Republican infighting has broken out into the open in the wake of the health bill failure as blame shifting took center stage. While the unsuccessful bill included some significant entitlement reductions and some beneficial reforms, it largely accepted the government centric provider model. The changes didn’t fix the long term problems with the marketplaces and wouldn’t have helped save the struggling law. Instead it would have shifted responsibility for success of the law’s flawed architecture onto the Republicans. The eventual failure could then be used as an excuse that the ‘free market’ way doesn’t work and its failure would justify further government intervention. However, since reconciliation (a limited legislative method that avoids the Senate filibuster) is the only politically feasible path to passing a change, Republicans aren’t entirely shelving this issue. It seems the negotiations are already underway on the next attempt, with Trump threatening conservative members who opposed the first bill with primary challenges.

I’ve mentioned it before, Trump has Democrat instincts on many policy fronts, even openly supporting single payer. If conservatives in Congress want to advance a conservative agenda they must provide easy legislative victories for Trump. The House allowed its internal strife to undermine Trump after he expended significant political capital promote the bill, and in return he’s lashed out at the Freedom caucus. The house needs to heal its divide because if they can’t agree on a way forward they risk pushing Trump towards the Democrats and their policy priorities. Fortunately for the right, Democrats seem to have zero desire to work with a man their base outright despises. If Republicans do make another attempt at passing a bill in the near future it will be very important to monitor which way the law has been modified. To my eyes, it looks like the Freedom caucus has significant leverage because they remain the only path forward in the current political environment, so I expect any second attempt to incorporate more of their priorities. Trump seems to understand this as well and is attempting to undermine it publicly in order to level the playing field. Even if successful, the law would then have to clear the Senate which carries its own political hurdles. This is just the beginning of a drawn out battle over the way forward for American healthcare, and it’s an open question if conservatives can get it done on their terms.