Governing American Style

Congressional Republicans are starting to resemble chickens with heads cut off, running hither and thither to no purpose. The House Republicans are divided on how to handle the federal budget, the debt limit, a rewrite of the tax code and more. The Senate is as divided but with the added conundrum of new healthcare legislation, which is unlikely to come to a vote.

The latest moves in Congress and the Executive are erratic, to say the least. First, the Senate majority leader, Mitch McConnell, has announced the summer recess will be delayed until August 11^th to try to deal with unfinished business. House Republican leadership seems unhappy with delaying the summer vacation for Congressmen. House majority leader, Kevin McCarthy, is effectively saying that the House has already done a great deal of business and members don’t need to hang around waiting for Senate action.

Second, the President’s agenda, set out in election promises, is in complete disarray. There is a possibility the President might himself order an emergency session of Congress to deal with the following matters: the annual budget resolution, which is one key to tax changes wanted by Trump; the necessary increase in the federal debt ceiling, without which there will be a federal government shutdown in September. And, of course there is the health care legislation, the other key to tax changes. Savings in federal spending after the repeal of Obamacare would free up billions in federal funds.

Last week, on his way to Paris in Air Force One, the President took time to chat to journalists on the flight. The topics moved around. On health care, Mr Trump said: 

            “I think, first, I want to do - well, we have a few things. We have a thing called healthcare.  I’m sure you haven't been reading about it too much. It is one of the - I'd say the only thing more difficult than peace between Israel and the Palestinians is healthcare. It's like this narrow road that’s about a quarter of an inch wide.  You get a couple here and you say, great, and then you find out you just lost four over here.  Health care is tough. But I think we're going to have something that's really good and that people are going to like. We're going to find out over the next - you know, we just extended for two weeks.”

Trump is surely the master of inarticulateness, not to mention the incomplete sentence! Remember the Presidential promises: “On the first day in office, we are going to repeal and replace Obamacare. We are going to build a big, beautiful wall” and, of course, “we are going to bring down taxes.” Who talks about the wall and tax changes these days? If Mr Trump was playing poker, I’d describe his hand as a busted flush.

If Trump is to free up funds, he needs to remove and replace Obamacare, which remains the law of the land. In June, the House of Representatives passed The American Healthcare Act but the Senate is struggling to pass its version, known as The Better Care Reconciliation Act. What is all the fuss? I’ll try to itemise the principal differences between the current Obamacare legislation and the AHA and BCRA proposals:

Under Obamacare, most Americans are required by law to have health insurance. If they don’t, they may be liable to pay a penalty. Both House and Senate bills remove this requirement but the insured may be fined if his insurance lapses, even if it is because the insured cannot afford increased premiums. Under Obamacare, large employers face penalties if they do not offer insurance to employees. Both House and Senate Bills eliminate this obligation. Currently, insurers cannot charge the elderly more than three times what the younger pay. Under both new Bills, the limit is raised to five times. Crucially, individual states could choose to expand Medicaid eligibility under Obamacare to include healthy adults. Both Republican bills end expansion rights. (Medicaid is the federal government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.)

Most important, Obamacare prevented insurers from denying coverage or demanding higher rates for pre-existing conditions. The House and Senate bills differ but both allow insurers to be free from that restriction. There are many other changes afoot: waiver of essential health benefits allowing insurers to exclude treatments; no federal funds for Planned Parenthood; reducing tax credits.

To pass the Senate bill, the Republicans need 50 votes. (In the event of a tie, the Vice-President has the casting vote.) But two Republican senators are on record that they will not vote for the bill because it does not go far enough to dismantle Obamacare. Two others are not in favour because the Senate bill goes too far. To use the President’s own description, “it is mean.” The vote is due this week but will it happen? Over the next days, McConnell and Trump will be promising, cajoling, threatening and even blackening reputations to get their way. However, the latest reports indicate that the Senate healthcare legislation has been abandoned.

On Tuesday, Trump told reporters that he plans to “let Obamacare fail. It will be a lot easier.” That way, he said, his party would bear no political responsibility for the system’s collapse. “We’re not going to own it. I’m not going to own it,” the President said. “I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us to fix it.”

If this is Trump’s idea of how to govern, he urgently needs schooling. He would be well advised to look how his predecessors coped with government crises. Sitting back and doing nothing was not an option. President Harry Truman had to face extensive trade union militancy in the early years after World War II. For example, led by CIO head John L. Lewis, miners went on strike or work stoppages every year for five years. Truman denounced the union action as threats to national security and brought in the military, as industry, railroads and homeowners rapidly switched from coal to oil.

Trump should also read Robert Caro on how President Lyndon Johnson had the Civil Rights Act, 1964, and the Voting Rights Act, 1965, passed when he was held to ransom by his own party. Southern Democrats in the Senate filibustered but LBJ persuaded moderate Republicans to pass the needed legislation. President Richard Nixon also offers a lesson in governing. Despite the 1954 Supreme Court ruling in Brown v Board of Education, by 1968 America’s public schools were still not segregated. Nixon introduced the busing policy. It took just three months to achieve the desired result.

If Trump gets his current wish and Obamacare is allowed to fail, what happens to people who are not entitled to Medicaid but cannot afford insurance? America will return to the times pre-Obamacare when 40 million people or more had no medical insurance. Is it not time for the Republicans in Congress to abandon old-fashioned ideology and accept that the federal government has an important part to play in protecting the health of their citizens.

I am no expert on health care legislation but I suspect that there are serious problems with Obamacare. Would it not be best for Republicans and Democrats in Congress to work together to fix the problems of the Affordable Healthcare Act? Democrats would have to give up their ideological positions and accept, for example, that Republican high earners can’t be expected to pay for everything. Likewise, died-in-the-wool Republicans need to abandon old ideals of “rugged individualism” and the obligation for people to look after themselves. Health care is a sufficiently big topic to require bipartisanship. I hope that moderate American voters will contact their representatives in D.C. and demand they work together to fix the problems. For sure, the President, who vaunts his abilities as a deal maker, has either lost the plot or just doesn’t understand how to do his job.