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Opinion How Trump blew it on health care

President Trump praises the House Republicans' plan to alter the Affordable Care Act, March 7, at the White House. (Video: The Washington Post)

Until Tuesday, President Trump and Stephen K. Bannon did a good job of keeping their base happy. They threw out red meat on immigration, ruthlessly attacked the press, cooked up an anti-Barack Obama conspiracy (to replace the birther conspiracy) and continued to talk tough on trade. If his actions and rhetoric horrified all Democrats, most independents, some thinking Republicans and the press, he did not care. Keep the base happy, stick to the nativist, protectionist Bannon hymnal.

Then on Tuesday Trump embraced the GOP health-care bill, which will keep or even expand the “administrative state” and which has been vilified by conservatives. He tweeted, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!” Trump also said after a meeting with members, “We’re going to do something that’s great. And I am proud to support the replacement plan released by the House of Representatives.”

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Now, whatever you think of the merits, it won’t pass as currently designed. Moreover, it is especially harmful to Trump’s lower-income, older Rust Belt supporters.

An insipid GOP attack line just got worse

The Kaiser Foundation has a user-friendly map and calculator which shows which states (most of them) and which counties specifically would pay more under the GOP American Health Care Act and which pay more under the Affordable Care Act. In almost every single county in Iowa, Michigan and Ohio, a 60-year-old with $30,000 in income would pay more for coverage. In some counties that would amount to more than $1,000. As Kaiser puts it, “Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement. Conversely, some people who are younger, higher-income, or live in low-premium areas (like Massachusetts, New Hampshire, and Washington) may receive larger assistance under the replacement plan.” Congratulations, House Republicans and Trump, you’re on the side of rich New England millennials. Seriously, this would be a tragedy for the “forgotten” Americans and hence a political disaster for Trump.

House Speaker Paul D. Ryan (R-Wis.) remarked on the American Health Care Act on Tuesday, saying it's "been a long time coming." (Video: The Washington Post)

From a political and policy standpoint, the smart move would have been to deplore the bill and tell the House to go back to work. Instead, Trump tied himself to the mast of a sinking ship. Why would he do this? Well, for starters he never had a bill of his own. This is the only vehicle Health and Human Services Secretary Tom Price and Vice President Pence have been working on. There was no “awesome” health-care plan in his back pocket. Second, this could be another case in which Trump did not read the fine print. (He doesn’t read much of anything, reportedly.) He took House Speaker Paul D. Ryan (R-Wis.), Price and Pence’s word that this would be fine and leaped before he really looked hard at the bill. Alternatively, he may never have intended to improve health care for his base or protect the most vulnerable. Perhaps his plan all along was to reward the rich, cover fewer people, enact painful cuts at the expense of the poor and repeal taxes for the upper-income taxpayers who’ve footed a large share of the cost of Obamacare. He might not actually care what is in the bill; he only wants “wins.” He therefore will deny the bill does the destructive things its critics (correctly) claim. On this one however, he’ll not have the amen right-wing chorus to echo his nonsense.

The Republican health-care plan’s top critics? Republicans.

Whatever your explanation, the Democrats considering a run in 2020 must be delighted. Trump’s no friend of the working man, they will claim. He’s just as mean-spirited as every other Republican, they will say. Democrats will hang the GOP health care bill around the necks of Republican incumbents. GOP voters who will be enraged the party did not do what it promised may sit home, or vote for challengers.

For all these reasons I find it hard to believe that in the end Trump won’t hang the House Republicans out to dry. (That would please Bannon, who has had a temporary truce with Ryan.) He will need to distance himself from the impending disaster. We’ll have to wait and see how he does it.