On Health Care, Trump Tells Conservatives to Take It or Leave It

Nor did it seem to bother him that Republicans on the Hill were in a frenzy to develop a consensus for replacement legislation. Up to now, Needham reminded me, the goal had been to inculcate in the party a ceaseless lust for Obamacare repeal. “For the last eight years,” he said, “it hasn’t made sense to litigate the nuance of, Do you use a tax credit or a tax deduction, or what are your views of block-granting?” The Republicans might not end up with a single gargantuan replacement bill, and maybe that was as it should be. “We’re probably in an age where smaller, humbler pieces of legislation are easier to get consensus around.” This struck me as sensible and, at the same time, somewhat naïve. If, as in Heritage Action’s dream scenario, Obamacare were to be immediately vaporized, it would leave a yawning vacuum — and the first thing to fill it would be anxiety. Every gruesome case of once-insured families now left to die would be duly chronicled by the media. Legislators would panic — but, if recent history is any judge, their reaction would be tame compared with that of the man who now thoroughly owned the post-Obamacare landscape. Was it really so hard, I asked Needham, to imagine Trump faltering under the specter of bad press and equally bad approval ratings and hastily offering up a Trumpcare that bore a suspicious resemblance to Obamacare? Needham paused for a moment before saying, in a vaguely amazed voice: “I’m a little surprised by the question. Right now, I don’t see much evidence of that playing out.” Trump’s vice president was Mike Pence, “my first hero when I came to Washington.” Tom Price, the nominee for Health and Human Services secretary, and Mick Mulvaney, whom Trump tapped to run the Office of Management and Budget, were longtime supporters of Heritage Action. The former senator Jim DeMint, Ed Feulner’s replacement as president of the Heritage Foundation, was helping to shape the selection of Trump’s prospective Supreme Court nominees. Trump’s team was loaded with Heritage staff members. All this counted for as much as whatever the new president himself thought. “Richard Viguerie, one of the icons of the conservative movement, said to me that what was great about Reagan was that when he walked into the room, you saw your friends and allies walking with him,” Needham told me.