Oh, what a circus! Oh, what a show! On Friday, March 24, Speaker of the House Paul Ryan pulled the Obamacare replacement bill known as the American Healthcare Act (AHCA) from a House vote when it became painfully clear that the bill did not have the Republican support to pass. The situation became even more embarrassing after the bill, which was originally scheduled for a House vote on Thursday, was abruptly moved to Friday where it was first scheduled for a 3:30 pm vote which was then later delayed until 4 pm. It is hard to believe that only a mere sixteen days separated the bill’s much trumpeted introduction and its whimpering collapse. And the Republicans complained about the Democrats trying to ram Obamacare down our throats seven years ago?
What exactly went wrong? How did this colossal policy roll-out disaster come to pass? Political analysts say that it comes down to a failure to build consensus. After all, the Republicans had seven years to monitor and analyze the data associated with the Affordable Care Act so that they could properly craft an alternative which would meet the healthcare needs of the American people, but also address the ideological concerns of their rank and file.
As the speaker of the house, Ryan should have found a way to weave together a plan that collectively addresses the hot buttons of the various moderate and conservative streams of the Republican party and maybe even throws a bone to the centrist Democrats. They call that type of strategy, “something for everybody”. While that may sound like a patently simple approach, when it comes to implementing change to a complex, multipronged entity like healthcare, the redesign process cannot be rushed. You need to make sure that you have buy-in from all the key stakeholders before you move to the implementation phase.
Once the design is agreed upon, the communication needs to be properly executed. Everyone impacted by the new healthcare act including congress, the President, the insurance companies and of course the American people needs to understand what is in the plan. And while the American Healthcare Act may have been an improvement over the Affordable Care Act in that it was packaged in a significantly shorter document (123 pages vs. 2700 pages), it still was not clearly articulated. The concept of three phases was confusing to Congress, let alone the American people. So basically, we have a situation where a product was introduced without consensus from the key stakeholders whose buy-in is critical to its success.
Furthermore, the unblessed product was unveiled with a communication plan that seem to be a series of tactics (congressional bowling and pizza, presidential rallies, all night sessions) in search of a strategy. When Ryan saw that key groups like the Freedom Caucus, Club for Growth, Americans for Prosperity, Heritage Action, etc. were protesting the plan, he should have listened to their concerns and made revisions they would accept without losing the moderates.
The other inherent problem with Paul Ryan’s shepherding of the American Healthcare Act is that he appears to have mislead congress, the President and the American people to try to pass the bill through the reconciliation process. Ryan claimed that the Senate Parliamentarian would not permit the bill to include a lot of enhancements such as the ability to sell health insurance over state lines, modifications to Medicaid, and reduced pharmaceutical prices as these changes could have a negative impact on the budget reconciliation process and potentially lead to a Senate filibuster. Once again, this narrative was revealed to be overstated. Apparently, Ryan had not even contacted the Senate Parliamentarian Elizabeth MacDonough until recently about the AHCA. Senator Mike Lee of Utah claims that he communicated with Ms. MacDonough and that she said that some of the changes which the Republicans wanted to make to the AHCA could have been implemented without impacting the budget reconciliation process. So much for transparency.
As for the impact of the AHCA’s current failure, it is not final word on Obamacare repeal and replacement. President Trump has already come forward and stated that he is willing to work with the Democrats on coming up with a replacement for Obamacare. And he has not said anything negative publicly about Speaker Ryan. However, President Trump is first a businessman. He was given the impression that Ryan has this covered and that he was just to be “the closer”. Learning that the healthcare deal was not locked down was sobering for the President. And of course, the Democrats are dancing in the streets about the failure of the AHCA.
That being said, President Trump will prevail. After all, he is still within his first 100 days. If he has other tangible accomplishments such as job creation and the tax reform which he is now pivoting to from healthcare, no one will pin this initial healthcare mis-step on him.
As for Speaker Ryan, his future is not so certain. After all, to quote Nancy Pelosi, the current Minority Leader of the House, the AHCA is “tattooed” to Speaker Ryan. And you know what they say, removing a tattoo can be painful.