If you’re a conservative, this’ll bug you. If you’re a very populist but not very conservative president who cares more about a political win here than about the substance of the bill, this sounds like … a pretty sensible proposal.
Between the Breitbart story about Ryan’s conference call last year and now this Newsmax piece by Chris Ruddy, I wonder if Bannon and other populists aren’t quietly coordinating their media offensive to convince Trump to ditch the bill. Although that raises the question: If Trump was destined to abandon Ryan’s vision, why’d he back the bill in the first place? Why risk any political capital selling a plan that seemingly no one except Ryan and Tom Price actually likes?
Here is a game plan for Trump to regain the initiative:
1. Ditch the Freedom Caucus and the handful of Senate Republicans who want a complete repeal of Obamacare. They don’t agree with universal coverage and will never be placated.
2. Find a few parts of Ryan Care II that can win passage in the House and Senate with either GOP support or bipartisan support. Declare victory.
3. Rekindle the bipartisanship in Congress that Obama destroyed. Empanel a bipartisan committee to report back by year’s end with a feasible plan to fix Obamacare.
4. Reject the phony private health insurance market as the panacea. Look to an upgraded Medicaid system to become the country’s blanket insurer for the uninsured.
5. Tie Medicaid funding to states with the requirement each pass legislation to allow for a truly nationwide healthcare market.
There are a few more steps in Chris Ruddy’s plan but those are the key ones. His underlying point is that the subsidy schemes in ObamaCare and TrumpCare are giveaways to insurance leviathans; if you want to do something for the people, skip the tax credits and focus on HSAs for the better off and a much more robust Medicaid program for the less well off. Coverage is key, especially for the lower classes. Vintage populism. Why he doesn’t take the next logical step and simply propose single-payer, I don’t know; it may be that “Medicare for all” is too daunting a summit for the CEO of Newsmax, who’s stuck for the moment at “Medicaid for more” base camp. But he’ll get there eventually! And maybe Trump will too. “Republican divisions are very plainly now populist/libertarian rather than conservative/moderate,” says Ross Douthat. Correctamundo. The lingering question is which group is bigger than the other. Given how the primaries shook out last year, you’d bet on populists — in which case, what the hell is Trump doing selling a bill that’s going to crush his older, blue-collar, rural base?
Is this a math problem in the end, though? The White House may feel it has no choice but to make the bill more conservative (or libertarian, per Douthat) because otherwise the Freedom Caucus has the votes to kill it in the House if — if — they vote as a bloc. Trump may have calculated that, in the end, conservatives are less likely to bend on voting for a bill they don’t like than moderates are, in which case he should pander to the right and expect the center to suck it up and do his bidding. The wrinkle in that strategy, though, is that the centrists are the ones better positioned to claim Trump’s populist mantle. They’re the ones worried that the bill will hurt the lower class by rolling back Medicaid; they’re the ones pointing to coverage while people like Ryan point to access to coverage. If you’re a Republican who’s worried about being on the wrong side of Trump, the logical thing to do is to try to outflank him on populism and present yourself as standing up for the sort of downscale voters Trump is supposed to be standing up for. That might end up immunizing you from White House pressure tactics.
Whereas if Trump were suddenly to dump Ryan’s bill and swing around to a more populist approach himself, suddenly it would be conservatives who are put on the spot and made to explain why they’re insisting on less robust Medicaid availability when Republicans just won an election vowing that the “forgotten men and women of our country will be forgotten no longer.” That is, if Trump followed Ruddy’s plan, this would turn into a gut-check moment on just how far Freedom Caucus members are willing to go to defy him. If he went full metal populist on them by demanding more money for Medicaid and an overhaul of the subsidies scheme keyed more to means rather than age, would they really kill the bill? Even if they did, from Trump’s perspective wouldn’t you rather be thwarted by penny-pinching conservatives than by centrist populists? At least you get to keep your brand in the first case.
Republicans in the Senate seem to be figuring all of this out:
Lots of Senate Rs saying they want to make the AHCA tax credits more progressive, which is anathema to Freedom Caucus.
— Dave Weigel (@daveweigel) March 14, 2017
Speaking of keeping your brand, imagine the reaction among Ted Cruz, Rand Paul, and Mike Lee if Trump took Ruddy’s advice, scrapped the Ryan plan, and then proposed something Medicaid-heavy with a bipartisan commission, of all things, authorized to plot the way forward. What would Cruz, whose seat is up next year, do in a case like that? If he votes yes, it would shatter his reputation as Mr Conservative. If he votes no with Paul and Lee, Trump’s populist bill would tank in the Senate and he’d get the blame. Either way, Trump’s image as a reformer crusading for the little guy and running into ideological roadblocks in Congress would be preserved — whereas under the current scheme, if Ryan’s bill ends up being enacted and the “millions lose coverage” headlines start piling up, he’ll be attacked by the left and (some on) the right as a guy who chose Heritage Action over his base at a fateful moment. Hard to understand why he’d go the route he’s going unless he’s convinced that conservatives are more of a threat to kill the bill than moderates. And even then, it’s still hard to understand.