TrumpCare is only mostly dead

There's a big difference between mostly dead and all dead

On TrumpCare.
(Image credit: Illustration by Lauren Hansen)

TrumpCare is dead ... right?

You never know. Sure, Republicans have now voted on several different iterations of ObamaCare repeal — from the most sweeping to the bare minimum — and failed to agree on any of them. The party can't seem to come up with a health-care bill that can get 50 GOP votes in the Senate (plus Vice President Mike Pence as the tie-breaker) and at least 218 House GOP votes.

But never say never. There are a few ways Republicans could still revive TrumpCare.

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1. Take another stab at passing something through the Senate. Sens. Ted Cruz (R-Texas), Rob Portman (R-Ohio), Lindsey Graham (R-S.C.), and Bill Cassidy (R-La.) all have ideas for new and different versions of TrumpCare.

Cruz's amendment would allow insurers to dodge a slew of ObamaCare regulations, probably destabilizing the insurance exchange markets in the process and causing premiums to spike. As such, it caters to the conservative ideologues while scaring off the more moderate Republican senators. Portman's amendment would offer an extra $100 billion of spending to stabilize the insurance markets. So it appeals to the moderates while angering the right-wingers. Neither is likely to corral 50 votes in the Senate.

That leaves the Graham-Cassidy amendment as the most likely candidate. It would keep most of ObamaCare's taxes, then lump the funding for the Medicaid expansion and the premium subsidies into block grants the states could experiment with as they see fit. But it would also cut that funding 34 percent below its currently projected level by 2026. It would keep the Senate's brutal cuts to the pre-ObamaCare portion of Medicaid. And since it would be passed via reconciliation, it likely wouldn't contain changes to ObamaCare's insurance regulations. It's unclear how Graham-Cassidy would bridge the divide the other bills haven't.

Which brings us to …

2. Combine TrumpCare and tax reform in the 2018 budget. Every year, Congress writes a budget blueprint. And every blueprint can include instructions for how Congress will use reconciliation that year. The GOP originally planned to pass ObamaCare repeal with the reconciliation instructions in the 2017 budget, and tax reform in 2018. But they haven't actually finalized the 2018 budget blueprint yet. So they could just combine ObamaCare repeal and tax reform into one giant reconciliation extravaganza.

More than anything, the Republicans' enemy is time. They still want to do tax reform. They still have to pass budget appropriations for 2018, and deal with the debt ceiling. They're about to lose a month to the August recess, and it won't be too far into 2018 when the House will be too distracted by midterm election campaigns to pass much of anything. Caught between all those various time crunches, the Republicans really do only have a matter of weeks before they absolutely must move on. Combining ObamaCare and tax reform in the 2018 budget could buy them some time.

But it wouldn't buy that much time. The Republicans have had seven years to resolve their internal contradictions on health care, and they haven't come up with squat. The chances they could do it in a few weeks or months, while juggling tax reform at the same time, seem ... slim, to put it mildly.

3. Sabotage ObamaCare. This isn't so much an option the GOP is considering as it is something President Trump has been threatening on Twitter. Primarily, he could use executive branch maneuvering to cancel ObamaCare's cost-sharing subsidies. That could destabilize the markets and cause premiums to spike. But beyond that, Trump could create the same result just by sowing enough doubt and panic among insurers about what he might do. Remember, ObamaCare is vulnerable. It has enough problems that it could face a serious crisis even if Trump behaves himself.

Trump's thinking is if ObamaCare does blow up, Democrats will be blamed. And then they'll be forced to come crawling to the Republicans for a fix.

The problem for Trump is voters blame the party in power if something bad happens on their watch. He can tweet all he wants about how Democrats will own ObamaCare's implosion. But wishful tweeting won't make it so.

4. Cooperate with the Democrats. The Democratic Party would probably be willing to cooperate with Republicans to prevent an ObamaCare crisis, even if it's in their raw political self-interest not to.

The real question is whether the Republicans can stomach cooperating, especially after they've now given up all their leverage. Back when they were gearing up to pass TrumpCare, they could've plausibly said to Democrats, "Cooperate with us now, and we'll throw you a few bones. Otherwise, we'll just ram something through on a pure partisan vote." But now the Democrats know the GOP is in far too much internal disarray to ram anything through on its own. That gives the Democrats all the power to set terms at the bargaining table. As a result, proposals so far for a bipartisan ObamaCare fix are exceedingly stingy when it comes to GOP priorities.

At this point, to cooperate with Democrats is to effectively concede that ObamaCare was a good starting point — that it simply needs to be adjusted, not eliminated. It would also require Republicans to sacrifice either their opposition to more spending, or their opposition to more regulation.

And that's an identity crisis the GOP seems utterly unprepared to face.

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