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12:33 PM

Why the House of Representatives Failed to Pass the American Health Care Act

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Why the House of Representatives Failed to Pass the American Health Care Act

Passing the AHCA would have overturned the status quo, ObamaCare, just as ObamaCare overturned the prior status quo, healthcare is an individual, not a government, responsibility. 

Tim Riesterer, instructor in the art of corporate storytelling, in his storytelling framework, explains that human beings have an innate bias to maintaining the status quo.

There is a good reason for this. It is called fear.  We are hard-wired to avoid danger.

We think the status quo protects us against danger in 4 ways.

1.     We prefer stability and see change as a threat to that stability.

2.     We believe the status quo is free and that there is a cost to change.  We generally like to avoid higher costs.

3.     Information overload. Too much information makes selection difficult. Staying with the status quo is easier than sorting through all of the options.

4.     We don’t change because we anticipate we will regret our decision to give up on the status quo.  We project that what we talked our colleagues in to won’t be as successful as we led them to believe it would be.

We can eliminate status quo bias in 4 ways.

1.     Weaken the status quo preference by introducing hidden challenges that make the status quo a less safe (more dangerous) course

2.     Showing the cost of inaction. Unfortunately, we tend to make decisions more often to avoid loss than to realize a gain.

3.     Contrast the status quo with the benefits of taking action to solve a problem. Paint side-by-side pictures of the current situation and the new and improved situation in order to make the case for change.

4.     Personalize the need for change.

Back to the AHCA, the Republicans who favored the proposed law failed to show that the real health care danger was not in changing the law but in not changing it.

 The GOP also failed to speak directly to the voters who were motivating the proposal’s opponents, by failing to personalize that the status quo ObamaCare would be more expensive to voters than the new American Health Care Act.

The Republican policy wonks also overwhelmed voters with statistical information, focusing on billions and trillions of federal dollars rather than thousands of dollars in personal health care outlays. Congressmen who favored the AHCA failed to convince their colleagues that failing to vote for the new healthcare bill was a vote for the status quo, which was the vote that would fraught with regret.

Republicans could have turned the situation around by undermining their colleagues’ apparent preference for the status quo. They could have accomplished this by projecting the future anger of their constituents when they saw their premiums continue to skyrocket and their health care choices dwindle.

The AHCA’s supporters should have focused their messaging like a LASER on the personal costs of not changing to the proposed new law and less on the legislative and policy nuances of the changes.

The bill’s supporters lead by Speaker of the House, Paul Ryan, should have driven home the personal cost issue with a side-by-side comparison of a family’s cost under ObamaCare and under the proposed AHCA. They should have learned the effectiveness of visual imagery from the Democrats’ “Paul Ryan wants to push Granny off the cliff” video ad attacking the then Republican vice presidential candidate Paul Ryan.

In the scare-tactic video, a man who appears to be Paul Ryan pushes an elderly woman in a wheelchair over a cliff in order to make the Democrats’ point that election of Republican Mitt Romney and his running mate Paul Ryan would result in the death of senior citizens who are dependent on Medicare for healthcare. Ryan blamed the Granny ads for turning the country against him thus clearing the way for the election of Barack Obama, the father of ObamaCare.

Again, the ACHA supporters should have spent more time and money personalizing the advantages of change and the dangers of the status quo, by putting a face on the health care debate rather than building the messaging around dry policy issues most voters don’t pay attention to. This is something President Obama himself recognized when he trotted out little Marcelas Owens front and center at the signing ceremony for the ObamaCare legislation in March 2010.



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8:13 AM

Abraham Lincoln and Healthcare Reform

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Abraham Lincoln is reported to have said in 1856 that “you can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time." 

Change “fool” to “please” and you have the essence of the current stalemate over the bill under consideration in Congress to replace the Affordable Care Act, known informally as ObamaCare. Congress is currently considering a Republican-crafted replacement bill dubbed the American Healthcare Act.

On one side of the divide are the congressional Republicans who have sworn for 7 years that upon assuming the majority in Congress and capturing the White House they would immediate dismantle the ACA and replace it with a more free market-oriented healthcare system.

On the other side are the Democrats, still smarting from 7 years of withering criticism of the failing ACA, which was passed and signed into law without any effort to engage Republicans on a bi-partisan healthcare solution. The Democrats are divided into establishment Dems and a more liberal bloc built around supporters of socialist Vermont Senator Bernie Sanders.

This bloc largely favors a European-style Democrat Socialist, single-payer healthcare system that would eliminate private insurance companies from the healthcare market making the government the only health insurer. Establishment Democrats see this as a losing political hand in the same way they saw Sen. Sanders as a losing candidate vs Hillary Clinton is the 2016 Democrat primary

Back on the Republican side. We have a further split. The Republican caucus is divided into the mainstream Republicans and more conservative Republicans. These conservatives are themselves split into one group calling itself The Freedom Caucus and the other, known as the Republican Study Committee. 

Back to Mr. Lincoln. The parliamentary maneuvering to either pass the bill into law or block its passage continues as the bill’s sponsors look for ways to entice recalcitrant Members to support the measure. This effort involves amending the legislation to make it more pleasing to the various factions. 

The issue is whether the Republican House leadership can please enough Members to cobble together the required votes to pass a bill that has been promised for 7 years. 

Earlier this week, the bill was amended to allow states the flexibility to impose work requirements on Medicaid recipients and to block-grant Federal Medicaid funding to the states, which would then decide the best way to spend the grant in each state. 

This more Federalist approach to Medicaid seem to have gotten Republican Study Group members seats on the American Healthcare Act train, but do not appear at this late hour to have been enough to get the Freedom Caucus on board. And liberals and some moderates do not favor allowing states set the administrative rules of the program.

We may be at a point where House leadership in order to please enough Members to pass the bill is facing the prospect of having to fool enough Members in order to get their votes. Also, changing the bill to please one faction may make it less likely that an opposing faction will sign on. 


Pleasing, fooling, it’s all the same in politics. Trying to fool or please all the people all the time is a zero sum game. Every vote you win may cost you a vote you lose from another faction.
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