The health-care struggle flips this order. Trump has embraced Ryan’s blueprint to radically retrench the ACA while cutting taxes for the wealthy. But in its devastating analysis of the Ryan plan, the Congressional Budget Office reaffirmed what I’ve called the Trumpcare conundrum. The plan would lower costs for younger and healthier people, many of whom now lean Democratic. At the same time, it would raise premiums—by as much as 25 percent—and swell the uninsurance rate for older adults ages 50 to 64, who now mostly vote Republican.
In that way, the House repeal bill embodies a pre-Trump ranking of GOP priorities: It subordinates the president’s pledge to protect those families to Ryan’s determination to systematically shrink government. “The House GOP Obamacare replacement bill … continues to make cost control a higher priority than health-insurance coverage for working families, and as such is not likely to be well received by the non-Republicans whose votes [elected] Donald Trump,” said Henry Olsen, a senior fellow at the conservative Ethics and Public Policy Center. “Trump’s implicit promise that he was a different type of Republican when it came to spending and the role of government … will be sorely tested if this bill is not amended.”
Ryan’s deference to Trump’s nationalism on trade and immigration, and Trump’s acceptance of Ryan’s libertarian approach to health care, has left the GOP with a policy mix crisscrossed by contradiction. In an interview, Neera Tanden, president of the liberal Center for American Progress, noted that the Trump-like European populist parties all combine suspicion of immigrants and trade with support for a generous welfare state, which often includes expanded retirement benefits and a higher minimum wage.