Where Do We Go From Here After Failure Of Healthcare Repeal

Where do we go from here? Both Republicans and Democrats are asking that question this morning after the failure of healthcare to move through the Senate. At least for the moment, Democrats, as they have for months, are signaling that they are willing to work with Republicans on crafting some sort of deal that would address some of the problems with the ACA. That is especially true now that the Senate has essentially admitted that repeal is off the table. Republicans are also claiming they want to keep working on passing something, with a minority willing to try and work with Democrats. Trump and presumably the reactionary right are more interested in trying to sabotage the ACA and then try to blame the Democrats.

Unfortunately, I think Trump and his reactionary base are the only ones who are likely to get what at least they say they want. I just do not believe that there is any bill that Democrats could craft with Republicans, and presumably that would have to be done in the Senate, that could possibly pass in the House. In the end, for Republicans, that means that they will most certainly take a shot at trying to do this all again on their own and without any Democratic votes. Like a zombie, the GOP attempt to repeal and replace will never die, it just suffers a temporary hibernation. I do, however, think that the GOP is done with healthcare this year. They will allow Trump to kill the CSRs, the subsidies for insurers, and let Price further subvert the ACA through various actions at HHS and then try to take another run at this next year with the never-ending claim that the ACA is imploding.

For Democrats, there is a danger of actually trying to work with the GOP on healthcare right now as it actually keeps the zombie alive for time being. So the tack of spouting bipartisan hopes and laying out ACA changes that they know Republicans will not accept is the proper stance for Democrats. In addition, those changes should be designed to laying out a path to single payer, similar to what Bernie Sanders is currently proposing.

Republicans in Congress will now probably want to move on to so-called tax reform. But the failure to repeal and replace the ACA has added a trillion dollars to the budget baseline, meaning that any tax reform will almost certainly have to sunset in the ten year window. And the similar divides within the GOP caucus that were laid bare in the healthcare debate will be equally present in tax reform, which is inextricably tied up with the 2018 budget. Perhaps, in some small way, the failure of healthcare may make it marginally easier to actually get tax reform and the budget done. Once again, however, it will probably still be rather difficult for Republicans to get that legislation done via reconciliation with just GOP votes.

That difficulty might actually force Republicans to seek Democratic votes, once again asking Democrats to be the adults in the room. They will certainly need Democratic votes to raise the debt ceiling which will require 60 votes. Mnuchin has determined that will need to be done by the end of September, which does not leave a lot of time and further complicates the ability to get tax reform and the budget completed. But that will also finally give Democrats some leverage and at least some ability to try and help craft an acceptable bipartisan solution on the budget and the tax plan. If that creates some momentum, there is a remote possibility that bipartisan spirit just might carry over to healthcare next year, but don't count on it.

The failure of the ACA repeal and having to get Democratic votes to pass a watered down version of tax reform, pass a budget, and raise the debt ceiling will infuriate the reactionary base and create more calls for the leadership to be replaced. On the other hand, Trump is liable to glom on to any legislative achievement as one of the great landmarks as President.

Meanwhile, Republicans in Congress will do their best to ignore Trump and the chaos he surrounds himself with and revels in. And they will try to find a way to salvage their electoral prospects in 2018. Both Trump and the reactionary base of their party will make that job increasingly difficult. And more and more vulnerable Republicans will become more comfortable with asking Democrats to help them save their own skin.

For Democrats, the question is whether they should work with Republicans or let the GOP own its failures. If recent history is any guide, the tactic of united and implacable opposition has worked wonders for the Republican party while not necessarily serving the best interests of the country. The GOP has chosen party over country for decades. Democrats may need to make a similar choice in order to regain political power.