President Donald Trump seems to be getting his first lesson in sausage making, and, if it keeps up at this pace, he may soon end up a vegan.
The tension between the different factions of the party is testing Republican leaders and a White House that has been dogged by poor messaging from the weekend they took power. It’s also bringing out the worst side of the GOP, as in fighting erupted even before House leaders unveiled their new health care proposal.
Now White House and GOP leaders at the Capitol are scrambling to show a unified front when it comes to overhauling the nation’s health care system, because the latest Republican proposal has sparked an inter-party fight that threatens to derail the latest proposal before it even hits the House floor.
House conservatives have rejected the GOP bill to repair Obamacare because the party promised voters a full repeal while on the stump in the past few campaign cycles. More moderate Republicans from states that took Medicaid expansion fear the party is moving too swiftly to undo that provision—putting their constituents and possibly their jobs—in jeopardy.
The new plan, released quietly by Speaker Paul Ryan Monday evening—officially dubbed the American Health Care Act—would scrap the health insurance subsidies that are a staple of Obamacare and replace them with tax credits. That’s a part of the reason the far right pounced on the bill, even as Trump put his stamp of approval on it, telling reporters he’s “proud” of it.
The conservative wing of the GOP has dubbed those credits a new entitlement program, which is a dirty insult in Republican circles. Those credits are a part of the reason that within 24 hours of the bill’s unveiling it had already been rejected by the Koch brother’s group Americans for Prosperity, the libertarian leaning FreedomWorks, Heritage Action, the lobbying arm of the Heritage Foundation, among other conservative groups promising to hold Republicans who vote for the package accountable. Even Breitbart “News,” whose former head, Steve Bannon, literally has a seat in the White House, derided the bill, dubbing it Obamacare 2.0.
The policy ideas included in the new health law seem to have been sucked into the vortex that is the conservative media machine where no previously held GOP belief, stance, or idea seems safe from the full onslaught of the loudest voices on the right.
The quick rejection of those tax credits, coupled with them being dubbed an entitlement program, came as a surprise to Sen. Marco Rubio (R-FL) who crisscrossed the nation for nearly two years promising them to conservatives.
“On the issue of tax credits, I can say to you that when we drafted my plan, when I ran for president on tax credits, conservatives groups helped us to draft it, including some that I’ve now seen potentially opining against it,” Rubio told The Daily Beast. So what changed?
“You’ll have to ask them what lead them—maybe the tax credits they had in mind were different than what was proposed,” Rubio demurred.
Maybe the president can ask them, because the bill now has Trump’s stamp of approval. Unlike Trump’s now defunct steaks and vodka brands, that’s supposed to mean some sort of quality control, but this is Congress and the president doesn’t seem to have been given that memo.
While most in the GOP support that the bill does away with the health insurance mandate that’s intended to prop up the rest of the health law and also unwinds a mix of taxes (like one that rolls back a tax on health insurance CEO’s after they rake in their first $500,000 annually), other Republicans are upset the legislation slowly does away with Obamacare’s Medicaid expansion.
It doesn’t seem anyone’s told the president that Republican governors are now in charge of 16 of the states that approved a Medicaid expansion, which means a lot of Republican senators and House members fear a backlash in the voting booth if they rip health care away from their constituents.
“We’re working through that,” said Sen. Cory Gardner (R-CO), one four senators from Medicaid expansion states to sign a letter of concern about the proposal. “But talking about, making sure we have the stability in the system that we have the flexibility to the states and the certainty that it can provide to the people of Colorado.”
In 2015 all of those Republicans voted for the repeal bill that landed on President Obama’s desk before being swiftly met with his veto pen, but the calculus seems to have changed for moderates in the party.
“Where we are today with a Republican Congress and a Republican White House we’re not passing messaging bills here—we are shooting live rounds,” Rep. Tom MacArthur (R-NJ) recently told The Daily Beast. “Before we repeal we need to know what the replacement is going to look like, so I cannot support that drive to repeal and then hope things work out—a hope so, maybe so replacement is no replacement at all.”
But conservatives accuse party leaders of caving and they argue the GOP needs to swiftly send President Trump the same repeal bill they sent Obama just two years ago.
“We are divided—we have to admit we are divided on replacement,” said Sen. Rand Paul (R-KY) who introduced his own bill on Tuesday for a complete repeal of Obamacare—with no replacement. “We are united on repeal, but we are not united on replacement. What’s the best way to get past this impasse? Let’s vote on what we voted on before, a clean repeal. Let’s separate out the replacement plans.”
The House proposal would also cut federal funding for Planned Parenthood for a year, which in the past has been opposed by Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME)—both of whom dodged reporters on Tuesday with the dismissive “nope” and “no comment,” respectively.
So where does the party go from here?
It seems leaders can’t get the bill out of the House, where no Democrats will support it, unless they tack to the right, which could then imperil its chances in the Senate.
Obamacare has been the rallying cry for the GOP for the last seven years and all the opposition from the party’s rank and file is testing Speaker Ryan who is adamantly trying to convince conservatives that his bill represents a full repeal coupled with a replacement. But that isn’t good enough for his right flank.
“I believe, when you look through it, it’s Obamacare in a different form,” Rep. Jim Jordan (R-OH) told a throng of reporters outside the Capitol.
“We put on President Obama’s desk a bill that repealed Obamacare, got rid of every single tax, got rid of the mandates,” Jordan continued. “And now the first thing Republicans are bringing forward is a piece of legislation that we’re going to put on a Republican president’s desk that says we repeal it but keeps Medicaid expansion and actually expands it, that keeps some of the tax increases—that is not what we promised the American people we were going to do.”
While the president has said he’s fully behind the new law, he’s also signaled he’s ready to play Let’s Make a Deal by signaling to conservatives that he’s willing to negotiate in the coming weeks.
“As the legislative process goes forward, the president and I believe the American Health Care Act is the framework for reform,” Vice President Mike Pence told reporters at the Capitol on Tuesday. “We’re certainly hoping to improvements and recommendations in the legislative process, but this is the bill and the president supports the American Health Care Act and looks forward to working with leadership in the House and Senate to move this bill.”
But the conservative wing of the party doesn’t seem to want to spend the next few weeks debating every jot and tittle of the bill.
“That’s where I don’t want to go, is this infinite labyrinth of [regulations] and picking and that kind of thing. That’s what’s wrong,” said Rep. Dave Brat (R-VA) who has come out opposed to Republican leader’s plan. “What we need is to get rid of the complexity.”
When The Daily Beast pointed out to Brat that health care is 20 percent of the U.S. economy and “is pretty freaking complex,” even according to President Trump, the congressman called for the government to get out of health care altogether.
“The history of the world is the history of failed central government planning—that’s the history of the world,” Brat responded. “The unique exception that made us the richest country on the earth is an experiment in free market economics.”
In the coming weeks the nation will be witness to whether Trump is able to help thread a congressional needle between two warring factions: The tea party conservative’s frothing at the mouth to unwind the entire health law and the moderate Republicans who were dubious of him on the campaign trail.
If he can unite those disparate wings of his fractured party he may prove to be the ultimate deal maker. If not, he may go down as a first term president who squandered his political capital on Twitter.