Lessons Learned from Obamacare Replacement

The talking heads and pundits have pointed their fingers and cast the blame on the “failure” of the Obamacare legislation vote that Speaker Ryan cancelled last Friday. I do not see productive value for the American people and the Republican Party in the finger pointing and blame.

It is beneficial to take a look at what happened and learn from the process. Three words summarize what happened: Communicated, Complicated, and Confidence.

Since Obamacare was first adopted, some states expanded Medicaid based on Obamacare. Several million were covered by insurance provided through Obamacare. (What the news never points out is that many of those already had insurance policies that were cancelled and they were forced into Obamacare.)

A simple repeal would impact those on Obamacare and the states who had expanded Medicaid coverage because of Obamacare. These are very real constraints that would impact real people.

Speaker Ryan and the White House worked together to develop a strategy to repeal and replace Obamacare. They came up with a three phase strategy which would ultimately accomplish a repeal and replacement of Obamacare with as little pain as possible to the states and those on Obamacare.

The Strategy was not Communicated

The first lesson learned is that strategy was not communicated until it was rolled out as the solution. The members of the Freedom Caucus, along with virtually every other Republican, campaigned on a simple three word slogan – Repeal and Replace.

In 2015, Republicans passed an 8 page bill that repealed most provisions of Obamacare. President Obama vetoed the bill.

There was a general expectation that Republicans would change the dates on the bill and send it through the process again. What Speaker Ryan rolled out with the three phase process was far from the simple 2015 repeal bill.

Conservatives who ran under the Republican standard of “Repeal and Replace” felt that their constituents would view this as a bait and switch. The strategy was not communicated.

The Strategy was Complicated

The second lesson is that the strategy was complicated. The strategy was laid out in three phases. Phase one was to adopt a partial replacement of Obamacare. It was not a simple repeal, but more like a major amendment.

This strategy was built on the budget reconciliation process in the Senate which could be done with a simple majority. Other provisions in Obamacare were not within the scope of the budget reconciliation process.

In order to repeal these other provisions, it would require 60 votes to end debate and vote on the issue. (See how complicated this is and we have not scratched the surface.)

After Phase 1 passed through reconciliation, then the Secretary of Health and Human Services, Tom Price, would use provisions in the portions of Obamacare that were not repealed, to change regulations.

Since these were regulations, Secretary Price could take this action without any votes from Congress. The regulatory changes would be Phase 2.

Phase 3 was legislation that would open the door for health insurance sales across state lines and other free market actions. Phase 3 could not be accomplished in reconciliation.

Legislation in Phase 3 would require 60 votes to end debate and then vote on the bill. The belief was that by this time, Democrats would be backed into a corner and the moderate Democrats from states where they faced a potential loss would join the Republican majority.

The average conservative voter who voted for a candidate calling for “Repeal and Replace” would get totally lost in any explanation of the three phase strategy. The strategy was complicated.

There Was a Lack of Confidence

The third lesson is that there was a lack of confidence. President Trump gave his assurance and promise that he would carry Phase 3 to completion.

Phase 3 required more than President Trump. It required bi-partisan congressional action.

The American people have no confidence in Congress. That is not pointing fingers or casting blame. That is reality. Senator Tom Cotton summed it up when he said that there never will be a phase 3. It will be “one and done.”

President Trump started out with a bank vault of political capital and multiplied his value each day. Congress, on the other hand is bankrupt in capital and has a negative trust rating.

The Freedom Caucus represented constituencies that expected their Representatives to keep the promises they made. Those constituencies were going to hold them accountable.

Three words sum up why this bill did not get to a vote: Communicated, Complicated, and Confidence.

I hope that Republican leadership in Congress and the White House will consider these lessons learned. Finger pointing and blame adds no value for the American people. Let’s learn the lessons and move forward.

Signature-Donald E. Cole

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