A nice bookend to this morning’s WaPo story quoting Trump as saying he wants “insurance for everybody.” The number of GOPers who agree that it’s the responsibility of the federal government to ensure that everyone has coverage is “only” 32 percent here, but it was 19 percent as recently as last March — and that increase comes with Trump and other top Republicans having devoted little energy to pushing the idea so far. Per WaPo, that may be about to change. If he spent the next three months, say, regularly flogging the message that the GOP’s ObamaCare replacement must cover everyone and that the federal government will somehow guarantee that it does, how long would it take for Republican approval to reach 50 percent? Over/under is March. Rush’s inevitable monologue calling the idea of more government in health care “brilliant politics,” if perhaps not something a hypothetical conservative might support, would be one of his finest ever.
Note the split among income level.
The charitable spin on that data is that it’s a straightforward reaction to the specter of ObamaCare repeal. The GOP has sworn for years that they’d tear down the exchanges once they had the chance. Voters gave them that chance in November but now have to face the risk of some people losing coverage. As such, this poll is less a statement of abstract opinion about big versus small government and more a way of signaling to the new GOP government to make sure that there’s continuity in coverage one way or another, whatever the new system ends up looking like. Hence the spike not only among the lowest-income Republicans, who are worried about Medicaid being rolled back, but among middle-class Republicans, who fear losing either their O-Care insurance or their subsidies or both. They’re simply sending a message to Trump, Ryan, and McConnell not to leave them with nothing. And do note: Few of these people prefer a total government takeover of health care in the form of single-payer. When Pew offered them that option, just 10 percent of Republicans chose it. Twenty percent wanted a mix of private and government programs and 56 percent wanted less than that, with government merely continuing Medicare and Medicaid. Another 10 percent of GOPers — as many as favored single-payer — chose the strong-form libertarian option of no role for government in health insurance.
As I say, that’s the charitable spin. The less charitable spin is that, for many Republicans, this was always less about wanting a smaller federal government than about wanting a smaller Democratic-controlled federal government. Once it’s our guy in charge instead of theirs, why not trust Uncle Sam to take care of you?
The share of the public that thought it was the feds’ responsibility to guarantee coverage for all was bouncing along in the 60s during the Bush years — until the bottom dropped out in 2009, when Obama took office promising a massive left-wing overhaul of the insurance system. For the first time, the number who thought government doesn’t have that responsibility exceeded the number who thought it does. It kept climbing up to 2013, the year ObamaCare was finally implemented. Then, as Obama’s presidency wound down and Trump made the thought of proactive government great again on the right, support for a federal guarantee returned to recent historical norms. What do you suppose the graph would have looked like if Hillary had pulled it out in the Rust Belt and was set to be sworn in on Friday? The best you can do to rationalize those shifts in opinion as something other than red/blue tribalism is to say that the public’s understanding of how the federal government might “make sure” that everyone has coverage shifts depending upon which party’s in power. When it’s the GOP, the mechanism is greater market options; when it’s the Democrats, the mechanism is a mandate to buy coverage. If that’s your spin, though, then you have to reckon with a scenario in which Trump pushed a Democratic-style plan for coverage. How do you think Republican opinion would greet that proposal?
I’m reminded of what Obama once said about the “permission structure” on the right that prevented Republicans in Congress from supporting some of his ideas, like comprehensive immigration reform. It’s not that Boehner’s majority hated the idea of amnesty for illegals — quite the contrary — it’s that they knew they’d be blasted as sellouts by the party’s populist conservative ideologues for making a deal with O. The shining lesson from the 2016 primaries was that the grassroots Republicans to whom those ideologues cater care a lot more about populism than about conservatism. Now they’ve got Trump, the populist president, preaching “insurance for everybody” and so suddenly it’s newly respectable to believe that the federal government should guarantee that. The permission structure now exists. I honestly wonder what would happen if the GOP re-passed ObamaCare, including the subsidies, and called it “TrumpCare,” with Trump tweeting every day about how much better health insurance is now. How long would it take before that got to 50 percent bipartisan approval? Over/under is four days.