The story of Wednesday morning is that the GOP health plan may be in trouble, because even allies of President Donald Trump are warning him to ditch it before he gets dragged down along with it. The alarm they are sounding is simple: By embracing Paul Ryan’s plan, which would dramatically slash taxes on the richest Americans while massively rolling back coverage for the poorest Americans, he is losing touch with the “populist” message and ideological heterodoxy that helped drive his appeal to working-class voters.
Here’s why this is important: It lays down a marker with which we can evaluate whether Trump is actually governing as the “populist” he telegraphed he would be. If Trump does not cut Ryan’s plan loose, we should theoretically be able to agree that in some key respects, the brand of populism he ran on during the campaign was pure fraudulence — by the lights of his own allies.
The Post reports that a “simmering rebellion of conservative populists loyal to President Trump is further endangering the GOP health-care push”:
Trump’s allies worry that he is jeopardizing his presidency by promoting the bill spearheaded by House Speaker Paul D. Ryan, Wis., arguing that it would fracture Trump’s coalition of working- and middle-class voters, many of them older and subsisting on federal aid. . ..
Trump loyalists warned that the president was at risk of violating some of his biggest campaign promises - such as providing broad health coverage for all Americans and preserving Medicaid and other entitlement programs - in service to an ideological project championed for years by Ryan and other establishment Republicans.
“Trump figures things out pretty quickly, and I think he’s figuring out this situation, how the House Republicans did him a disservice,” said Christopher Ruddy, a longtime Trump friend. “President Trump is a big-picture, pragmatic Republican, and unfortunately the Ryan Republican plan doesn’t capture his worldview.”
It is true that Candidate Trump strongly telegraphed to working-class white voters that, in replacing Obamacare, he would support a robust government role in helping the poor and the sick. It seems reasonable to assume that this, combined with his rhetorical break from GOP orthodoxy on trade, immigration and cutting taxes for the rich (which is also turning out to be a sham), helped create the populist allure that his allies fear might be at risk. It is also true that the Ryan plan would leave a lot of those voters without health coverage, while deeply slashing taxes on the very rich. The Congressional Budget Office report makes this conclusion impossible to obfuscate away any longer.
Yet Trump continues to fully embrace the Ryan plan, anyway. How can this possibly be?
The most likely answer is that Trump simply doesn’t care about the details of health-care policy, and just wants a win — which means really nothing more than delivering on his vow to repeal the ACA and replace it with “something terrific.” It has long gone without saying for Trump that the replacement he champions will be far superior to Obamacare, whatever it is. Trump’s guiding articles of faith have been that Obamacare is an irredeemable disaster (Trump knew he had to say this, and came to believe it, even though the evidence strongly suggests he has no idea how it actually works) and that Trump is a winner who is a whiz at fixing things. So of course Trumpcare will deliver more and better health care for less money.
But we are now learning that to cover as many people as Obamacare does, you have to spend far more money than the priorities of congressional Republicans will permit. Indeed, as the CBO report showed, the GOP plan gets a big chunk of its savings by cutting Medicaid spending by over $800 billion, resulting in 14 million fewer people benefiting from it — thus allowing an enormous tax cut for the rich.
These are the priorities that Trump has now fully embraced, and his conservative populist allies understand the political danger of it. Putting aside the question of what these allies would like to see Trump champion instead, they are probably onto something. While it’s true that the ACA’s individual mandate is very unpopular, it’s also true that there is broad public support for key elements in the law that regulate and spend money to cover the poor and sick.
Indeed, a new Morning Consult poll finds that 46 percent of Americans support the new GOP health bill, which is roughly the popularity of the ACA. But crucially, the poll also finds far more support for the elements in the new plan that are holdovers from the ACA, such as the protections against discriminating against preexisting conditions. (The new poll shows opposition to the GOP plan’s means for making that possible, the penalty for discontinuous coverage that insurers could charge.) Meanwhile, a recent Kaiser Family Foundation poll found that large majorities favor keeping Medicaid the way it is under the ACA.
So Trump’s conservative populist allies are probably right that embracing Ryanism is politically perilous. But here’s the bottom line: We know that the new GOP plan betrays Trump’s promises, which were that under his replacement, no one would lose coverage. We have reason to suspect Trump’s populist appeal was rooted partly in his willingness to ideologically part ways from Ryan-ism, which is something he clearly signaled on the campaign trail. And so, if he continues to embrace the Ryan plan, this means that posture was mostly a sham.
If Trump is falling into Ryan’s trap, he’s doing so willingly — because the details don’t really matter to him; because all he wants is a win; and because he currently believes this is the only way to get one as quickly as possible.