Turning campaign promises into policy is tricky. Especially if the campaign promise is an oversimplified version of reality.
The attempt by congressional Republicans and President Trump to repeal and replace the Affordable Care Act is a case in point. What sounded like a slam dunk turned out to be a quagmire. Instead of a policy triumph, the GOP has a concrete anchor around its political neck.
The Congressional Budget Office is once again the bearer of bad news. CBO scoring of the various iterations of the repeal and replace bills helped sink them with predictions of millions of Americans losing health insurance coverage.
Now CBO says if Trump carries through his pledge to deep-six subsidy payments to health insurers, as provided for in the Affordable Care Act, health insurance premiums could rise 20 percent next year – and the federal budget deficit could balloon by $194 billion over the next decade.
Since the chief GOP objectives of repealing and replacing “Obamacare” were to lower health insurance premiums and cut the budget deficit, the CBO estimate wasn’t reassuring.
Tennessee Senator Lamar Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, is entertaining bipartisan legislation to “stabilize and strengthen” the individual health insurance market. He is working with Washington Senator Patty Murray. There is a similar bipartisan tandem working in the House. Both the Senate and House efforts involve retaining the cost-sharing subsidies that Trump threatened to jettison.
The failure to repeal and replace the Affordable Care Act provides lots of lessons. One of the most important is not to promise what you can’t deliver.
For the Trump administration, this is a lesson that could be applied across a wider policy spectrum, including throwing out trade agreements. Negotiations to update and modify the North American Free Trade Agreement, which Trump called the worst trade deal in history, are just beginning among the United States, Mexico and Canada. One of the loudest skeptics about wholesale changes in NAFTA are US automakers – one of the industry sectors the administration wants to help.
Like the Affordable Care Act that interacts with a complex web of health insurance and health care delivery systems, international trade has deep roots in commercial activity that can easily be upset, resulting in unintended negative consequences – including job losses. You may think tariffs on foreign goods will boost US industry, only to discover it may hurt more than it helps. That explains why Trump’s negotiation points in the NAFTA talks are a lot more restrained than his campaign proclamations.
Politicians of all political stripes deserve some sympathy. Most voters aren’t interested in policy details or complication explanations. They tend to react to sound bites and bumpersticker phrases. Opponents and pundits are quick to pounce on spongy policy pronouncements, so candidates opt to go with punchy and simple.
For all the griping about the non-responsiveness of governmental institutions, political leaders and agency bureaucrats do listen. And the legislative process, which was designed to be messy, works in most cases to get to a more nuanced policy place than a campaign promise.
The prospects of bipartisan legislation to address shortcomings of the Affordable Care Act and negotiations to modernize, not destroy, a major continental trade deal are examples of how government is supposed to work.