By: Kailas Rajan
On the campaign trail last September, Donald Trump promised that when he became president, he would repeal and replace the Affordable Care Act (ACA/ObamaCare) with a healthcare plan that covered everyone, had lower premiums and costs, and would be “better for everyone.” For many Americans, these were passionate words that railed against the disastrous ObamaCare, something Republicans had pointed to for years as former President Obama’s signature failure. Once President Trump came into office, everyone was waiting for the new, universal healthcare plan. Speaker of the House Paul Ryan (R-Wisconsin), for the past 6-7 years, had called for ObamaCare to be repealed and replaced. Once he became Speaker of the House in 2015, Ryan was solidified as the figurehead of the Republican party- the man with a plan to put an end to the “socialist” Democrat agenda. And from the look of things, most of that was a bluff.
A month ago, the American Health Care Act (AHCA or TrumpCare/RyanCare) was crafted, and much to everyone’s (or no one’s) surprise, Ryan had come up short of every promise. With no practical way to craft a new, moderate healthcare act, Paul Ryan ended up creating a Frankenstein of the original ACA, a piece of legislation conservative enough for Democrats to hate, but moderate enough for conservatives to disown. In short, it seemed like no one wanted the bill.
Breaking down the AHCA, many of the major provisions of the ObamaCare had been revoked. The “penalty tax” on people without healthcare, a way to pull healthy individuals into the market, was removed. The plan also allows more leeway for health insurers to charge for varying packages. While this would make it easier for healthy, high-income people to get a small healthcare package, it could make lower-income, sicker individuals have to pay far more for the package they need. The plan also switches ObamaCare tax credits based on income, to be based on age instead. Some provisions of ObamaCare were present in TrumpCare, like a restrained Medicaid expansion till 2020, allowing more low-income families access and also the popular provisions of 1. Preventing providers from discriminating against patients with preconditions and 2. Allowing people up to the age of 26 to stay on their parents’ plans.
Photo: Win McNamee, Getty Images
In total, TrumpCare was a significantly weaker version of ObamaCare, with the caveat of a masked, massive tax cut for the rich. Many who prior were essentially “paying for the poor to live” would gain from the AHCA. The nonpartisan Congressional Budget Office (CBO) estimated that 24 million Americans would lose health insurance, which sparked widespread resistance to the bill. However, in the days leading up to the bill’s collapse, it seemed as if Republicans would hold their nose and vote for it. Unfortunately for Trump and Ryan, the House Freedom Caucus, a set of highly conservative Republicans, refused to vote for the bill, citing that it did not repeal enough of ObamaCare’s measures.
If the AHCA had passed, President Trump and the new Republican White House could’ve touted their first real accomplishment, their first “win” for Trump and Ryan-led Republican party. The New York Times, CNN, and other “liberal news” sources would have to acknowledge the conservative victory. Trump would’ve held exuberant rallies to celebrate the end of ObamaCare. Paul Ryan would’ve likely appeared on various news channels explaining how the party had come together and bridged divisions and that the media’s narrative was so far wrong.
Unfortunately for Trump and Ryan, the bill was pulled when it became clear it wouldn’t pass. The real irony is that for the Freedom Caucus, the bill wasn’t conservative enough. The Caucus saw too much of ObamaCare in the bill and likely wanted to do away with government entitlements like Medicaid entirely. Without the support of the Freedom Caucus, as well as other more moderate Republican members of the House, Ryan advised Trump to pull the bill, and declared defeat, stating “ObamaCare is the law of the land.”
This is an important defeat for the Trump-Ryan Republican party. The “liberal” media narrative that showed deep divisions within the party was correct; divisions in the Republican party are significant and are tearing the party apart. After seven years of railing against the ACA, Republicans, who now control the White House, Senate, and House, were unable to repeal and replace it. While it’s been clear that government has been a mess, the general expectation was that the party would eventually coalesce around Ryan, and by extension, Trump. Now it’s obvious that Republicans won’t necessarily stand in line.
To make matters even more complicated, House representatives have complained that chief White House strategist Steve Bannon (and former executive chairman of Breitbart News, a far right-wing news website) threatened them. Many claim that Bannon told them to stay in line with the president otherwise they would be removed during the 2018 mid-term elections. Even after the bill was pulled and Trump admitted defeat, Bannon said that health care reform was back on the table. The intimidation was unsuccessful, with Senate Majority Leader Mitch McConnell stating “It’s pretty obvious we were not able in the House to pass a replacement [for ObamaCare]. Our Democratic friends ought to be pretty happy about that because we have the existing law in place and I think we’re just going to have to see how that works out.”
At this point, the different camps within the Republican party have started to slowly form. One is the clear Trump-Ryan- Bannon camp -the authoritarian, opportunistic side. Another is a set of highly conservative Republicans, including the Freedom Caucus and other representatives who view government entitlements as the bane of democracy. And on the other side sit the moderate Republicans, many of whom are conflicted between Trump, personal pride, and their special interests. From here on out, Trump and Ryan are not only going to need to reach across the aisle to Democrats, but compromise within their own party.
Since Paul Ryan became House Speaker in 2015, he has acted as the figurehead for the Republican party, and the main proponent of the (inevitable) ObamaCare repeal. Now, Trump has declared that “ObamaCare will explode” and wants to wait for Democrats to come to him for a compromise. Ryan himself has come out to say this is a bad move, that he’d rather work within his own party. What we’re seeing now is a complete deconstruction of the Republican party, and a need for total reformation.
Image by Gabriella Demczuk for The New York Times
Until this point, the focus of the media on the Trump presidency has been about Russian interference, irreverent tweets, scandals in the administration, and the unqualified or dangerous people picked for positions in government. In my eyes, this is first (of many) Republican failures. This is not a Trump-led failure, as so many other things have been. It’s a clear-cut Republican policy failure, something the administration couldn’t simply dismiss, the way it has to everything so far. The Republicans can no longer just work together to push against the Democrats. Now, compromise is a necessity, or Trump’s tax plan will fold just as his health care bill did. Threats from Steve Bannon or other government officials aren’t going to work. With the admission of defeat by both Trump and Ryan, it’s obvious they must pull closer to the center if they want a functioning government. With any luck, Democrats will be able to stop more conservative bills and pull Congress closer to a more moderate position. In the words of Mitch McConnell, “[we] ought to be pretty happy.”