RUTHFULLY YOURS

https://www.wsj.com/articles/the-republican-obamacare-crack-up-1501280459

After promising Americans for seven years that it would fix the Affordable Care Act, the Republican Party failed. This is a historic debacle that will echo politically for years.

A divided GOP Senate could not muster a majority even for a simple bill repealing the individual and employer mandates they had long opposed. Nor were they able to repeal the medical-device tax that some 70 Senators had gone on record wanting to repeal in previous Congresses.

The so-called skinny bill that failed in the Senate would have gone to a conference with the House, which had signaled its willingness to work out a compromise. That arduous process is the way the American legislative system works. A strong majority of the GOP caucuses on both chambers supported the effort to repeal and replace ObamaCare, but that was undone by an intransigent and petulant minority.

Where to begin in comprehending John McCain’s last-minute defection? Early Friday morning Senator McCain turned his thumb down on the bill, which doomed this long effort. Explaining that vote, Mr. McCain said the bill “offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.” This is hard to credit, because his “no” has left the American people with ObamaCare in toto.

On Thursday, with three other Senators, Mr. McCain said he wanted assurances that House Speaker Paul Ryan would negotiate in conference. Mr. Ryan said he would, and the other three voted yes. Senator McCain nonetheless chose to cast the decisive vote that broke the GOP promise.

The Arizona Senator’s politics has always been more personal than ideological. His baffling, 11th-hour vote makes us recall Donald Trump’s infamous campaign slight about Mr. McCain’s war imprisonment. Whatever his motives, the greater shame is that his vote keeps the edifice of ObamaCare in place with all of its harm to patients, the health-care system and the national fisc.

There were many other contributors to this debacle. The Freedom Caucus dragged out the process in the House, which created time for opposition to build. Alaska Senator Lisa Murkowski betrayed her many previous votes and public statements. Two GOP Governors, Ohio’s John Kasich and Nevada’s Brian Sandoval, grandiloquently assaulted the bill for their own political gain, which made life difficult for their states’ Senators, Rob Portman and Dean Heller.

The Senate’s GOP moderates conspired to kill both a historic Medicaid reform and repeal of ObamaCare’s myriad taxes. Senators Rand Paul and Mike Lee worked to defeat Majority Leader Mitch McConnell’s compromise draft to no good end. We cannot recall a similar effort by so many to subject their own party to such an abject public humiliation.

Mr. Trump in a tweet blamed the three GOP Senators who voted no, but he was also an architect of his own defeat. Mr. Trump was elected in no small part on his promise to do big deals like this one. In the end he couldn’t close. He never tried to sell the policy to the American public, in part because he knows nothing about health care and couldn’t bother to learn.

His chaos theory of White House management, on morbid public display this week, also means no one on Capitol Hill knows who is in charge. As his approval rating sinks below 40%, few in politics fear him and increasingly few will step forward to defend him.

What next? The Senate failure has burned the reconciliation process available from last year and thus the ability to pass anything with 50 votes. The next reconciliation bill is earmarked for tax reform, if the hapless GOP can first pass a budget outline. Meanwhile, the ObamaCare exchanges will continue to deteriorate. This means the Trump Administration will face a choice of how much money to spend to keep some of them from collapsing. HHS Secretary Tom Price can give insurers more flexibility, but premiums will keep rising while choices for consumers decline.

The Republicans who did so much to kill repeal and replace will now clamor for bipartisan action. And it would be nice to think Democrats would meet Mitch McConnell halfway. But Democratic leader Chuck Schumer knows he has Republicans on the run, and his price for 60 votes will be a costly bailout of ObamaCare, which liberal health-care academics are already proposing. Good luck repealing the law’s mandates and taxes, or deregulating insurance markets.

Mr. Schumer knows that a “bipartisan” Senate insurance bailout will further divide the GOP and put the House on the spot if it fails to go along. With the House majority in jeopardy in 2018, Speaker Ryan could face an excruciating choice: Attempt to save the seats of his party’s moderates by voting with Democrats to bail out the exchanges, or get blamed by Democrats and the press for all of ObamaCare’s ills.

Republicans will now try to salvage what is left of this Congress with tax reform. But the tragedy remains: Republicans in their selfish political and personal interests squandered a once in a generation chance to show that their principles can make life better for Americans.