Analysis: Republican Party at war with itself hits the wall on health care

By any measure, the collapse of the Senate health-care bill represents an epic failure for the Republican Party and a major embarrassment for President Trump. The crusade that animated – and bound – conservatives for seven years proved to be a mirage, an objective without a solution. Power comes with consequences.

There is no way to spin to those who were promised that the Affordable Care Act would be repealed and replaced once Republicans held full power in Washington that what has happened is the fault of forces outside the party. This has been a Republican undertaking from start to finish. It is as if Republicans unknowingly set a trap and then walked into it without having prepared escape routes.

What price, if any, Republicans will pay for this setback will be revealed over the coming months. Perhaps they can move quickly on other priorities – a tax bill being the most appealing now though not necessarily a slam dunk – and wash away the bitter taste of the health-care debate. That might be the best they can hope for, but there are no guarantees.

The failed promise to repeal and replace Obamacare surely will affect the mood and enthusiasm of the Republican base heading toward 2018. When the Gallup organization asked Americans about the future of Obamacare recently, 30 percent of Americans said they favored "repeal and replace," but 70 percent of Republicans picked that option. GOP lawmakers will have left them empty-handed, perhaps disillusioned. That will energize Democrats even more in their quest to take control of the House in 2018.

The breakdown that has been on vivid display over the past weeks also cannot help but to bring more attention to divisions inside a Republican Party whose coalition has been reshaped by the rising voice of white working-class voters who helped put Trump in the Oval Office. All parties have divisions, but what Republicans must reckon with is not simply a conflict between conservatives and moderate-conservatives, but differences rooted in potentially incompatible perceptions of government and Washington.

The president spent Tuesday morning tweeting his frustrations, blaming Democrats and "a few Republicans" for what happened in the Senate. "We will return!" he said in one tweet. "Stay tuned!" he said in another. Let Obamacare fail, he proclaimed. Those are standard exhortations by the president, meant to shore up his supporters but they carry no particular force with those in his party who have been doing the heavy legislative lifting.

Instead, those tweets underscored the futility of trying to make what happened on health care anything other than what it was, a self-inflicted wound by a party that succumbed to easy appeal of campaign slogans without also doing the hard work of policymaking over the past seven years.

William Galston of the Brookings Institution noted Tuesday that the health-care debate showed anew that Republicans have not bridged the gap between campaigning and governing. This has been a longtime problem for a party that is at best ambivalent about the federal government and at worst openly anti-government, at least rhetorically. This condition existed before Trump came on the scene. It has worsened because of his political success.

Trump's rise and his victory in the presidential campaign intensified a point of internal conflict for the Republicans, one that pits hard line, anti-government conservatives against many of those working-class voters who believe in the federal programs that deliver services to them and don't want them torn down.

"The Republican Party is grappling with the fact that conservative orthodoxy is one thing and populism is another," Galston said. "Populists are not anti-government. Populists are in favor of government that helps people like them."

The president's embrace of the Republican promise to repeal and replace the Affordable Care Act was and is incompatible with political views he often stated as a candidate. He adopted the rhetoric of repeal and replace but whenever he talked about health-care policy, he did not sound like a conservative Republican. He wanted coverage for everyone. He didn't want to hurt people. He didn't want to make cuts to entitlement programs, whether Medicare, Medicaid or Social Security.

What Trump espoused clashed with what conservative, small-government Republicans long had been preaching. In office, his ambivalence has been evident at virtually every turn in the debate. He complained about the House bill as too mean after publicly praising it. He wanted repeal and replace without any pain. He wanted a victory but could not engineer it.

Republicans have experienced two well-known lessons. Tackling big issues on a partisan basis is fraught with political risk. And once government benefits are extended to tens of millions of Americans, taking them away is as risky politically as it is substantively difficult.

After seven years of the Affordable Care Act, despite its flaws and weaknesses, Republicans were forced to concede that parts of Obamacare were extremely popular. Trying to keep the good while fulfilling a promise to get rid of the bill called for legislative and policy gymnastics beyond their capability.

That a repeal-and-replace effort failed is all the more disheartening for Republicans, given what appeared at the start of the year as to be an almost-ideal set of players to carry it to passage. It started with Trump, who had a megaphone, as do all presidents, and came to office claiming he alone could fix things and with the reputation of a skilled dealmaker.

In the House, Republicans were led by Speaker Paul Ryan (R., Wis.), who was long seen as enough of a policy expert to be entrusted to develop an alternative to Obamacare that could match the party's stated goals and produce a legislative majority.

In the Senate, Republicans were led by Majority Leader Mitch McConnell (R., Ky.), regarded not as a policy wonk but a shrewd and tough-minded legislative strategist, the best of a generation, someone who could shepherd a bill through the legislative maze, if anyone could.

Ryan, after false starts, managed to get a bill through his chamber, but it was enough flawed that Senate leaders knew they would have to change it. McConnell tried with different versions but overreached. He couldn't find the legislative magic many assumed he would be able to employ. And the president proved not to be a dealmaker.

Trump tried to walk away from the mess on Tuesday. "Let Obamacare fail," he said. "It will be a lot easier." He said Democrats would own that failure, if that is the case. He said he would not own it, regardless. Republican lawmakers will take all that in and recognize, as they already know, that the president will claim any victories they produce for him and run from any defeats but he is not likely to be the architect of a policy that will match his campaign rhetoric.

There also will be a period of recrimination in the wake of what happened in the Senate. If that spills into the debate over a tax bill, there could be more trouble ahead. The six-month battle over health care has been a time waster and a tone setter. Leaders have to regroup and quickly.

In normal times, a party would look to its president to hasten the healing process and pick up the pieces. But these are not normal times. Trump operates by his own standards. And this is a Republican Party that has yet to come to terms with what is has become and what is expected of a majority party.

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