How Trump Could Ditch the Freedom Caucus and Pass a Bipartisan Health-Care Bill – The New Yorker

He has shown little ability to learn in office. But a health-care deal with some Democratic support might not be completely out of the question.CreditPHOTOGRAPH BY MICHAEL REYNOLDS / POOL / GETTY

Every President is surprised, at the beginning of his term, at how difficult it is to move legislation through Congress, but Donald Trump seems not to have known even the most rudimentary facts about the legislative system before assuming office. He claimed in February that nobody knew that health-care reform could be so complicated. Last month, Trump and his aides seemed surprised that the Freedom Caucus, a group of some forty right-wing House Republicans, defeated the first Republican bill to repeal and replace Obamacare, despite the fact that the Freedom Caucus has played a starring role in every congressional battle for the past several years, regularly torpedoing the plans of Republican leaders. And Trump seems to have been only dimly aware of the Senate filibuster, which can only be broken with sixty votes.

While Republicans have majorities in both chambers of Congress, the Freedom Caucus in the House and the filibuster in the Senate mean that they have to win at least some Democratic votes to pass most of Trumps agenda. As dysfunctional as Congress seems, it wont always be impossible. This week, Congress negotiated a spending bill to keep the government running, which will pass with bipartisan support in the House and Senate. Democrats and Republicans were both able to spin the deal as a victory for their party. No wall, no deportation force, no defunding sanctuary cities, no Planned Parenthood cut, none of Trumps proposed eighteen billion dollars in non-defense cuts, a top Democratic aide wrote atop a long list of other victories. At the same time, House Speaker Paul Ryan, in a press conference on Tuesday, bragged that Republicans were able to secure more in defense spending than Democrats received in domestic discretionary spending.

But on health care Trump and Ryan have handed over negotiations to the Freedom Caucus, which killed the first Obamacare repeal bill. Mark Meadows, the chairman of the Freedom Caucus, negotiated a more conservative repeal bill with Ryan and Tom MacArthur, one of the three chairman of the moderate Tuesday Group. The final product, which as of this afternoon was still a few votes short of passing the House, has infuriated several Tuesday Group members.

MacArthur really got himself in trouble on this, a member of the group told me. We had a discussion: Should we be negotiating with the Freedom Caucus on this? And our membership said no. He went on, MacArthur went out and he said he was only speaking on his own behalf, and he ended up negotiating an amendment that only brought Freedom Caucus guys over. So who the hell was he representing? Its crazy. Suffice to say the members are furious with him.

Ryan and Trumps decision to accede to the Freedom Caucuss demands makes some sense. Their goal is to get any bill they can to the Senate. But, even if they succeed in passing the Meadows-MacArthur bill in the House, they may run into the buzz saw of the Freedom Caucus later. Senate Republicans will need to rewrite the bill to win over moderate members of the Party, and a conference committee of House and Senate members will make its own changesall of which are likely to turn off purists like Meadows, who will have a another opportunity to kill the bill before it reaches Trump. When asked by USA Today how much the Senate could change the Freedom Caucus-endorsed bill and still garner votes from its members, Dave Brat, a Freedom Caucus member from Virginia, responded, Not at allnone.

So how do Republicans pass health-care legislation when they lose the Freedom Caucus? The answer, of course, is to win over Democrats, as they did with the spending bill.

There are obvious reasons to be skeptical that a bipartisan fix for Obamacare could ever pass Congress. But, as complicated as health care is, Democrats and Republicans actually agree on the basics. Both sides accept the current employer-based insurance system, which covers some hundred and sixty million Americans, and the use of Medicare, Medicaid, and the Obamacare exchanges to cover everyone else. Both sides recognize that neither Democratic plans to replace the employer-based system with a single-payer one nor Republican ones to scrap it and replace it with individual tax credits are politically feasible.

The two sides have been discussing a few specific compromises for years, even before Obamacare passed, in 2010. Liberal and conservative policy wonks both like the idea of taxing health benefits to help ratchet down costs, though neither side wants to deal with the political consequences of taxing such benefits. You could get bipartisan agreement on bringing discipline to the employer system if both sides were willing to take political blame, James C. Capretta, a health-care-policy expert at the American Enterprise Institute, said.

There are other possible deals to be struck. On Medicaid, Republicans could accept Obamas expansion of the systemas several Republican governors have donein return for some reforms, perhaps lowering the income threshold for eligibility, which Obamacare set at a hundred and thirty-eight per cent of the federal poverty level.

Then there are the insurance-market regulations. Theres bipartisan support for the most popular ones, such as the requirement that insurers cover individuals with prexisting conditions (which the Meadows-MacArthur bill would undermine). But less popular regulations, such as the mandate that individuals buy health insurance, might be massaged. The Democrats require Americans who dont buy insurance to pay a tax. The Republicans want to allow insurers to charge more if an individual has a gap in coverage. They are actually not that far apart, Capretta said. They both say if someone hasnt been insured they shouldnt be penalized on their health status. And they both want to penalize people for dropping out of the insurance market. One of the most surprising aspects of the G.O.P.s effort to repeal and replace Obamacare is how many of the laws basic features Republicans have come to accept.

If the current effort to pass a bill with only Republican votes fails, Trump will have a major decision to make. He has shown little ability to learn in office, and almost none to master policy details. But if Ryan and McConnell agreed to lead the effort, a health-care deal with some Democratic support might not be completely out of the question.

Youd have to say were not getting the Freedom Caucus, one of Trumps advisers told me. Right now, they are holding us by the short hairs. Youd have to say, O.K., were going to go with the Democrats so that Mark Meadows cannot be Mr. Veto. Thats the fundamental decision. If this goes down, they have shown you that the far right cannot generate anything and that going with the far right is a failure over and over again.

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How Trump Could Ditch the Freedom Caucus and Pass a Bipartisan Health-Care Bill - The New Yorker