For Trump, this has never been about improving our health-care system. Trump, who visibly had no idea how the ACA works or what was in the various GOP replacements, and who openly said he would sign whatever Republicans put in front of him, just wanted to boast of a “win” while triumphantly using Barack Obama’s signature domestic achievement as his own personal toilet paper roll.
Trump has not yet secured that opportunity for himself. The “skinny repeal” bill failed, after Sen. John McCain cast the dramatic vote against it that, along with the opposition of Sens. Lisa Murkowski and Susan Collins, sealed its fate, and for now, the fate of the GOP repeal push. Trump raged that all Democrats and three Republicans had “let the American people down.” But this outcome, ironically, was good news not just for the American people overall, but also for untold numbers of Trump’s own voters, the low-income and aging whites who also benefited from the ACA’s historic coverage expansion. Trump’s voters were spared the destructive impact of his peculiar combination of ignorance, megalomania and sheer indifference to the fate of millions.
Trump’s threat to keep sabotaging the ACA, however, could actually still end up hurting a lot of people. There are plenty of tools that the administration can employ to keep sabotaging the individual markets and the ACA. Politico has a good rundown: The administration can do too little to promote enrollment or scale back enforcement of the mandate or give states more leeway to experiment with Medicaid in destructive ways. The administration can continue to refuse to guarantee cost-sharing reductions, which has already caused insurers to exit the markets and hike premiums, something that could continue or get worse, leaving many more people without coverage options. Insurers are already warning of such an outcome.
I don’t know if Trump will make good on these threats. But the important point is that the openly stated goal here is to hurt our health-care system — which would hurt real people — in service of an end that Trump has not articulated. Democrats cannot support GOP plans that would leave millions uncovered, and yet, because Trump has no interest in understanding what challenges the ACA and our health system face, he has no idea what any “deal” with Democrats would look like. His only discernible strategy is to use the threat to harm millions to force Democrats to capitulate to him in some manner that will remain undefined.
But there is another way. If there is one thing I hope happens now, it’s that Trump and Republicans can shape their current response to the ACA around an acceptance of an idea that many of them have refused to acknowledge: that the ACA has effected positive change in the lives of millions, making American life more humane and just. The Medicaid expansion has expanded coverage to millions of poor people, many of whom no doubt never had coverage in their lives, and many deep in the heart of Trump country. The exchanges, for all their problems, have helped extend coverage to millions more, particularly people with preexisting conditions, who can now get robust insurance packages, and lower-income people who can now get coverage with the help of subsidies.
Trump’s ongoing threats to sabotage the ACA have important overlap with the position of many congressional Republicans. Unlike Trump, Republicans had genuine principled reasons for wanting the ACA repealed — many of them sincerely believe that the ACA’s expansion of government spending and regulation is not worth the benefits the law has brought. But beyond this, many Republicans have also refused for years to tell the truth about the real-world impact of the law, or about what their own replacements for it would actually do. House Speaker Paul D. Ryan kept lying right up until the end, claiming the ACA is merely “collapsing and hurting American families.” Throughout, Republicans claimed endlessly that their solutions would not cut Medicaid and would leave nobody worse off, and that if millions were left uninsured, it would be by choice under the new reign of freedom they would usher in. Trump, too, hopes to sabotage the ACA under the guise of the lie that it is collapsing of its own accord.
But the American people flatly rejected all of these arguments. By finally introducing concrete plans of their own that would bring about an enormous rollback of the ACA’s historic coverage gains, Trump and Republicans managed to get Americans to take another look at Obamacare. The result is that it finally edged into positive approval territory, with large majorities supporting the basic priorities embedded in its expansion of health spending on poor and working people, paid for by high-end taxes, and large majorities rejecting the GOP’s massively regressive alternative.
My point is not that Republicans should stop making arguments against the ACA or stop trying to move our health-care system in a conservative direction. Indeed, a genuinely bipartisan approach to reforming our health-care system could end up giving Republicans some deregulatory measures in exchange for GOP help in shoring up the exchanges and a GOP acceptance of the ACA’s coverage expansion. Some Republican health wonks are now calling on their party to adopt a similar approach. But for this to happen, we would all have to proceed from shared agreement that this coverage expansion — one fostered by government — has actually helped enormous numbers of people, even if it isn’t in the manner that Republicans had hoped.
* REPUBLICANS WHO VOTED FOR BILL KNEW IT COULD BE DISASTROUS: An important point in the New York Times overview:
Even some senators who voted for the bill Friday conceded that its enactment could have been disastrous. It would have repealed the mandate that most Americans have insurance, without another mechanism to push Americans to maintain insurance coverage. Under those circumstances, healthy people could wait to buy insurance until they are sick. The insurance markets would become dominated by the chronically ill, and premiums would soar, insurers warned.
Let’s not forget that most Senate Republicans, in an act of staggering bad faith, voted for something they knew (if the House passed it, which Ryan suggested could happen) could end up becoming law, despite knowing it would be massively damaging to the country.
* MIKE PENCE’S LAST-MINUTE PLEAS FAIL: The Post has a great anecdote showing how the vice president’s last-minute plea to John McCain, Susan Collins, and Lisa Murkowski failed:
Pence walked over at 12:44 a.m. McCain smiled, pointed at Collins and Murkowski, said something about “marching orders,” and stood up. “Mr. Vice President,” he said, greeting Pence. For the next 21 minutes, the vice president cajoled McCain, Collins and Murkowski. Twice during the conversation, a Pence aide came to whisper in the vice president’s ear — other reporters learned it was the White House calling.
The ignominious performance of Vice President Pence, who lied about the GOP bill in truly reprehensible fashion, should also not be forgotten.
* WHERE MUELLER’S PROBE MAY BE HEADED: USA Today scoops:
Since Election Day, President Trump’s businesses have sold at least 30 luxury condos and oceanfront lots for about $33 million. That includes millions of dollars in properties to secretive shell companies … Now, details of some of those deals and other transactions by Trump’s family business could be unmasked as special counsel Robert Mueller expands his inquiry … Federal investigators are expected to delve into records revealing some of the President’s most closely guarded secrets, including how much money he makes, who he does business with and how reliant he is on wealthy, politically-connected foreigners.
Keep in mind, some of this appears to include financial activity that took place after Trump was sworn in as president.
* CONGRESS’S CHECK ON TRUMP FOREIGN POLICY IS UNUSUAL: Yesterday the House voted to dramatically restrict Trump’s ability to ease sanctions on Russia, and the Washington Examiner notes the larger context:
Foreign policy analysts … say that it is highly unusual for Congress to hamstring a president’s ability to conduct foreign policy. The trend over the past 25 years or so has been to show deference on these matters to the executive. “It’s unusual. The last time Congress overrode a presidential veto in a major foreign policy issue was Ronald Reagan in 1986 on South African sanctions,” said Aaron David Miller, a scholar at the Wilson Center.
Between this and the failed health-care vote, it was a very bad day for the tweeter-in-chief.
* RUSSIA RETALIATES OVER SANCTIONS VOTE: Meanwhile:
Russia announced Friday it would seize U.S. diplomatic properties and demand that the State Department reduce its staff in Russia, a tit-for-tat punishment that the Russian Foreign Ministry said was spurred by a financial sanctions bill now awaiting a signature from President Trump.
This creates a very interesting situation for Trump, who still has not said clearly whether he’ll sign the sanctions bill or veto it.
* ON HEALTH CARE, DON’T FORGET THE BIG PICTURE: Paul Krugman reminds us of it:
This story didn’t start in the last few weeks, or the past few months. Republicans have been denouncing Obamacare and pledging to repeal and replace it for seven years, only to be caught flat-footed when given the chance to come up with an alternative. Shouldn’t someone in the G.O.P. have asked, “Hey, guys, what is our plan, anyway? If we don’t have one, shouldn’t we consider helping make this law work?” But nobody did.
Even more cynically, Republicans spent years voting to repeal the law, secure in the knowledge that Obama would veto those attempts and spare them from owning the consequences.
* AND TRUMP LOVES ‘THE MOOCH’: New White House communications director Anthony Scaramucci is getting lots of attention for saying really nasty stuff about other top White House people. Axios reports:
The President likes people with backbone. And at the moment, Scaramucci is empowered: We’re told the President loved the Mooch quotes. But President Trump doesn’t like being upstaged. “Mini-me” can’t forget the “Mini” part. Being more Trump than Trump, in Trump’s house, is a dangerous game.
The funny thing about this is that it’s entirely plausible, both in Trump’s affection for “the Mooch” and in how Trump might be conflicted over all the attention he’s getting.