An array of conservative lawmakers, organizations and activists are demanding a swifter and more aggressive remake of the Affordable Care Act than many Republicans are comfortable with, raising questions about whether President Trump and the GOP are headed toward gridlock as they try to fulfill their promise to repeal the health-care law.Three conservative senators known for bucking GOP leadership during Barack Obama’s presidency — Ted Cruz (Tex.), Rand Paul (Ky.) and Mike Lee (Utah) — are raising the possibility of doing the same under Trump.And outside Congress, three prominent groups — FreedomWorks, Americans for Prosperity and Heritage Action for America — plan to increase pressure on lawmakers to repeal the law fully or risk retribution from the conservative grass roots.
Understand what these full-repeal advocates are saying: They want to return Medicaid to pre-ACA levels and leave people who previously got subsidized coverage through the exchanges with no coverage. It’s hard to think how that will go over with the White House, which wants to cover “everybody,” let alone moderate Republicans and Democrats who worry that the Obamacare replacement plan will be less generous than Obamacare. Well, no coverage for large numbers of people would surely be less generous.
The idea of taking away coverage from millions of people is an idea only those in the right-wing echo chamber could love. Remember that Obamacare now polls better than “repeal Obamacare.” For those who want a change to the ACA, 30 percent — according to the Kaiser Health Tracking Poll — want to make Obamacare more generous. And Republicans are looking more favorably on government guaranteed coverage as well. (“Even among Republicans, while the majority want to see Congress vote to repeal the law – fewer want them to vote to repeal the law immediately (31%) than want them to wait until they have the details of a replacement plan announced (48%), and 16 percent of Republicans do not want the law repealed at all.”)
Moreover, the down-on-their-luck Trump voters in the Rust Belt and elsewhere who are out of work or have taken much lower-paying work have been the very ones to benefit from the Affordable Care Act. One study from Decemeber 2016 found, “An estimated 19.2 million nonelderly people gained health insurance coverage from 2010 to 2015, based on our analysis that accounts for population changes over the period. … The large majority (87 percent) of adults gaining coverage from 2010 to 2015 did not have a college degree. Among them, 6.2 million were non-Hispanic white and 7.9 million were nonwhite or Hispanic.” That group sounds a lot like Trump’s base, especially when you break down the newly insured by geography. (“More than 2.3 million people gaining coverage from 2010 to 2015 lived in the Midwestern states of Illinois, Michigan, Ohio, and Wisconsin, with uninsured rates declining between 38 and 49 percent.”)
Once again we see a determined, critical mass of Republican lawmakers who want something very few Americans want (akin to the shutdown) but who want it so badly they are willing to prevent something that might be more popular.
The Ryan/Price Republicans frankly don’t have a popular product either, which is why their bill is apparently in a locked room. They and the White House promised a super-duper health-care plan at less cost and with no taxes. Whatever they have, therefore, will disappoint those who thought there was a better, cheaper, more flexible and more accessible plan out there.
The danger for Republicans is that whether it is the plan desired by conservatives or the uber-conservatives, the public (and therefore the popularity-conscious president) won’t like a a plan that is worse than what Obamacare provides (higher deductibles, more out-of-pocket costs). Get ready for Democrats to make a very strong push to not let Republicans “take away health care.” And watch them focus directly on members of Trump’s base, who have the most to lose. Given what the GOP has come up with, the Democrats may well have a winning argument.