Over the past two years, we’ve learned countless times that President Trump indulged in this or that reckless, venal, destructive or racist act or utterance to please his base. This is treated as so routine at this point that the sheer depravity and dereliction at the core of this posture often no longer even get remarked upon.
But the latest example of this perhaps deserves a category all its own. We’re now learning that pleasing his base is a key reason Trump fully embraced a lawsuit targeting the Affordable Care Act that, if successful, could unleash enormously destructive damage throughout the health-care system, including, perversely enough, in areas often mythologized as “Trump country.”
Multiple new reports have filled in the details on the battle inside the White House that resulted in this decision. It does not appear that questions about the law or the real-world impact the lawsuit might have weighed heavily on Trump’s mind.
The lawsuit in question, as you’ve heard, seeks to overturn the Affordable Care Act based on a legal theory that is being dismissed by commentators across the spectrum as bad-faith nonsense. But a Texas judge decided to pretend otherwise and recently struck down the entire ACA as unconstitutional. It’s now up on appeal, but the administration has now embraced the lawsuit’s argument that the whole law is invalid, after having held a relatively measured position in the past.
Now we’re learning more about how this happened. The New York Times reports that during a “heated” argument inside the White House, acting chief of staff Mick Mulvaney, a tea party zealot, and another adviser named Joe Grogan, prevailed upon Trump as follows:
Mr. Trump has declared that he has kept his promises, Mr. Mulvaney and Mr. Grogan argued, and as a candidate he campaigned on repealing the health law. His base of voters would love it. Besides, they argued, Democrats have been campaigning successfully on health care, and Republicans should try to claim the issue for themselves. This could force the matter.
Among those with concerns was Pat Cipollone, the White House counsel, who shared that the new attorney general, William P. Barr, opposed such a move. Vice President Mike Pence was worried about the political ramifications of moving ahead without a strategy or a plan to handle the millions who could be left suddenly uninsured if the suit succeeded.
His base of voters would love it. This apparently overrode the fact that the new attorney general opposed the move, presumably because the lawsuit is utterly absurd on its legal merits, and the fact that the administration has no plan to deal with the millions who would suddenly lose health coverage. Note that Pence appeared worried about the politics of this, not its enormous human toll, but never mind that for now.
Similarly, The Post reports that Mulvaney and his allies “told Trump that joining a lawsuit to overturn the ACA will help him fulfill a campaign promise and could help lead to his reelection.” Translation: It will keep the base happy.
This comes as many Republicans appear ready to concede (rhetorically and for now) that they’ve lost the political argument over the ACA’s future. As one GOP strategist notes, it’s an enormous political risk to align the GOP with “advocating for the disruption in coverage for Americans who are currently pleased with their own health care.”
That’s a funny stance, given that Republicans have been trying to repeal the ACA with no serious replacement for nine years, but in effect, it concedes that repeal is now a political impossibility. And Republicans just learned this the hard way, losing the House in a massive rout after trying and failing at repeal. Those inside the White House against this move (Pence) offered Trump this warning.
What’s telling is the argument that Mulvaney used to prevail against it. He told Trump not just that blowing up Obamacare would thrill his base, but also that Trump and Republicans could take the health-care issue back for themselves — which, of course, would require having an actual plan.
But the White House doesn’t have any plan. And the Washington Examiner reports that Senate Republicans concede that the White House has not provided assurances that one is forthcoming. Indeed, this is precisely why Pence argued against fully endorsing the lawsuit!
Yet Mulvaney was able to manipulate Trump into backing it. Mulvaney likely played on Trump’s ignorance about the complexities of health care, and his unshakable confidence that he can simply make things come true if he says so, to persuade him that he’ll be able to conjure one up. And sure enough, Trump has been suggesting this will happen, blithely asserting: “The Republican Party will soon be known as the party of health care.”
The idea that coming up with an alternative plan would magically mitigate the consequences of total repeal at this point is itself daft. That’s because those consequences would be truly dire. As health-care expert Nicholas Bagley explains, the ACA is now "part of the basic plumbing of the American health care system”:
It guarantees protections for people with pre-existing medical conditions. It expanded Medicaid to cover 12.6 million more people, and it offers crucial protections to the 156 million Americans who get insurance through employers.
Beyond that, the law forces insurers to cover preventive care and contraception without charge; changed how hospitals and physicians bill for their services ... imposed hundreds of billions of dollars in taxes; and much, much more.
Unceremoniously ripping up the law would inflict untold harm on the health care system — and on all Americans who depend on it.
On top of all this, Paige Winfield Cunningham reports that if this lawsuit succeeds, it would also do deep damage to efforts to combat the opioid epidemic, something that is hitting “Trump country” hard, and that Trump has claimed to be vanquishing. Importantly, the health-care official in charge of those efforts tells Cunningham that no one in the administration “has briefed me on the alternative proposal that would take the place of the ACA.” Does Trump have any awareness of these potential consequences?
Despite all this, Trump went ahead, anyway. By these accounts, either he actually believes Republicans might come up with a plan to mitigate all this damage (in which case he’s dangerously incurious about the policy complexities involved and is willing to take a preposterous risk, given the GOP’s failures on this front), or he doesn’t care if they do not (in which case he’s dangerously venal and reckless).
Either way, his base will be happy — or so he thinks. And that’s what matters most — or perhaps all that matters.