Opinion: Why the GOP’s health-reform effort is flailing

WASHINGTON — A couple of hours after Senate Majority Leader Mitch McConnell said he wouldn’t put the GOP’s health-reform bill to a vote this week after all, his Democratic counterpart, Chuck Schumer, made a number of biting comments. One of them had the added benefit of being true.

“On this issue, from Day One,” Schumer told reporters just outside the Senate chamber, “Democrats have been united and on offense, and Republicans have been divided and on defense.”

Therein lies the difficulty Republicans, in the House as well as the Senate, have had in passing the repeal and replacement of Obamacare they’ve promised for seven years.

It is not that they had no plan. The basic outlines of the GOP effort have existed for years: tax credits to subsidize premiums; a penalty to discourage people from waiting to get sick before buying insurance, not a mandate that they buy it; greater use of health savings accounts; fewer regulations about what plans must cover; an emphasis on private insurance rather than Medicaid for the working poor; broad changes to Medicaid more generally to rein in a program that increasingly strains state budgets.

The trick was arriving at the details of such a wide-ranging reform. The degree of difficulty is that much greater with a president who is keen to sign a bill but, by most accounts, only passingly familiar with or interested in the specifics.

Thus, the defensiveness. It’s a losing posture for an effort as sweeping and complicated as health-care reform. Various opinion polls show the GOP reform, whether the Senate bill or the similar House version, with approval as low as 16 percent, depending on the pollster.

In our polarized times, it’s nigh-impossible to get such a low mark for an endeavor viewed through such a partisan lens. How did this happen?

There’s a clue in one of the more recent polls, from NPR/PBS NewsHour/Marist, which has approval of the Senate bill at just 17 percent. It shows Democrats mostly united in their opposition, with 8 percent in favor of the Senate bill, 78 percent against it and 13 percent waiting to hear more before forming an opinion (one might have anticipated even worse numbers from Democrats, a likely sign many of them are still dissatisfied with Obamacare). Among Republicans, the bill has a net positive rating: 35 percent favorable to 21 percent unfavorable. But a whopping 39 percent of them say they need more information.

Translation: They want to support a bill, and haven’t given up on it, but they haven’t seen any reason to support this one. And that may be GOP congressional leaders’ biggest failing.

Neither the House bill nor the Senate version, when finally revealed, arrived with explanations about its provisions, why they were important, how they would work. The bills hadn’t been created through the usual legislative process — another fair criticism of GOP leaders — so their merits hadn’t been debated and settled in a public setting. Those who drafted these bills needed to provide this in the alternative.

I don’t mean mere talking points or spin, but a robust and substantive argument for the bills and what they aim to accomplish. What we got instead was a barrage of predictable criticisms from Democrats, to which Republicans have spent all their time responding, to little effect. Meanwhile, potential allies in the activist ranks, policy shops and media were left scrambling to figure out what exactly had landed before them like a smoking meteor from the cosmos.

This isn’t the old “explain it better” canard. The bill hasn’t been explained, championed, fought for, at all. No wonder Americans are treating it so warily.

The prevailing view is this show-the-bill, pull-the-bill act is just one step in a drama that ends with 50 Republican senators lining up behind a slightly revised text. Maybe so. But it didn’t have to be this way, and the GOP may pay a price for handling its business so poorly.

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