The failure of Trumpcare last week, amid opposition from Republican moderates and extremists in the House of Representatives, is certainly a sigh of relief for Obamacare supporters and the millions of Americans who rely on the law. But as the New Republic’s Brian Beutler wrote on Tuesday, “ACA supporters shouldn’t become complacent simply because a Republican health care bill is not going to become law anytime soon. Republican opposition to Obamacare is about to become more dishonorable than at any point since Obama signed it seven years ago.”
No sooner was that column published than Republicans indicated they might yet attempt to pass the American Health Care Act, which House Speaker Paul Ryan pulled from the floor after realizing he didn’t have the votes to pass it. The New York Times reported Tuesday that “Republican leaders and the White House, under extreme pressure from conservative activists, have restarted negotiations on legislation to repeal the Affordable Care Act.” And according to The Washington Post, the White House has reached out to Democrats in search of compromise legislation.
These are likely dead ends, leaving the Republicans to move ahead with their simplest route to replacing Obamacare: to sabotage the law administratively, then push for changes after it falls apart. On Saturday, stung by the AHCA’s failure, Trump tweeted:
But Obamacare won’t “explode” on its own unless he lights the fuse. As Greg Sargent notes at The Washington Post, Trump’s plan seems to be to “allow the law to collapse, or even further undermine it through executive action, and pin the blame for the resulting human toll on Democrats. As it happens, Trump does have the tools to inflict immense damage on the Affordable Care Act and hurt a lot of people in the process.” Doing so would deprive millions of health care, including many Trump supporters.
Even if we take Trump’s statement as fact—that Obamacare is flawed and will collapse on its own—it would be a remarkable dereliction of duty. Trump is the president, and his party controls Congress. If Obamacare is so flawed, Republicans have a responsibility to fix it, or to replace it with a humane alternative. To simply wait for the ACA to “explode” would be to knowingly doom countless Americans to uncertainty about one of the most fundamental matters in life: their health.
That Republican leaders in Congress would attempt such a cynical, callous plan should come as no surprise given their increasingly extreme positions under President Barack Obama. But Trump’s apparent intention to sabotage Obamacare shows that his campaign’s empathetic populism was always a sham—or, more generously, that he lacks the power to rule his party. Either way, it’s clear the president is succumbing to the central policy of conservative Republicans: cruelty to the needy.
Trump never hid his nasty side as a candidate, but he did make clear that this viciousness would be reserved for the imagined enemies of his supporters: He would build a wall to keep out immigrants from Latin America, deport undocumented immigrants in America, empower police to abuse minorities, create a government database to track Muslims legally in the U.S., and commit war crimes in the fight against terrorism.
By contrast, Trump promised to help Americans in need—not just by creating more jobs, but by improving health care. “You’re going to end up with great health care for a fraction of the price and that’s gonna take place immediately after we go in,” he told a Las Vegas crowd. “Okay? Immediately. Fast. Quick.” In a town hall that same month, he guaranteed that every American would get healthcare. “We’re going to take care of them,” he promised. “We’re going to take care of them. We have to take care of them. Now, that’s not single payer. That’s not anything. That’s just human decency.” Trump also promised that he wouldn’t cut Medicaid, and that nobody would lose health insurance.
Trump isn’t just failing to keep these promises; he’s trying to do the exact opposite of what he promised. Trumpcare would phase out Obamacare’s Medicaid expansion, which is one of several reasons the Congressional Budget Office estimated that 24 million Americans would lose health insurance by 2026 if the Republican bill became law. No wonder Trump’s popularity, even among his most hardened supporters, started to spiral downward once the harshness of his Obamacare replacement clear.
Trump’s incredible cruelty might come as a surprise to his fans, but it’s entirely consistent with the Republican agenda of the Obama years.
Paul Ryan, who was chairman of the House Budget Committee before he became speaker in 2015, has long advocated for cutting programs that help Americans in need. The Ryan budget last year, brazenly titled A Better Way, “would cut programs for low- and moderate-income people by about $3.7 trillion over the next decade,” according to the Center on Budget and Policy Priorities. “In 2026, it would cut such programs overall by 42 percent—causing tens of millions of people to lose health coverage and millions to lose basic food or other support.” These budgets were consistent with Republicans’ broader, longstanding war on the poor.
That is, Trump ran as a Republican at a time when his GOP cohort in Congress embraced ever more extreme economic austerity, as evidenced by the rise of the Tea Party-ite House Freedom Caucus and Ryan’s elevation to speakership. Conservative orthodoxy notwithstanding, Trump’s cruelty was indeed predictable based on his biography. He has spent his entire adult life embodying the ideals of unfettered plutocracy, enriching himself without any concern for the public good. Such conditions and character don’t usually lend themselves to a committed populism.
In theory, President Trump could’ve tried to cut himself loose from his party and tried to gain support from Democrats and moderate Republicans. But such a move would involve caring about the details of policy, which Trump has never shown any interest in. That’s why, in economic terms, Trump is a much less revolutionary figure than many feared or hoped. To live up to his campaign rhetoric, he’d have to battle the economic conservatives who dominate the Republican Party. It’s now apparent that he lacks the will or wits for such a fight, and his many struggling voters will suffer further as a result.