But now The Post has some important new reporting that suggests a split has opened up among top Trump advisers around this very topic. Some of them appear to be balking at such a course of action — and it’s telling that one of them is Stephen K. Bannon, because he is the keeper of the eternal flame of Trump “populism.”
The Post piece, from reporters Juliet Eilperin and Amy Goldstein, notes that top White House advisers are divided on how far Republicans should go in repealing and replacing the ACA. One key point of disagreement centers on the Medicaid expansion, which would be repealed under the GOP measure, doing away with it as an entitlement and instead restricting funding via a per capita or block grant arrangement.
Conservatives inside the administration want to forge ahead with aggressive repeal-and-replace, but others are wary of the political dangers of doing so, particularly when it comes to Medicaid:
Several people in Trump’s orbit are eager to make bold changes to reduce the government’s role in the health-care system. That camp includes Vice President Pence, who told conservative activists last week that “America’s Obamacare nightmare is about to end” …Other White House advisers, according to multiple individuals who asked for anonymity to describe private discussions, have emphasized the potential political costs to moving aggressively. That group includes [Jared] Kushner, NEC Director Gary Cohn, senior policy adviser Stephen Miller and chief strategist Stephen K. Bannon.
If Bannon is really arguing that overly aggressive repeal-and-replace, including major cuts to the Medicaid expansion, carry political peril, that’s potentially significant. There are good grounds for concluding this: It appears that the ACA, and particularly the Medicaid expansion, helped produce large drops in the ranks of the uninsured among non-college whites, who voted overwhelmingly for Trump.
As Ronald Brownstein recently detailed, data compiled by the Urban Institute shows that there has been a large expansion in coverage among non-college-educated whites in Rust Belt states that flipped from Obama to Trump (Iowa, Ohio, Michigan, Wisconsin, Pennsylvania) and even in some core Trump states (Indiana, West Virginia, Kentucky, Arkansas). Note that all of those states except Wisconsin expanded Medicaid — it’s reasonable to surmise that this played a big role in the huge drop in uninsured among those voters.
During the campaign, Trump went well out of his way to telegraph that he isn’t an ideological fellow traveler with other Republicans when it comes to government’s role in expanding health care to the poor. Now advisers such as Bannon are coming face to face with the harsh ideological and mathematical realities of the GOP repeal-and-place push and are apparently asking themselves whether going along with it — which would make Trump the guy who kicks millions off coverage — will undercut his aura of ideological heterodoxy on economic matters. It is likely one group of voters they’re worried about is the low-income whites who populate Trump’s base.
Now, this does not mean that Trump won’t shaft lower-income people — including many in his base — at the end of the day. He very well may go along with the GOP’s downsizing of Medicaid. Beyond that, Trump and Republicans will pursue budgeting that deeply cuts taxes on the rich, which will likely require large cuts of some kind to government programs.
“It’s hard to get to any of their goals without a big overall reduction in health care spending on low income people,” Isaac Shapiro, a senior fellow at the liberal Center on Budget and Policy Priorities, tells me. The cuts could go after other safety net programs, of course, but the CBPP concluded in a recent study that such cuts would also hit many non-college whites hard, because they rely on such programs to an unappreciated degree. “Given the amount of cuts we’re talking about, under almost any combination, the white working class would be hit significantly,” Shapiro says.
So things could still get very ugly. But it’s intriguing that top Trump advisers see political danger in going too hard after the Affordable Care Act. And they face another problem, too. But that brings us to our next item.
* GOP GOVERNORS PRESS TRUMP ON REPEAL: CNN reports that governors, including Republicans, are worried about the impact that Obamacare repeal will have on the Medicaid money flowing to their states:
Efforts to weaken Medicaid are already facing deep resistance from governors, including some Republicans who hail from states that expanded the program. … The future of Medicaid was a prominent topic of discussion at a gathering of governors over the weekend in Washington. A group of governors sat down with Health and Human Services Secretary Tom Price to air their concerns about Obamacare repeal and potential changes to Medicaid.
CNN notes that governors will air this at a meeting with Trump today. By the way, a lot of GOP senators represent states that have expanded Medicaid, so keep an eye on them.
* DEMS MOUNT BIG STATE-LEVEL PUSH: USA Today reports that Democratic legislators in 30 states are planning a coordinated release of legislation to help working people, to contrast with Trump’s expected agenda in his address to Congress:
The timing creates a juxtaposition between Democratic economic security prescriptions for workers, such as raising the minimum wage and paid family leave, and Trump tax reform and federal budget policies that, Democrats say, are at odds with his populist campaign oath to prioritize “forgotten” Americans from the factory floors of the Rust Belt to the sawmills of the Mountain West.
Thus begins the Democratic push to use Trump as a foil in the quest to win back ground on the state-level.
* SPICER ENLISTED OFFICIALS IN RUSSIA PUSHBACK: Axios scoops more detail on White House press secretary Sean Spicer’s efforts to debunk recent stories about links between Russia and the Trump campaign:
Spicer personally picked up the phone and connected outside officials with reporters to try to discredit a New York Times article about Trump campaign aides’ contact with Russia, then remained on the line for the brief conversations, Axios has learned. … The officials reached by Spicer were CIA Director Mike Pompeo and Senate Select Intelligence Committee Chair Richard Burr (R-N.C), according to a senior administration official.
Spicer also gave phone numbers to House Intelligence Committee Chairman Devin Nunes (R-Calif.). Remember, the Senate and House committees are supposed to be investigating this themselves. Drain the swamp!
* TRUMP SELLS OUT HARD-LINERS ON DREAMERS: Trump has not rescinded Obama-era protections for children brought here illegally as children, and the Times reports that immigration hard-liners are furious:
The president is already coming under intense pressure from the immigration hard-liners in his Republican base to keep his promise. … “He’s really starting to anger his base with this,” said Roy Beck, the president of NumbersUSA, a group that works to reduce immigration. “I’ve got people really angry and talking about ‘He’s double crossed us, he’s deceived us.’ You could say that the troops are restless, and I can’t blame them.”
One surmises this is a bait-and-switch designed to keep pressure up on Trump to go through with mass deportations more broadly, not necessarily of the dreamers.
* WHAT STEVE BANNON REALLY MEANS: Stephen Bannon has been vowing the “deconstruction of the administrative state.” E.J. Dionne has an apt description of what this really means:
This is a war on a century’s worth of work to keep our air and water clean; our food, drugs and workplaces safe; the rights of employees protected; and the marketplace fair and unrigged. … Trump and Bannon are happy to expand the reach of the state when it comes to policing, immigration enforcement … and the browbeating of individual companies that offend the president in one way or another. The parts of government they want to dismantle are those that stand on the side of citizens against powerful interests.
And this is all supposed to benefit working people, because … well, because Bannon says the administrative state is their enemy, so it must be true.
* CIVIL SOCIETY MUST RISE UP AGAINST TRUMP: Paul Krugman has a good column arguing that one of our last defenses against Trump’s authoritarianism is robust pushback from civil society:
This means supporting news organizations that do their job. … It means patronizing businesses that defend our values and not those willing to go along with undermining them. … it is not O.K. for newspapers to publish he-said-she-said pieces that paper over administration lies, let alone beat-sweetening puff pieces about Trump allies. It’s not O.K. for businesses to supply Mr. Trump with photo ops claiming undeserved credit for job creation.
I would only add that this requires us to make our case for the virtues of liberal democracy, which is a good challenge to face, because it could have a re-invigorating effect.