure as Speaker of the House is still in place, despite the populist shakeup Trump has given to GOP orthodoxy. The Freedom Caucus seems to be as determined as ever to be a thorn in Paul Ryan’s side, and establishment members continue to feud with the party’s obstructionist element.
Across the aisle, Democratic lawmakers have little incentive to work with the President. The only thing that seems to unite the Democratic Party is opposition to Trump, and its voting base has shown no appetite for compromise.
Perhaps this will be a learning experience for President Trump and Speaker Ryan, with better outcomes just over the horizon. However, stalled legislative momentum this early in a new administration can just as easily be too much for a President lacking experience in governing to overcome.
The alpha-dealmaker has been stumped on his first legislative foray, and with a speaker struggling to effectively whip his conference, there’s little reason to think the next attempt will be any better.