Republicans are squabbling over healthcare. Again. But the repeal and replacement of Obamacare will go forward. Why? Because this has been the signature issue of every GOP campaign for over six years; they cannot afford to fail. Also, since the Affordable Care Act is neither affordable nor sustainable and is harming the country, President Trump wants the GOP plan to succeed.
The coming fight over the new American Healthcare Act will test Trump’s resolve and clout. Unlike Obama, who rarely inserted himself into Congressional tussles, Trump appears eager to engage. The night before the program was revealed, he dined with Budget Director Mulvaney and HHS Director Tom Price, talking strategy and messaging. He has also hosted a series of get-togethers with Congressional leaders, and yesterday the president met with the deputy whip team from the House – the folks who will be counting noses. When needed, Trump will gladly strong-arm Republicans in the House and Senate to corral their votes.
He’s good at that; that’s the art of the deal. And no deal has even been more critical to Mr. Trump’s success.
The bill laid out by House Republicans is predictably causing feinting fits among liberals; one columnist wrote it would “destroy the ability of millions of Americans to access any healthcare worth the name.” Voices on the left object to the possible defunding of Planned Parenthood, the tax breaks (which would accrue to those with income – i.e. the “wealthy”), the reversion of more authority to the states (which, for reasons unknown are meant to be less generous to residents than the federal government), and the removal of Obamacare’s mandate-enforcing taxes, which would lead to fewer young and sick people buying insurance. Of course, that is already happening because the fees imposed under Obamacare were insufficient to make people sign up. That’s why Aetna’s CEO has said that the program is in a “death spiral.”
There may be some accommodation to liberals; for instance, there are signs the Trump White House is reluctant to withdraw funding to Planned Parenthood. Also, Maryland Rep. Elijah Cummings has announced he will meet with Trump to explore ways to bring down prescription drug costs. But mainly, the negotiations will be with Republicans who have the votes to push the new health plan through if they are united.
Tea Party stalwarts fret about creating new entitlements or budget-busting tax credits and call the bill “Obamacare light.” As ever, the far right is willing to make perfect the enemy of the good.
But many of those critics represent states and districts where Donald Trump won convincingly. As he rolls out policies, they will defy him at their political peril. The most recent average of polls shows Trump’s approval ratings at a negative spread (-9); that’s not great, but it sure beats the -42 percent polling for Congress.
Rand Paul, for instance, raised objections to the House plan even before he saw it, making the case that it was concocted “in secret;” the Kentucky senator engineered a made-for-TV moment by “hunting” for the legislation last week before it was released to the public. It is hard to take Rand’s complaints seriously. Surely he knew that the minute Democrats had a look at the proposed legislation, they would rip it to shreds.
Trump carried Kentucky by 62.5 percent to Hillary Clinton’s 32.7 percent; Mitt Romney had carried the state by only 20 points. Rand Paul won reelection 57.3 percent to 42.7 percent. Trump carried all counties but two; Paul lost seven counties and barely won a handful of others. Paul doesn’t face reelection for six years, but bucking Trump could cost him support and dim his prospects for another presidential run down the road.
Four GOP senators have complained in a letter that the House proposal “does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.” Sens. Rob Portman (Ohio), Shelley Moore Capito (West Virginia), Cory Gardner (Colorado), and Lisa Murkowski (Alaska) all represent states that expanded Medicaid under Obamacare; other than Gardner, they are all from states won easily by President Trump. There will likely be some accommodation on both sides.
Trump’s approval ratings are not high, but so far Republicans like what they see. As Gallup reported recently, while his overall standing is below average for a new president, his 87 percent approval among Republicans trails only George W. Bush among all GOP presidents elected in the past seven decades. Another data point that is encouraging for the White House: 45 percent of the country thinks the U.S. is heading in the right direction – a higher number than for any single week of Obama’s presidency.
The White House will spend considerable political capital to sell the bill. A full-bore communications effort is underway, touting among other things, the bill’s simplicity. Whereas the ornate mandates of Obamacare occupied 2,400 pages, the initial measure from the House Commerce Committee is only 66 pages.
As they roll out their program and seek to remind voters why changes are necessary, the White House should quote one of the great communicators of our day.
Speaking at a rally in Flint, Michigan last October, President Clinton summarized some of the ACA’s defects: “You’ve got this crazy system where all [of a] sudden 25 million more people have healthcare, and then the people are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half.”
Clinton is right, and he was also correct when he noted that the ACA “works fine” for those who receive Obamacare subsidies or who are enrolled in Medicare or Medicaid but that “The people who are getting killed in this deal are small business people and individuals who make just a little bit too much to get any of these subsidies.”
Trump should bring Clinton aboard to sell Americans on the new bill; that would be a heck of an artful deal.