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What the GOP Could Have Learned from Obamacare

President Donald Trump walks in a corridor of the White House to greet visitors, while a portrait of Hillary Clinton hangs on the wall, March 7, 2017 in Washington, DC.
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First Read is a morning briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter

What the GOP could have learned from Obamacare

The 2010 Affordable Care Act — or Obamacare — was far from a perfect piece of legislation, and it created so many political problems for Democrats after its passage (see the 2010 and 2014 midterms). Yet it did accomplish something that no other major health reform has in modern political times: It actually passed Congress and was signed into law. So it's all striking that the Trump White House and congressional Republicans have ignored some of the key lessons in how to pass health reform through Congress:

1. Get industry and major stakeholders to support the legislation: That's what Democrats and the Obama White House achieved in 2009-2010. Yet by comparison, consider all of the groups that ALREADY are opposed to the GOP House bill: AARP, American Hospital Association, American Medical Association, and the American Nurses Association. What's more, the powerful group representing the country's health insurers (AHIP) released a letter Wednesday asking for changes to the legislation, including more Medicaid funding (something conservatives are opposed to).

2. Go slow: Ultimately, the year-long process to pass Obamacare backfired politically, especially after Democrats lost Ted Kennedy's Senate seat. But as a way to pass legislation, the slow process worked. Public subcommittee work. Committee hearings. Congressional Budget Office scores. This time around, however, Republicans have marched to markup the legislation BEFORE public hearings and a CBO score. As Sen. Tom Cotton (R-AR) tweeted this morning, "House health-care bill can't pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don't get it fast."

3. At least reach out to the political opposition: Yes, Obamacare didn't get a single vote from a Republican lawmaker. But it wasn't for a lack of trying. The Obama White House actively courted Sens. Susan Collins and Olympia Snowe (R-ME), as well as Sen. Chuck Grassley (R-IA). Indeed, Snowe voted for the Senate Obamacare proposal in committee in October 2009 -- although she backed away in the votes for final passage. This time around? The Trump White House and congressional GOP leaders haven't made at least the appearance of this kind of effort.

4. Unite the party around the central tenets of the legislation: In 2009-2010, Democrats/independents from Ben Nelson and Joe Lieberman to Nancy Pelosi and Bernie Sanders agreed on the major provisions of the Affordable Care Act — exchanges working with private insurers, subsidies to help disadvantaged Americans to pay for insurance, major health-insurance regulations, and Medicaid expansion. Yes, they argued over a public option, but they agreed on almost everything else. Yet in 2017, Republicans are divided over tax credits, Medicaid expansion, and whether there should even be a replacement plan combined with repeal. Those aren't minor issues. As conservative Philip Klein notes, "For years, GOP chose short-term messaging victories on Obamacare for doing hard work of hashing out health-care differences."

5. Have supermajority support — or close to it: Finally, and perhaps most importantly, Democrats held a supermajority in the U.S. Senate (60 votes), or close to it in 2009-2010. But this time, Republicans are trying to repeal and replace Obamacare with just 52 senators, who range from Rand Paul (R-KY) and Ted Cruz (R-TX) to Susan Collins (R-ME). And while Republicans are attempting to pursue some of their goals via reconciliation (which requires just a simple majority), other key components to drive down costs and reform the health-insurance industry will eventually require 60 votes. And it's why the current House bill doesn't contain these provisions.

Democrats: We told you health care was hard
Relatedly, NBC's Alex Seitz-Wald reports on Democrats who have uncorked a fine bottle of schadenfreude. "President Donald Trump said last week that 'nobody knew that health care could be so complicated.' But the aides and advisers who worked on health care for Bill Clinton and Barack Obama — they knew. 'Maybe I should just say karma is a serious thing,' said Neera Tanden, who was a top health official in the Obama administration. 'Health care is hard. Governing is hard. And Republicans are now living with the fruits of never putting forward a plan and making promises they can't keep.'"

More: "It's a strange place to be for the Democratic operatives and elected officials who saw their party devastated in part by Obamacare. And some can't help but feel a bit of cosmic justice as they watch Republicans stuck in a policy quagmire they know all too well. Jonathan Gruber, an MIT economist who helped design the Affordable Care Act, said health care policy is both extremely complicated and extraordinarily personal. 'It's healthcare, it should be easy. Everyone goes to the doctor. But it's super hard,' Gruber said. 'As a result, it's easy to demonize everything.'"

More from NBC News:
The GOP health care plan is in critical condition
Kasich after Trump meeting: If you're on a plane, you root for the pilot
First Read's morning clips: Winners and losers in the GOP health care bill

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At 11:00 am ET, the president holds a listening session with CEOs of small and community banks… At 2:00 pm ET, he meets with former Commerce Secretary Pete Peterson… At 3:00 pm ET, Trump visits with CIA Director Mike Pompeo and Homeland Security Secretary John Kelly… And at 4:00 pm ET, he makes remarks to the Senate Youth Program.

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