Sen. Majority Leader Mitch McConnell likes to say there’s nothing to learn from a second kick of a mule. But, the Trump White House is doing its best to challenge that. After failing to repeal Obamacare in 2017 (thereby failing to fulfill a campaign promise they’d made for the last seven years), Republicans still managed to pass a bill through the House that put GOPers on the hook for attempting to undercut the most popular provisions of the Obamacare law. Democrats effectively bashed GOP candidates over the head for that vote on the way to a 40-seat pick-up in the House -can you say, pre-existing condition, anyone?
This week, of course, the Department of Justice argued that the entire Obamacare law should be declared unconstitutional, leading a bunch of Republicans (and Democrats) to wonder if the White House is going to, once again, allow Democrats to control the terms of the health care debate in 2020.
It comes at a time when Obamacare is more popular than ever. And, when opinions of how Trump has handled health care are deeply underwater. In other words, of all the issues that Trump could focus on, this is the least friendly territory for him. The latest Kaiser tracking poll found the law with a 50 percent favorable to 40 percent unfavorable. As important, strong support for the law is equal to strong opposition; 27 percent strong favorable to 28 percent very unfavorable. This is a big change from October of 2016, when those who felt very unfavorably about Obamacare outnumbered those who really liked it by 13 points (32 percent very unfavorable to 19 percent very favorable).
For much of 2019, however, the attention has been on Democrats and their internal debates over where to go on health care. Pushed along by 2020 contenders, the Democrats are no longer talking about ‘fixing’ or ‘shoring up’ the ACA, but instead, are calling for a more expansive government role in health care delivery. Republicans were looking forward to labeling Democrats as the party of socialism and gutting private health insurance.
And, there’s now empirical evidence that Democratic voters are significantly more interested in seeing Democrats focus on Medicare for All than they were even just a year ago.
Since September of 2017, the Kaiser Foundation poll has asked voters who identify as Democrats if they’d rather see Democrats in Congress “focus their efforts on (improving and protecting the 2010 Affordable Care Act) or should they focus their efforts on (passing a national Medicare-for-all plan)?
Back in the fall of 2017, 51 percent of Democrats wanted to see Democrats focus on shoring up the ACA, while just 34 percent wanted to see a push on Medicare for All. As of this March, support for Medicare for All went up to 49 percent, while improving the ACA dropped to 41 percent. In other words, in less than two years, Democrats support from wanting to simply focus on making the ACA better to pushing ahead with passing a national Medicare for All plan, moved 25 points.
Yet, the White House’s decision to support a complete repeal of the law - with no obvious legislative strategy to replace it — allows Democrats to pivot from playing defense on "socialism" to playing offense, attacking Republicans for trying to take away popular Obamacare provisions like Medicaid and protection on pre-existing conditions.
The DoJ decision, meanwhile, was only the most recent action taken by the Trump White House to try and repeal Obamacare. Ron Brownstein, one of the smartest political analysts around, especially on the issue of health care reform, wrote recently that in the "2020 federal budget that President Donald Trump unveiled, he renewed his commitment to repealing the Affordable Care Act and replacing it with a block-grant system that would likely strip coverage from millions of Americans, especially those in the primarily blue states that have most effectively implemented the law. And he once again promoted sweeping cuts to the Medicaid program that could eliminate coverage for millions more."
The proposed budget got less attention than the DoJ decision, in part because of timing. This was supposed to be a ‘good week’ for the GOP. They were more than happy to take a victory lap on the Mueller report. Instead, Republicans find themselves caught flat footed, wondering why the White House would want to revisit this politically precarious issue.
The best news for Republicans, joked one GOP strategist to me the other day, is that the White House is terrible at follow-through. Despite reports of Trump putting pressure on Republicans to “be the party of health care,” his party no longer has complete control of Congress, nor the buy-in from GOP members. The reports from Capitol Hill show a less-than-enthusiastic response from members across the board to the idea of engaging in another health care fight before 2020. The idea of a bipartisan bill that can pass the House and the Senate is laughable.
With no chance of legislative action, the issue is in the hands of the courts. The 5th Circuit could overturn the lower court ruling that declared the law unconstitutional. Or, the fate of Obamacare could end up in the Supreme Court, Of course, that could backfire spectacularly on the GOP right before the 2020 election. As the Washington Post writes, “if the law is struck down, Republicans fret that the party will be blamed for more than 20 million people losing their health insurance — and they fear that crafting an alternative would prove unwieldy in a deeply divided Congress.”
We may not see any real action on Obamacare this year or next. Even so, this entire episode is yet another reminder that the president is going to run his 2020 campaign exactly the way he ran in 2016. Instead of mining opportunities to exploit Democratic weaknesses with swing voters, the president is more focused on keeping his own voters happy. That wouldn’t be a problem if he were more popular. But, with a hard-core base of 28-30 percent, and a job approval ceiling around 45 percent, ‘all about the base’ isn’t a winning strategy for re-election.