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National Politics|By Charlie Cook, March 15, 2017
This story was originally published on nationaljournal.com on March 10, 2017

In many ways, the chal­lenge fa­cing Re­pub­lic­ans in en­act­ing their Amer­ic­an Health Care Act looks pretty close to in­sur­mount­able. The most con­ser­vat­ive mem­bers of the House Re­pub­lic­an Con­fer­ence, as well as al­lied groups such as the Club for Growth, Freedom­Works, the Her­it­age Found­a­tion, and Breit­bart News, are de­rid­ing it as “Obama­care Lite” and a be­tray­al of prom­ises to scrap the Af­ford­able Care Act. Mod­er­ates and law­makers from swing dis­tricts are nervous that the bill goes too far, and could res­ult in many people los­ing in­sur­ance, cut­backs in state Medi­caid pro­grams, and a par­ing of pub­lic-health pro­grams. Even law­makers who didn’t hold town meet­ings dur­ing the re­cent re­cess saw what happened to those who did, and they’re feel­ing the heat.

Key pro­vider groups such as the Amer­ic­an Med­ic­al As­so­ci­ation, the Amer­ic­an, Cath­ol­ic and Chil­dren’s Hos­pit­al As­so­ci­ations, and the Amer­ic­an Nurs­ing As­so­ci­ation, along with con­sumer groups in­clud­ing the AARP, have come out against the plan. House Speak­er Paul Ry­an and oth­er pro­ponents of the bill must feel a little like Gen­er­al George Arm­strong Custer at Little Big Horn.

The best and per­haps only com­pel­ling reas­on why this bill might pass is that Re­pub­lic­ans don’t have an­oth­er ob­vi­ous choice. As Ry­an put it earli­er this week, “We as Re­pub­lic­ans have been wait­ing sev­en years to do this. We as Re­pub­lic­ans, who fought the cre­ation of [Obama­care], and ac­cur­ately pre­dicted it would not work, ran for of­fice in 2010, in 2012, in 2014, in 2016, on a prom­ise that if giv­en the abil­ity we would re­peal and re­place this law.”

Ry­an con­tin­ued, “This is the closest we will ever get to re­peal­ing and re­pla­cing Obama­care. The time is here; the time is now. This is the mo­ment.” He called it a “bin­ary choice”: kill Obama­care or keep it. If the GOP fails at what has been its key or­gan­iz­ing prin­ciple for the past eight years, the party will look weak and in­ef­fec­tu­al, jeop­ard­iz­ing the rest of the Re­pub­lic­an and Pres­id­ent Trump’s agenda.

The truth is that many newly elec­ted pres­id­ents have had key agenda items de­feated early in their first terms. After House pas­sage, Pres­id­ent Obama’s Clean En­ergy and Se­cur­ity Act of 2009 was nev­er really even con­sidered, let alone voted on by the Sen­ate. Pres­id­ent Clin­ton’s Health Se­cur­ity Act, aka Hil­lary­care, died in his second year in of­fice. In the first year of a pres­id­ency, everything looks like a life-or-death mat­ter, but few ac­tu­ally end up that way. That could be the out­come here.

In a dif­fer­ent era, after the first ef­fort went down to de­feat, both parties might come to­geth­er in a more ac­com­mod­at­ing spir­it, with neither side able to get its own way. But that’s when the sys­tem ac­tu­ally worked, be­fore com­prom­ise be­came a four-let­ter word, be­fore “my way or the high­way” be­came a way of life in Wash­ing­ton.

The sad thing is that the Af­ford­able Care Act, pushed through by Obama and Demo­crats with the best of in­ten­tions, was a deeply flawed law, one that des­per­ately needed to be fine-tuned be­fore it passed. It’s pos­sible that a huge and com­plic­ated bill could be en­acted with no need for modi­fic­a­tion, but it would be ex­tremely rare. Big le­gis­la­tion is al­most al­ways a work in pro­gress. It needs con­stant tinker­ing, un­der­taken in good faith, to make it bet­ter, not kill it. But if one party sees a law as of an im­macu­late con­cep­tion, not to be changed in any way, and the oth­er party views it as the most hor­rible piece of le­gis­la­tion ever en­acted, it’s hard to make con­struct­ive changes. That’s what happened with Obama­care.

It’s in­ter­est­ing how much Pres­id­ent Trump is try­ing to push the bill without ac­tu­ally own­ing it. He makes no pre­tense of hav­ing had a hand in writ­ing it, thus leav­ing de­feat as more a prob­lem for Ry­an than for the White House. Sim­il­arly, Sen­ate Ma­jor­ity Lead­er Mitch Mc­Con­nell has no own­er­ship stake either. This is a House Re­pub­lic­an thing, through and through. While the Trump White House can make prom­ises and threats be­hind the scenes to law­makers, they may be more re­spons­ive to one of his barbed tweets or, worse yet, a pres­id­en­tial vis­it to their home dis­tricts where he scorches them as pre­vent­ing Amer­ica from be­com­ing great again.

Con­gres­sion­al Re­pub­lic­ans are keenly aware that Trump has an 86 per­cent ap­prov­al rat­ing among Re­pub­lic­ans in the latest NBC News/Wall Street Journ­al poll, so they’re likely to think care­fully be­fore cross­ing him. While the vast ma­jor­ity of GOP in­cum­bents are un­likely to lose a primary, most really don’t even want to have an op­pon­ent, let alone spend money and time on a con­tested in­tra­party race.

But to the av­er­age Re­pub­lic­an voters, all of this is be­hind-the-scenes stuff. A typ­ic­al Trump sup­port­er doesn’t think it’s his bill. This is the House Re­pub­lic­ans’ bill, it’s Ry­an’s bill. It’s not hard to see Trump say­ing, “Well, it’s too bad they failed. They just couldn’t get it passed.”