Stuff just got real here in Washington. With the introduction of the Obamacare repeal/replace legislation (the American Health Care Act) we are now going to finally find out if an ideologically flexible president who lacks a core governing philosophy (or governing experience) can get an ideologically diverse party with little experience in political power to pass his agenda. While the legislation was drafted in the House, the White House team - from HHS Secretary Tom Price to Vice President Pence to President Trump - is putting on the full-court press to get Republicans to support it.
At first blush, the challenge for Trump looks fierce. The immediate reaction to the ACHA has been, well, universally bad. Conservative groups and leaders have been especially critical, with everyone from the Freedom Caucus, to the Heritage Foundation to the Club for Growth coming out against it. As the New York Time’s Ross Douthat writes, “it’s a bill that nobody on the right much likes: Not libertarians and not reformocons, not right-wing donors and not mushy moderates, not the Tea Party senators who promised full repeal and not the swing-state senators who well know that their own voters want the coverage expansion to endure.” Commentary’s Noah Rothman writes, “The bill is the product of a messy divorce between conservatives and conservatism….The GOP replacement for ObamaCare pleases no one because it is an effort to synthesize two fundamentally incompatible philosophies.”
Yet, if past is prologue, the odds are good that Trump can succeed in getting his party in line. I was deeply skeptical throughout 2016 that the GOP would rally around Trump. At regular intervals I would write that THIS was the moment/issue/event that will split the party from their unconventional frontrunner/nominee. Yet, neither his ideological inconsistency nor his unorthodox (and unbecoming) behavior was enough to keep GOP voters from flocking back to Trump. He won 90 percent of the GOP vote in November. The latest Survey Monkey polling shows Trump with a 92 percent approval rating among Republicans (with 71 percent strongly approving).
There is, then, a certain irony – or is it hypocrisy – that many of the voices on the right cursing the plan for its lack of conservative principles were many of the same ones willing to look the other way when Trump disavowed those same core values. Did any of those who are dubbing this “Obama-lite” watch the 2016 campaign? To be fair, there were plenty of conservatives (some who were active #NeverTrumpers) who warned about the ideologically inconsistent slippery slope. For those who embraced Trump but are upset about a health care plan that’s not “conservative enough” let’s take a look back at some of the then-presidential nominees views on the health care law: Here’s what he told CBS’ Scott Pelly in late September about his plan to fix Obamacare:
Pelley: How do you fix it?Then he said this to CBS’ Lesley Stahl right after he was elected in November:
Trump: There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, "No, no, the lower 25 percent that can't afford private. But--"
Pelley: Universal health care.
Trump: I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now.
Pelley: The uninsured person is going to be taken care of. How? How?
Trump: They're going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably—
Pelley: Make a deal? Who pays for it?
Trump: —the government's gonna pay for it. But we're going to save so much money on the other side. But for the most it's going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.
Lesley Stahl: Let me ask you about Obamacare, which you say you’re going to repeal and replace. When you replace it, are you going to make sure that people with pre-conditions are still covered?(highlights are mine)
Donald Trump: Yes. Because it happens to be one of the strongest assets.
Stahl: You’re going to keep that?
Trump: Also, with the children living with their parents for an extended period, we’re gonna--
Stahl: You’re gonna keep that--
Trump: Very much try and keep that. Adds cost, but it’s very much something we’re going to try and keep.
For those who say they appreciate that Trump is sticking to promises he made on the campaign trail, well, guess what, he said he’d keep parts of Obamacare. And, this bill is living up to that commitment. When the GOP decided to embrace Donald Trump, they embraced all the inconsistencies that come with him and his brand. Many conservatives rationalized that he was better than the alternative of a President Hillary Clinton. Others were convinced that when in office he’d embrace a more traditional conservative outlook/agenda. Now, they are starting to realize the price to pay for cognitive dissonance. The more immediate political concern for all Republicans, however, is how this bill is perceived by rank and file voters in 2018. While many on the right are most concerned about “keeping their promise” of repealing Obamacare “root and stem,” there are plenty of voters – many of whom supported Trump – who are most concerned with the cost of care.
Here’s what then president-elect Trump told the Washington Post in mid-January: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law, “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” Yes, breaking their promise to fully eradicate Obamacare is going to anger plenty of core GOP voters. But, anything that passes but doesn’t make the cost of health insurance more affordable is going to be the toughest thing for Republicans to defend in 2018.