The fallout from the collapse of Trumpcare has left most of the blame, or credit, on the House Freedom Caucus. President Trump has pointed his finger at the restive right-wingers, and news coverage has taken their central role (“the ultraconservative GOP lawmakers who stymied Trump on health care ”) as a given. It is true that the House Freedom Caucus made life difficult for Paul Ryan and the Trump administration. But it overlooks the main cause of Trumpcare’s failure, which is the revolt it generated from the left.
The left, not the right, was the source of public pressure, like large-scale rallies, inundating Congress with phone calls, and swarming town hall meetings. It was also the source of the opposition from doctors and hospitals, which stood to lose billions of dollars in business from customers who could no longer afford to pay for regular medical care.
Many Republicans in the House opposed to the bill heard this message explicitly because it threw their constituents off their insurance. A sample of quotes:
Congresswoman Jaime Herrera Beutler (R-WA): “The difficulties this bill would create for millions of children were left unanswered … I will not vote to let those kids fall through the cracks.”
Congressman Charlie Dent (R-PA): “will lead to loss of coverage and make insurance unafforable for too many Americans, particularly for low-to-moderate income and older individuals.”
Congressman Rodney Frelinghuysen (R-NJ): The bill “would place significant new costs and barriers to care on my constituents in New Jersey.”
Congressman Frank LoBiondo (R-NJ): “Simply put, this bill does not meet the standards of what was promised; it is not as good as or better than what we currently have”
Congressman Chris Smith (R-NJ): “The overriding concern I have is the Medicaid expansion being significantly altered. It affects so many of our disabled individuals and families, and the working poor.”
Congresswoman Ileana Ros-Lehtinen (R-FL): “It would be practically impossible for the leadership to make the kind of changes that could accommodate the needs of my constituents. They will be severely hit.”
Perhaps the most fatal barrier faced by the bill was the opposition of the Senate. Trumpcare was dead on arrival in the upper chamber, in part due to the opposition of a handful of arch-conservatives, but mostly because upwards of a dozen Republicans deemed its coverage inadequate. Some vulnerable House Republicans might have risked their seat to pass a bill slashing coverage to finance upper-bracket tax cuts. None of them were going to do it just to see their handiwork die in the Senate.
The most telling statement about the bill’s defeat came from Senator Bill Cassidy, a Louisiana Republican and an unexpected source of opposition. “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” Cassidy told the New York Times.
Conservatives wish to comfort themselves by attributing the failure of their repeal crusade to poor legislative tactics — by ultraconservatives, by Ryan, by Trump. Republican leaders certainly did a terrible job of designing and selling their law. But their greatest error was in fooling themselves into believing the country truly wanted to rip away coverage from the poor and sick.