Trumpcare is dead. Long live Obamacare.
So cheered the Democrats when Senate Majority Leader Mitch McConnell delayed a vote on the latest Republican healthcare bill as support for the legislation collapsed faster than the individual insurance market.
The math in the 52-48 Republican Senate is even more daunting than it was in the House when GOP leaders pulled and then just barely passed their healthcare bill in a death-defying act. And the Senate’s handiwork would have to be able to pass the House again.
But maybe the stage is being set for something closer to Trumpcare than what we’ve already seen.
In public, Trump has dutifully supported whatever healthcare legislation Republican leadership believed could conceivably get through a chamber of Congress and celebrated in the Rose Garden when the House passed the American Health Care Act.
In private, Trump reportedly complained that the House-passed bill was “mean.” He has supported that contention by publicly asking Republican lawmakers to spend more money on healthcare and pass legislation with “heart.”
This isn’t surprising. The bills congressional Republicans have delivered are a far cry from what Trump promised on the campaign trail.
“I am going to take care of everybody… Everybody’s going to be taken care of much better than they’re taken care of now,” Trump vowed on healthcare to “60 Minutes.”
Since winning the White House, Trump has continued to promise universal coverage. “We’re going to have insurance for everybody,” he told the Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
“We’re going to get private insurance companies to take care of a lot of the people that can afford it,” Trump remarked on “Fox and Friends.” “That’s going to take a tremendous burden off, and they’re going to be able to have plans that are great plans.”
“And it’s going to be much less expensive,” he added. “And you will be able to actually have something to say about who your doctor is and your plan.”
“I firmly believe that nobody will be worse off financially in the process that we’re going through,” Trump Secretary of Health and Human Services Tom Price told NBC’s “Meet the Press.”
“We don’t want anyone who currently has insurance to not have insurance,” counselor to the president Kellyanne Conway said on MSNBC’s “Morning Joe.”
Trump converted from supporting single-payer healthcare — something he now warns GOP lawmakers could be inevitable if they fail to pass a bill — to a backer of more competitive insurance marketplaces. But he’s never accepted the view of some conservatives that it is not the federal government’s job to ensure access to healthcare or insurance.
“We’re going to take care of people who are dying on the street because there will be a group of people that are not going to be able to think in terms of private or anything else,” he said during a Republican presidential debate last year. Trump also campaigned against cutting entitlements, including Medicaid.
Why does any of this matter when Trump doesn’t seem especially concerned about the policy details and has repeatedly backed legislation that breaks some of these pledges? Most of these promises don’t add up to a coherent, affordable healthcare program in any event.
Because the votes in play right now seem to belong to centrists and soft conservatives from Medicaid expansion states.
Up until now, that role has been played mainly by conservatives. Trump, Vice President Mike Pence and Tuesday Group castoff Rep. Tom MacArthur, R-N.J., negotiated with the Freedom Caucus and those conservatives provided the American Health Care Act with its margin in the House.
Before bringing the rest of the Republican senators to the White House, Trump met with Sen. Rand Paul, R-Ky., a ringleader of a group of conservatives trying to reprise the Freedom Caucus’ role in the Senate.
But now the people saying they might not vote for the Obamacare replacement bill include not only centrists like Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, but also right-leaning Medicaid expanders like Sens. Rob Portman, R-Ohio, Shelley Moore Capito, R-W. Va., and Dean Heller, R-Nev.
Even Sen. Jerry Moran, R-Kans., appears to be in play.
With the exception of Heller, most of these Republicans represent states that Trump won handily in November. He also carried a congressional district in Collins’ Maine, good for an electoral vote.
These are Republicans looking for more money for Trump voters in the healthcare bill. One upside to the Congressional Budget Office score is $321 billion in deficit reduction, more than the House version, giving Senate Majority Leader Mitch McConnell, R-Ky., some additional money to play with.
It was centrist Democrats like Joe Lieberman and Ben Nelson who kept the public option out of Obamacare. It was the Freedom Caucus that got relief from certain Obamacare insurance mandates written into the American Health Care Act. Those were the factions who could have taken the healthcare bills or left them.
Trump has so far dealt predominantly with Republicans who want to push the healthcare bill to the right, with his White House furiously disputing the CBO coverage numbers, because theirs were the votes needed to get to a bare majority.
But it’s not where Trump’s personal preferences lie. If a bill with more “heart” — and more government — is what can pass, don’t expect him to be an obstacle.
Trumpcare, indeed.
