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Trump is leading the GOP over a health care cliff

Donald Trump is impulsive. He does things on a whim. Based on gut instinct. And at times trying to live up to what he believes his base wants (see, the Wall). He seems to be using a similar calculus — such as his political thinking deserves comparison with complexity — to re-insert health care into today’s leading political issues.

By now you’ve likely read about a change in legal strategy by the White House to target Obamacare more comprehensively via ongoing litigation against the law, including coverage here at the Resurgent. Trump himself touted the shift declaring the GOP would soon be “the party of health care.”

That’s high comedy to anyone who has been paying attention to politics for most of Trump’s lifetime, and Congressional Democrats have not surprisingly pivoted to return health care to the top of their rhetoric. It was after all what helped them win in 2018, with more moderate Democratic winners in GOP House seats touting shoring up the ACA rather than Medicare-for-all.

Most people with political antennae know this, which is probably why the following happened when Trump then talked to Republicans:

The president used the closed-door meeting in the Capitol for a rambling, unscripted recitation of his legislative priorities, and repeated his intention to make the subject of health care a major issue over the next two years. That pronouncement elicited a muted response, according to a person in the room.

Indeed, even mostly Trump-acquiescent House Minority Leader Kevin McCarthy is trying to call timeout to re-think the approach. Notably:

McCarthy is far from alone in his view. Multiple GOP sources— from the most conservative to the most moderate wing of the party — have told Axios that they can’t fathom why the president would want to re-litigate an issue that has been a clear loser for Republicans.

They’re also exasperated about Trump’s substance-free declaration that Republicans will become “The Party of Healthcare.” Republicans aren’t united on health care, and they have been unable to advance a replacement for the ACA.

That lack of unity and previous failure at Repeal & Replace are essential to understand, including given the probability Democrats will run on health care as a top issue next year. Ramsesh Ponnuru has some of the best work assessing the issue. In a 2017 piece he observed the three disparate cohorts of the GOP and their Obamacare views:

First,

“[m]any libertarians and conservatives have rejected Obamacare because they do not believe that government should pursue the goal of increasing the number of people with health coverage.”

Think the Freedom Caucus. Second,

“[a] group of conservatives did not object in principle to federal subsidies to help people buy insurance — or, rather, considered that principle to have been abandoned a very long time ago.”

Think the median remaining GOP Member of Congress. Third,

“[a] third group of Republicans, more moderate…thought Obamacare was too expensive and too regulatory…[t]hey did not want to take Obamacare subsidies away from millions of people or to end Obamacare’s popular regulatory protections. At the same time…they said they shared the party’s goal of “repealing and replacing” the law.”

Think Susan Collins.

Yet, the problem of GOP differences is worse than that. It’s possible to unite disparate wings of a party if, you know, you actually have a cogent plan. Which today’s Trump-led, Republican party most definitely does not.

Ramesh, with Yuval Levin, also assessed the lessons of Repeal & Replace’s failure :

It is certainly understandable that Republicans do not wish to relive their 2017 experience of trying to legislate on health care…

It would be another one if Republicans failed to overcome a second force that held them back last year: their own ignorance and lack of preparation [emphasis added]. Very few Republicans had a sense of the trade-offs involved in different approaches to protecting people with preexisting conditions, which became as contentious an issue as anyone who had followed health policy would have predicted. Republicans conducted the 2016 campaign without any broadly shared commitment, even a rough one, about how to handle Obamacare in the event they won. President Trump only added to the confusion. During the campaign, he praised other countries’ nationalized health-insurance systems and published a few nonsensical paragraphs he called his “plan.”

Or as Lindsey Graham observed after his failed efforts to intervene in the latter stages of Repeal & Replace:

“Well, I’ve been doing it for about a month. I thought everybody else knew what the hell they were talking about, but apparently not,” Graham clarified, adding he had assumed “these really smart people will figure it out.”

Smart people working in advance on politically volatile policy changes to a huge portion of the national economy as well as of state and federal government expenditures would have indeed been useful.

This is a substantial problem without a clear remedy. No serious conservative who stomachs voting for Donald Trump believes his White House and Administration offers the best of right-of-center policy minds. And Congressional Republicans have shown their weak hand on this score for health care as well.

Matt Lewis wrote a column back in 2017 with an interesting theory as the Repeal & Replace debate was raging and he reviewed a range of potential GOP policy solutions. They should punt:

Each of these plans consists of some good ideas. But it’s like a novice trying to solve a Rubik’s Cube. Every conceivable scheme or solution creates new problems. None of them solve the problem because this problem is simply too complicated to “solve.”

Which sounds remarkably similar to Ramesh’s more wonky takes on the Republican policy puzzle. And, Lewis was right on the politics too:

It feels like Bush’s Social Security all over again,” one senior industry official told me. “It’s really hard to see how this ends up with as many people being covered at the same or lower costs. It’s a mess.”

Even that may be a best-case scenario. Social Security reform was a bust that wasted President George W. Bush’s second-term political capital, but Republicans didn’t repeal Social Security. There is always the danger that this could go catastrophically wrong.

Spoiler: it did.

Now, Trump seems poised to repeat the error. Bigly.

Intriguingly, much like Ted Cruz seeming to think shutting down the government over the ACA would turn out well, this White House blunder is being driven by former Tea Party stalwart and current Chief of Staff Mick Mulvaney:

[AG William Barr and HHS Secretary Alex] Azar argued against backing a lawsuit seeking the full repeal of the health care law at a White House meeting in late December, citing the lack of a Republican alternative, according to two sources briefed on internal discussions, while Mulvaney said that taking a bold stance would force Congress into repealing and replacing the law.

“Force Congress?” That’s cute.

They couldn’t figure it out when they had GOP majorities. How do you think this is going to go now with a Democratic House frothing at the bit to pummel Republicans on health care in 2020?

John Boehner set the bar for predictions of coming Republican woes on health care:

“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once,” Boehner said. “And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we’ll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it.”

Now Mulvaney, and Trump, want to break it. Which would take the Congressional GOP and the White House down an all-too-familiar path that doesn’t end well if health care remains a top election issue next year.

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