We are only a few weeks into the booyah! boasting phase of the Trump GOP Era. But we are already seeing a central theme emerging, especially on health care policy. Both on repealing Obamacare and phasing out Medicare, Republicans are now realizing they have to ask Democrats for help, despite the fact that they control every branch of the federal government. (Don’t believe me. See what The Wall Street Journal says.) This is obviously the case in the Senate if Mitch McConnell maintains the filibuster and thus the need for 60 votes. What’s not clear I think is that it remains the case even if McConnell finds a way to push through changes with only 50 votes.
It’s important to understand why this is happening.
One key reason is that on both Obamacare and Medicare, the GOP – especially the House GOP – is the dog who caught the car. What do they do now? Paul Ryan, whose genial demeanor and packaging conceals a political radical on fiscal policy, social insurance and almost everything else tied to money, risk and financial security, got House Republicans to vote for Medicare Phaseout for five years straight.
But it was an easy vote since nothing would ever come of it.
Republican Senators are now telling pretty much everyone who will listen that they don’t want to get dragged into phasing out Medicare this year. Some of that is the complexity of the legislative calendar. You can only push through so much at a time. But don’t believe the hype. They know that killing Medicare is toxic politically. Unlike their GOP brethren in the House, they have to run in districts (i.e., states) that were drawn in the 17th, 18th or 19th centuries (with a handful of exceptions). Not big data driven maps gerrymandered in 2010. To paraphrase Augustine, they want Movement Conservative purity, but just not yet.
They’re getting a similar message on Obamacare. A couple weeks ago, Paul Ryan was boasting that he might take down Obamacare and Medicare in the days just after the inauguration, in one combined action. Just a few days ago, House Majority Leader Kevin McCarthy announced that Repeal and Replace could be set aside in favor of Repeal and We’ll Look Into It. But Senate Republicans are saying Obamacare repeal could be a years’ long process.
Indeed, Senate Republicans seem so gun-shy of confronting Obamacare that you have top Republican Senators making the case for Obamacare to reporters – even if not all of the reporters realize it.
Here’s Lindsey Graham from Lauren Fox and Tierney Sneed’s piece from yesterday.
“Once you say that everybody should be covered, can’t be denied coverage because they are sick – which most Americans would agree with that – you put yourself in a box. Insurance is about young people who are healthy buying insurance like you all to pay for me and him,” Sen. Lindsey Graham (R-SC) said, pointing to the oldest reporter in the scrum. “If you don’t have to buy insurance until you get sick, most people won’t. That’s where the mandate becomes important.”
Graham added: “Somebody’s got to work through this problem. If we’re going to accept the proposition that you can never be denied coverage because you’ve been sick, then somebody’s got to create a system where people participate.
What he’s explaining there is Obamacare.
He even seems to be arguing for the mandate which ended liberty in 2012. Republicans have loosely committed and President-Elect Trump has specifically committed that no one will lose their care in the new system and that key protections (pre-existing conditions) will stay. As Graham seems to realize, there’s really no way to accomplish that without something like Obamacare. You could just go single payer of course. But given the choice, they’ll certainly take Obamacare.
Opposing Obamacare is one thing. Actually taking health care coverage from tens of millions of people is another. There’s also the insurance industry which has significantly restructured itself around the Affordable Care Act. They will at a minimum need lots of care and feeding through any transition.
Here’s another critical point.
Over the past month, according to the Kaiser Family Foundation poll, the percentage of Republicans who support full repeal has dropped from 69% to 52%. What could explain that? I think it’s pretty simple. A huge amount of opposition to Obamacare has been driven by partisan identity. Take Obama out of question and things start to look quite different.
The key political reality is that Senate Republicans are spooked by going after both Obamacare and Medicare, though to much different extents. One big reason they’re hesitant is that they believe they’ll have to do it on more or less straight party line votes, with no Democratic cover. A number of Senate Republicans have also made clear they do not foresee flat repeal in any case – rather something between reforming and repealing and then replacing with something that is significantly similar to Obamacare.
On the other side of the equation, there will certainly be Republicans in the House and the Senate who will resist any move to compromise on Obamacare and Medicare, particularly Obamacare. Where do you figure Ted Cruz will be if a mushy Obamacare semi-repeal comes through the Senate? There’s no question that his mix of extremism and opportunism will make him jump for the chance at being the leader of the Obamacare-Pure Republicans. With possible defections on the right, that’s another reason why Republicans will need some Democratic votes. But the biggest reason they will want Democratic votes is that people who face real elections won’t want to face the electorate with that much health care carnage without bipartisan cover.
Add into the mix of course that the Trump transition is being run by the Ryan-Pence-Priebus Koch wing of the party. That’s how you got Rep. Tom Price – an arch foe of Obamacare and Medicare – getting appointed to lead the Department of Health and Human Services, which largely overseas both. But is Trump for Medicare Phaseout? I doubt he’s really given it any thought, despite his Transition Website now saying he supports it. Maybe he said it sounded like a good idea when Pence described it to him. Will he fight for it if it’s not popular? Take a wild guess.
I don’t mean to be Pollyannaish. I could easily see Obamacare and Medicare gone by the end of the year. But Republicans have a Ryan House wing focused on taking down both, a GOP Senate wing made up of men and women who would probably like to do it but lack the stomach for it and a President-elect whose transition is taking steps to ally with the Ryan House wing even though the president-elect himself likely hasn’t considered the politics or policy of either.
Get ready for GOP begging for Democratic help to get louder and louder.