Trump and Obamacare Changed the GOP

Trump and Obamacare Changed the GOP
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Republicans once wanted to eliminate Obamacare “root and branch,” repealing every last regulation, tax and mandate. The Affordable Care Act was anathema; they wanted government out of health care, and they sought to tame the nation’s debt burden by reforming entitlement spending.

Now it’s 2017, and those days are over. Republicans cannot keep their seven-year promise to repeal Obamacare, so they are scrambling to repair it. Ask any GOP lawmaker and they will tell you the smell of defeat is everywhere. Senate Majority Leader Mitch McConnell grimly conceded Thursday the law must be reformed with Democrats if Republicans can’t pass their own fix. “If my side is unable to come up with an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said at a Rotary Club gathering in Kentucky, adding: “No action is not an alternative.”

Meanwhile, President Trump leads the Republican Party and has vowed not to touch Social Security or Medicare. The debate has now turned left of the center instead of right. Deeply divided over how much of a safety net to preserve in Obamacare, McConnell and Sen. Rob Portman -- conservatives and friends -- recently fought about Medicaid in front of their colleagues, according to Politico. Portman’s governor in Ohio, John Kasich, is the former House Budget Committee chairman who helped launch a conservative revolution under the leadership of House Speaker Newt Gingrich, and is now the champion of the party’s wing seeking to protect the Medicaid expansion created by Obamacare.

Sen. Ted Cruz, who knew years ago his party would fold tent once the Affordable Care Act kicked in, is proposing plans that don’t cover people with pre-existing conditions in order to create more low-priced options. The mere mention of them panicked Republicans who fear the political backlash. Cruz warned years ago before the law took effect that Americans would become “hooked on the subsidies.” He said in late 2013, “If we get to January 1, this thing is here forever.”

To pay for more subsidies, Republicans are even considering keeping a tax cut on investment income they promised to eliminate. “It is an inappropriate proposition to lower the tax on the wealthy and increase the burden on the poor,” said Sen. Bob Corker. “My goal is to not focus necessarily on the wealthy. My goal is to make sure we’re dealing with the poor.” That’s Corker, not Sen. Bernie Sanders.

Over on the other side of the Republican divide, Sen. Pat Toomey countered that he would be “shocked if that tax increase is not repealed.” Retaining the tax on investment income would make the path to tax cuts and reform that much steeper.

Meanwhile, Toomey, who once ran the Club for Growth, is pressing his party to change the budget “reconciliation” rules to open the window for tax cuts from 10 years to 20-30 years. Permanent tax cuts must be paid for under reconciliation rules, which means Toomey is acknowledging the cuts won’t be revenue-neutral. Trump all along has pushed for larger, deficit-funded cuts and Toomey warned without the gimmick, “the alternative is weak tax reform.”

But there are Republicans objecting, most importantly House Speaker Paul Ryan, who -- eager to avoid the fiscal cliff that resulted from the expiration of the Bush tax cuts, and to provide more certainty to the business environment to spur hiring -- is advocating permanent, paid for, tax cuts. Ryan tweeted last week that “a temporary tax rate cut would actually result in economic decline rather than growth.”

Trump’s tax cut promises to be the biggest in history, and on health care he has promised voters the moon, where there are lower prices and lower deductibles and the best care. He has declared: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can't pay for it, you don’t get it. That’s not going to happen with us.” 

Trump’s reactions to the health care drafts and debates shift rapidly without warning, unnerving GOP lawmakers who fear he will abandon the final version anyway. After the House bill passed, Republicans were ushered up to a command-performance Rose Garden ceremony to celebrate the vote, only for the president to later tell Republican senators the House bill was “mean.” After a Congressional Budget Office score of the Senate bill scared Republicans, Trump saw Sen. Ben Sasse on “FOX and Friends” and suddenly backed his plan to repeal and delay the replacement effort, tweeting: 

Nope, said McConnell later that day. 

It seems there are still a few small-government conservatives Trump and his coalition are unlikely to sway. The three states that saw the largest declines in the number of uninsured are Arkansas, West Virginia, and Kentucky, where Trump won by 27, 40 and 30 percentage points. While Sen. Shelly Moore Capito of West Virginia has opposed the Senate plan, Kentucky Sen. Rand Paul has opposed it from the right, while his senior senator has fought for its survival, and it has retained the support of Sens. Tom Cotton and John Boozman of Arkansas.

Paul’s father, former Rep. Ron Paul, has lambasted the GOP more directly, saying “Republicans and Democrats both believe in government medicine.” Libertarians like the Pauls and conservative activists are furious and are threatening retaliation at the polls next year. “Bob Corker needs to find whatever shred of conservative he has left in his soul,” Jason Pye of FreedomWorks warned in Politico. “The past votes they took apparently don’t matter anymore ... they've spent seven years lying to conservatives.” Ken Cuccinelli, former Virginia attorney general and now president of the Senate Conservatives Fund, said, “It’s distressing to see so many Republicans who’ve lied about their commitment to repeal.” 

For eight years, through differences and disagreements over foreign policy, immigration, same-sex marriage, trade, abortion, climate change, campaign finance reform and more, Republicans have been bound together in opposition to Obamacare.

It’s been hard to lose that glue. And privately, Republicans admit they’re terrified to face voters in next year’s midterm elections if they fail. They’re convinced only a health care bill can produce success on tax reform. Without a bill to repeal and replace Obamacare, their party could be glue.

A.B. Stoddard is associate editor of RealClearPolitics and a columnist.

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