THE MORNING PLUM:
The set of policy proposals and ideas loosely known as Trumpism goes something like this: President Trump is not an ideological fellow traveler of congressional Republicans on the economy, the safety net and immigration. Unlike Paul Ryan Republicans, he sees a robust government role in maintaining protections for the poor, sick and old; and he is much more willing than other Republicans to slam the brakes on immigration to protect blue collar whites from global forces that are making them feel culturally, economically and demographically destabilized.
But little by little, as Trump seeks to make good on his promises, Trumpism — as sold by the man himself — is being revealed as fraudulent to its core.
NBC News reports that health-care experts across the political spectrum agree that the new House GOP health-care plan, which Trump has now endorsed, falls short of his promises:
The bill, experts said, falls far short of the goals President Donald Trump laid out: Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid. Instead, the bill is almost certain to reduce overall coverage, result in deductibles increasing, and will phase out Obamacare’s Medicaid expansion.
The American Medical Association came out against the GOP bill on Wednesday morning, arguing that its subsidy scheme and rollback of Medicaid expansion would produce a “decline in health insurance coverage,” instead calling on Republicans to “ensure that those who are currently covered do not become uninsured.” The GOP bill would likely result in millions losing insurance, even though Trump himself recently promised that the GOP replacement would mean “insurance for everybody.”
It’s plausible that the GOP bill would hit a lot of Trump voters. A new Kaiser Family Foundation analysis concludes that older, lower-income people will likely see a loss of financial support for insurance — many of whom are probably Trump voters. Non-college whites in the Rust Belt states that flipped to Trump saw a big drop in the uninsured rate under the ACA. Meanwhile, the GOP bill would mean cuts to Medicaid over time and potentially a phasing-out of the expansion, something that might also hit many Trump voters.
As Ross Douthat suggests, Trump’s hijacking of the GOP was in part driven by his ability to grasp “the political logic of reconciling his party to some form of coverage expansion” and to a “future in which the GOP accepts a health-care subsidy for the working class.” Indeed, as I’ve argued, Trump sent a strong signal to his white working-class base during the campaign that he is not ideologically like other Republicans on health care. But this is now colliding with the specific challenges attendant on repealing Obamacare and replacing it, which have revealed that there is an irreconcilable split among Republicans over the specific outcome they envision for a post-Obamacare health-care system.
The split was obscured for years, because Republicans could call for repeal, secure in the knowledge that it wouldn’t happen. It is between two camps. There are conservatives (mostly in the House) who actually want repeal, because they don’t think the government should be spending and regulating to expand coverage to poor and sick people, and instead want free markets to fulfill this goal. And there are other Republicans (mostly senators and governors) who want to say they’re repealing Obamacare (since they’ve railed against it for years in the abstract) while actually minimizing just how much of the coverage expansion gets rolled back in their states. Trump is more or less in the second camp, since he doesn’t want to be the guy who kicks millions off insurance or shatter Trumpism’s aura of ideological heterodoxy.
The result is a kind of kludge solution, which tries to give both camps a way to argue that they are getting their way. But the practical result is that it doesn’t actually give either what they want. And there is simply no way of pretending it comes anywhere near what Trump explicitly promised or vaguely signaled in ideological terms. This has left Trump spewing outright gibberish as he tries to sell the plan:
“It follows the guidelines I laid out in my congressional address — a plan that will lower costs, expand choices, increase competition, and ensure healthcare access for all Americans.
“This will be a plan where you can choose your doctor. This will be a plan where you can choose your plan. And you know what the plan is — this is the plan. And we’re going to have a tremendous — I think we’re going to have a tremendous success. It’s a complicated process, but actually it’s very simple. It’s called good healthcare.”
Thus, Trump’s only play is to fall back on the GOP trick of conflating “health-care access” with coverage and robotically describing the plan as “good health care,” in hopes that his magical Twitter feed and powers of salesmanship can envelop the specifics in impenetrable fog. And the fraudulence doesn’t stop there. But that brings us to our next item.
* TRUMP IMMIGRATION CRACKDOWN REQUIRES BUDGET CUTS: The Post reports:
The Trump administration, searching for money to build the president’s planned multibillion-dollar border wall and crack down on illegal immigration, is weighing significant cuts to the Coast Guard, the Transportation Security Administration and other agencies focused on national security threats, according to a draft plan.
The proposal, drawn up by the Office of Management and Budget (OMB), also would slash the budget of the Federal Emergency Management Agency, which provides disaster relief after hurricanes, tornadoes and other natural disasters. The Coast Guard’s $9.1 billion budget in 2017 would be cut 14 percent to about $7.8 billion, while the TSA and FEMA budgets would be reduced about 11 percent each to $4.5 billion and $3.6 billion, respectively.
The cuts are proposed even as the planned budget for the Department of Homeland Security, which oversees all of them, grows 6.4 percent to $43.8 billion, according to the plan, which was obtained by The Washington Post. Some $2.9 billion of that would go to building the wall on the U.S.-Mexico border, with $1.9 billion funding “immigration detention beds” and other Immigration and Customs Enforcement expenses and $285 million set aside to hire 500 more Border Patrol agents and 1,000 more ICE agents and support staffers.
Politico reports that some Republicans are criticizing this diversion of funds. As I’ve argued, Trump’s plan for stepped-up deportations will have to be paid for, which will require diverting resources from other immigration enforcement or national security spending. Republicans spent years screaming that President Barack Obama’s de-prioritization of the removal of longtime residents was tantamount to “non-enforcement.”
But this shows that Trump’s vow to undo Obama’s priorities — a promise made as part of a broader narrative holding that undocumented immigrants represent an economic, cultural and political threat to his voters — is not a mere matter of “enforcing the law” where Obama supposedly failed to do so. It’s a matter of making choices and trade-offs. And now Republicans may be asked to defend these choices.
* MILLIONS COULD LOSE COVERAGE, AND PREMIUMS COULD SOAR: The New York Times reports that health-care analysts think the new House GOP health plan could cause millions to lose insurance and patients’ costs to rise due to less generous subsidies. And there’s this:
J. Mario Molina, the chief executive of Molina Healthcare … said insurers are likely to increase their premiums significantly because they will worry about enrolling more high-cost patients as healthier people opt to go without coverage. “Insurance companies are going to jack up the rates,” predicted Dr. Molina, who said premiums might increase even more than they did last year when some companies raised the rates by 25 percent or more.
This is because the replacement for the mandate (a surcharge for non-continuous coverage) will be insufficient. So: Millions lose coverage; subsidies are smaller; and premiums soar. Great plan!
* CBO SCORE COULD UPEND GOP HEALTH PLAN: Politico observes that Republicans may balk once they see the Congressional Budget Office’s score of the new GOP health plan:
With no official estimate from the Congressional Budget Office, they have no idea yet how much their American Health Care Act costs and how many people might lose their health coverage because of it … if the CBO numbers are ugly, they could send critics to even higher decibel levels. Republicans spent years trashing the Democrats’ health care law as a budget buster (even though the CBO didn’t agree).
A high cost could alienate conservatives; kicking millions off coverage could alienate moderates. Turns out repeal-and-replace involves more than just shouting lies about Obummercare.
* CONSERVATIVES STILL IN REVOLT: CNN reports that House conservatives remain resolutely opposed to the House GOP bill and don’t think it will pass the House:
“No new position tonight. Our position is the same,” caucus chairman Mark Meadows told reporters following a closed-door meeting of his caucus. “We believe we need to do a clean repeal bill.” … Rep. Raul Labrador, an Idaho Republican, said: “I don’t think there is any tinkering that will get us to 218.”
And this is before the CBO score has told anyone how much it will cost.
* GOP’S MARGIN FOR ERROR ON PLAN IS VERY SLIM: With both conservatives and moderates expressing skepticism about the new plan, The Post observes this about the challenge facing Paul Ryan and Mitch McConnell:
The margin of error is slim for House and Senate GOP leaders — in the House, Ryan can afford to lose only 21 GOP lawmakers. In the Senate … McConnell must persuade all but two Republicans to support the plan. Republicans have 52 seats in the Senate, and no Democrats are expected to back the overhaul in either chamber.
Meanwhile, at least seven GOP senators are currently expressing reservations: Cory Gardner, Shelley Moore Capito, Rob Portman, Lisa Murkowski, Dean Heller, Bill Cassidy and Susan Collins.
* GOP GOVERNORS ARE LIKELY TO OPPOSE PLAN: It seems likely that GOP governors in states that expanded Medicaid may also oppose the new House GOP plan. Note this, from Ohio Gov. John Kasich:
Kasich expressed deep doubts in a statement that took issue with congressional plans to curb Medicaid coverage expanded under Obama. “Phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug-addicted, mentally ill and working poor who now have access to a stable source of care,” said Kasich.
It’s a reminder that if this passes, it will be a major issue in the 2018 gubernatorial contests, which will have important long-term ramifications for the Democratic Party.
* AND THE EPA IS NOW STOCKED WITH CLIMATE SKEPTICS: Coral Davenport reports on the latest moves by Trump’s new EPA chief, Scott Pruitt:
Mr. Pruitt, a former Oklahoma attorney general who built a career out of suing the agency he now leads, has moved to stock the top offices of the agency with like-minded conservatives — many of them skeptics of climate change … Mr. Pruitt has drawn heavily from the staff of … James Inhofe, long known as Congress’s most prominent skeptic of climate science.
Sen. Snowball now has his hooks deep into the EPA. Awesome.