Will Trump make a populist pivot on ObamaCare?
Here's how Trump could turn the GOP fault lines into a political earthquake
The GOP is deeply divided over what to do about ObamaCare. For years Republicans in Congress railed against the law, vowing to repeal and replace it. This was a great electoral success, as American health care remains a bureaucratic and costly nightmare. But instead of developing a real plan for a replacement, the GOP mostly just hoped that the Supreme Court would strike it down for one reason or another, or that their eventual presidential candidate would outline his preferred reforms in a campaign.
No such luck.
The justices found ways to keep ObamaCare on life support. And despite three or four Republican health care plans floating through the conservative wonkosphere for the past four years, nobody has been able to rally Republican lawmakers to one set of ideas.
A normal Republican presidential candidate would have shown great partiality to one plan or another. Trump didn't bother. He merely promised something "great" that would "take care of everyone." And he noted that no one would "die in the streets" on his watch. In fact, the only truly concrete idea he had sounds more like a dramatic expansion of the federal government's role, one that ends in "insurance for everybody." And now the divisions in the party are becoming obvious.
On Tuesday the GOP-dominated National Governors' Association warned House Republicans against any reform that would impose more costs on the states. The libertarian-leaning Sen. Rand Paul (R-Ky.) then walked out of a glad-handing meeting in which Speaker of the House Paul Ryan tried to brief his Senate colleague on the health care reform he was preparing to pass. "If they don't seem to care what conservatives think about complete repeal of ObamaCare, they're going to be shocked when they count the votes," Paul said.
Unfortunately for Republicans, the most popular parts of the law are the ones that most offend the budget hawks in their party, like the way that the law expands Medicaid and subsidizes insurance coverage for millions of Americans. Ripping up these arrangements will mean a wave of insurance cancellations — just like the ones that temporarily torpedoed Obama's approval ratings.
Anyone who watched the 2016 election may remember that a divided Republican Party usually benefits one man, Donald J. Trump, and he usually reaps the benefit by promising some great deviation from conservative orthodoxy.
Trump is still enormously popular with Republican voters. Nobody in the House or Senate has his ability to whip votes or put a fright in reluctant members of the party to support a piece of legislation. Trump's power to do this will only increase as it becomes obvious that no one on Capitol Hill can truly lead the Republican caucus in this new dispensation, where one tweet from the president could wreck a promising Congressional career.
Trump did hire a diehard conservative wonk to help him in Health and Human Services Secretary Tom Price. But Price's ideas about health-care reform tend to devolve into a complicated set of pushes and pulls and nudges. A tax credit here, another one there. It's the type of politics that Trump mostly despised during his campaign.
If Trump is surrounded by populist Svengalis, they should be whispering in his ear about a great opportunity. Trump's advisers should know that the Paul Ryans or Rand Pauls of this world are eminently "gettable" so long as the Republican president they serve is popular, and so long as they don't see a viable path to changing his course.
If he decided to tackle the project with energy, Trump could unite enough of his party behind a health-care reform that expands coverage even more than ObamaCare. He may be able to do this while lowering the price of coverage on the bottom end through some smart deregulation of insurance plans. If he has to do this by pairing it with even deeper tax cuts, so be it. Republican lawmakers only care about deficits and debt ceilings when a Democrat is in the White House.
It's a grand opportunity. And the more Republicans broadcast their divisions, the larger and more obvious the opportunity for a truly disruptive form of leadership becomes.