washington, dc

The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Ed Kilgore

January 26: Feels a Lot Like a Pat Buchanan Administration

As Donald Trump announced various “America First” initiatives on his first day in office, I could not avoid the feeling another nationalist-populist’s legacy was finally reaching fruition, and so I wrote about it at New York.

Jeff Greenfield wrote a column in September with the headline: “Trump Is Pat Buchanan With Better Timing.” The similarities are obvious: Both men spurned the Republican Establishment, rejected GOP economic doctrines from free trade to inclusive immigration laws to “entitlement reform,” and were hostile to globalism in all its forms. They even shared the same “America First” slogan, itself a typically Buchananite shout-out to the old-right isolationists who were indifferent (or worse) toward the possibility of Hitler winning World War II.

That reflects one difference between the two demagogues, of course: Buchanan has always had an acute if skewed sense of history, while the 45th president’s contact with the subject is probably limited to extremely brief exposure to the History Channel. And they are hardly in lockstep on every policy issue: Buchanan has taken angry exception, for example, to his protégé’s long-distance love affair with Bibi Netanyahu.

But it is the priorities President Trump has revealed in his first days in office that really make one pause to realize how similar he is to Buchanan: canceling TPP and demanding the renegotiation of NAFTA; tossing day one goodies to the anti-abortion movement; ordering a quick start to his beloved border wall while threatening the undocumented; and now, initiating a systematic program of disinvestment in international organizations, especially the U.N. All these are things you might have expected in a Buchanan administration, including the last item: As the Reform Party candidate for president in 2000, Buchanan made withdrawal from the U.N. and expelling the organization from New York a campaign staple. And in 2002, he wrote an entire book attacking liberal immigration policies under the inflammatory title, The Death of the West.

Beyond policies, the tone Donald Trump has adopted as president so far is very faithful to the example set by Buchanan, the pol who invented the term “culture war,” which he regarded as a very good thing. Trump’s belligerent inaugural address and manifest determination to bend the GOP to his will nicely reflect Buchanan’s incessantly combative approach to intra-party and inter-party politics.

While we naturally think of Pat Buchanan as a figure from another era, he is actually only eight years older than Donald Trump. Perhaps he can lend Stephen Miller a hand in the presidential speechwriting shop, where he once labored in the vineyards of Richard M. Nixon. He would fit right in.


Feels a Lot Like a Pat Buchanan Administration

As Donald Trump announced various “America First” initiatives on his first day in office, I could not avoid the feeling another nationalist-populist’s legacy was finally reaching fruition, and so I wrote about it at New York.

Jeff Greenfield wrote a column in September with the headline: “Trump Is Pat Buchanan With Better Timing.” The similarities are obvious: Both men spurned the Republican Establishment, rejected GOP economic doctrines from free trade to inclusive immigration laws to “entitlement reform,” and were hostile to globalism in all its forms. They even shared the same “America First” slogan, itself a typically Buchananite shout-out to the old-right isolationists who were indifferent (or worse) toward the possibility of Hitler winning World War II.

That reflects one difference between the two demagogues, of course: Buchanan has always had an acute if skewed sense of history, while the 45th president’s contact with the subject is probably limited to extremely brief exposure to the History Channel. And they are hardly in lockstep on every policy issue: Buchanan has taken angry exception, for example, to his protégé’s long-distance love affair with Bibi Netanyahu.

But it is the priorities President Trump has revealed in his first days in office that really make one pause to realize how similar he is to Buchanan: canceling TPP and demanding the renegotiation of NAFTA; tossing day one goodies to the anti-abortion movement; ordering a quick start to his beloved border wall while threatening the undocumented; and now, initiating a systematic program of disinvestment in international organizations, especially the U.N. All these are things you might have expected in a Buchanan administration, including the last item: As the Reform Party candidate for president in 2000, Buchanan made withdrawal from the U.N. and expelling the organization from New York a campaign staple. And in 2002, he wrote an entire book attacking liberal immigration policies under the inflammatory title, The Death of the West.

Beyond policies, the tone Donald Trump has adopted as president so far is very faithful to the example set by Buchanan, the pol who invented the term “culture war,” which he regarded as a very good thing. Trump’s belligerent inaugural address and manifest determination to bend the GOP to his will nicely reflect Buchanan’s incessantly combative approach to intra-party and inter-party politics.

While we naturally think of Pat Buchanan as a figure from another era, he is actually only eight years older than Donald Trump. Perhaps he can lend Stephen Miller a hand in the presidential speechwriting shop, where he once labored in the vineyards of Richard M. Nixon. He would fit right in.


January 20: Trump’s Divisive Inaugural Address

Immediately after watching Donald Trump’s strange, divisive inaugural address today, I offered an unhappy take on it at New York.

Those familiar with Donald Trump’s inaugural address before he delivered it advised us it would be “Jacksonian.” By that I suppose they meant belligerent, nationalist, and populist. But if you look at the address Andrew Jackson himself delivered at his first inauguration, after a bitter campaign, it could not have been more different. Here’s how Jackson referred to his predecessors in office (including the man he defeated, John Quincy Adams):

“A diffidence, perhaps too just, in my own qualifications will teach me to look with reverence to the examples of public virtue left by my illustrious predecessors.”

Trump began (after a brief thank-you to Barack Obama for cooperating during the transition) by attacking all his recent predecessors, as, well, self-interested betrayers of the public trust:

“For too long, a small group in our nation’s capital has reaped the rewards of government while the people have borne the cost. Washington flourished, but the people did not share in its wealth. Politicians prospered, but the jobs left and the factories closed. The Establishment protected itself, but not the citizens of our country. Their victories have not been your victories. Their triumphs have not been your triumphs. And while they celebrated in our nation’s capital, there was little to celebrate for struggling families all across our land.

“That all changes starting right here and right now because this moment is your moment; it belongs to you.”

That set the tone for his address, an angry screed of a campaign speech. I’ve been watching and listening to inaugural addresses since John F. Kennedy’s, in 1960. I’ve never heard anything like this one in terms of its divisive content and complete lack of uplift. Even its call for the blessings of the Almighty was to a nationalist God Trump seemed to be charging with protecting the country — if and only if our military and police forces failed. And absent any admission of his own fallibility, his appeal to unity sounded more like a threat of repression than a call for mutual understanding and bipartisanship.

He accused “Washington” of deliberately abandoning factories and their workers, deliberately robbing Americans of their income and wantonly spending it on foreign countries, and deliberately refusing to hear the cries of an aggrieved, impoverished, and powerless citizenry. And having painted this dark picture of a horrific status quo, he proceeded to set out literally impossible goals for his own presidency.

The “American carnage” of crime and gangs and drugs “stops right here and stops right now.” Really? And as for “radical Islamic terrorism”? He plainly promised that “we will eradicate [it] from the face of the Earth.” Seriously. And: “We will bring back our jobs … our borders … our wealth.” Gee, will the rest of the world cooperate to make that happen?

By the time Trump got to the climax of the address, a secular doxology of the national greatness he would achieve (wealthy! strong! safe!), the hope of so many people, especially those who fear him, that the 45th president would rise to the moment and make a graceful, civic-minded speech, had long been dashed.

Trump can, of course, eventually transcend this moment. But it was an ominous beginning for a presidency that was so hard to envision as normal.

I began the day depressed, and ended it depressed and nearly as angry as Trump himself. As he would say on Twitter: Sad!


Trump’s Divisive Inaugural Address

Immediately after watching Donald Trump’s strange, divisive inaugural address today, I offered an unhappy take on it at New York.

Those familiar with Donald Trump’s inaugural address before he delivered it advised us it would be “Jacksonian.” By that I suppose they meant belligerent, nationalist, and populist. But if you look at the address Andrew Jackson himself delivered at his first inauguration, after a bitter campaign, it could not have been more different. Here’s how Jackson referred to his predecessors in office (including the man he defeated, John Quincy Adams):

“A diffidence, perhaps too just, in my own qualifications will teach me to look with reverence to the examples of public virtue left by my illustrious predecessors.”

Trump began (after a brief thank-you to Barack Obama for cooperating during the transition) by attacking all his recent predecessors, as, well, self-interested betrayers of the public trust:

“For too long, a small group in our nation’s capital has reaped the rewards of government while the people have borne the cost. Washington flourished, but the people did not share in its wealth. Politicians prospered, but the jobs left and the factories closed. The Establishment protected itself, but not the citizens of our country. Their victories have not been your victories. Their triumphs have not been your triumphs. And while they celebrated in our nation’s capital, there was little to celebrate for struggling families all across our land.

“That all changes starting right here and right now because this moment is your moment; it belongs to you.”

That set the tone for his address, an angry screed of a campaign speech. I’ve been watching and listening to inaugural addresses since John F. Kennedy’s, in 1960. I’ve never heard anything like this one in terms of its divisive content and complete lack of uplift. Even its call for the blessings of the Almighty was to a nationalist God Trump seemed to be charging with protecting the country — if and only if our military and police forces failed. And absent any admission of his own fallibility, his appeal to unity sounded more like a threat of repression than a call for mutual understanding and bipartisanship.

He accused “Washington” of deliberately abandoning factories and their workers, deliberately robbing Americans of their income and wantonly spending it on foreign countries, and deliberately refusing to hear the cries of an aggrieved, impoverished, and powerless citizenry. And having painted this dark picture of a horrific status quo, he proceeded to set out literally impossible goals for his own presidency.

The “American carnage” of crime and gangs and drugs “stops right here and stops right now.” Really? And as for “radical Islamic terrorism”? He plainly promised that “we will eradicate [it] from the face of the Earth.” Seriously. And: “We will bring back our jobs … our borders … our wealth.” Gee, will the rest of the world cooperate to make that happen?

By the time Trump got to the climax of the address, a secular doxology of the national greatness he would achieve (wealthy! strong! safe!), the hope of so many people, especially those who fear him, that the 45th president would rise to the moment and make a graceful, civic-minded speech, had long been dashed.

Trump can, of course, eventually transcend this moment. But it was an ominous beginning for a presidency that was so hard to envision as normal.

I began the day depressed, and ended it depressed and nearly as angry as Trump himself. As he would say on Twitter: Sad!


January 19: Trump’s Reelection Slogan

Even as we all try to understand how Donald Trump’s election as president, he’s looking ahead. I noted this, with awe, at New York this week:

The most visible symbol of Donald Trump’s implausibly successful presidential candidacy — with the possible exception of his hair — were the red hats he and many of his supporters routinely wore, emblazoned with the slogan “Make America Great Again.” In an interview with the Washington Post’s Karen Tumulty, Trump discussed how he came up with and quickly trademarked the MAGA slogan back in 2012. His lawyers actually fired off cease-and-desist letters whenever GOP rivals used the phrase in speeches.

The president-elect, a man whose convictions about the value of “branding” are clearer than those he possesses about almost any other topic, is undoubtedly convinced his alleged origination and fierce flogging of MAGA was key to his political success. And perhaps he is right: Its plainly reactionary, yet policy-flexible nature made it a lot more compelling than the straddling stances on the past and present all his opponents assumed. That definitely included Hillary Clinton, who could never overcome the sense she was running for a third term for her husband or for Barack Obama, or both. And it put the Trump campaign in touch with an important strain of right-wing sentiment that is not strictly about limited government — viz. the efforts of David Brooks and William Kristol to promote something they called “National Greatness Conservatism” just before the turn of the millennium.

In any event, the shelf life of MAGA is limited, and as this remarkable moment in the interview with Tumulty shows, Donald Trump is thinking ahead:

“Halfway through his interview with The Washington Post, Trump shared a bit of news: He already has decided on his slogan for a reelection bid in 2020.

“‘Are you ready?” he said. “ ‘Keep America Great,’ exclamation point.’

“‘Get me my lawyer!’ the president-elect shouted.

“Two minutes later, one arrived.

“’Will you trademark and register, if you would, if you like it — I think I like it, right? Do this: ‘Keep America Great,’ with an exclamation point. With and without an exclamation. ‘Keep America Great,’ ” Trump said.

“‘Got it,’ the lawyer replied.”

It’s news indeed that a few days before he becomes president Trump is already thinking about his reelection. And there’s an obvious logic to KAG. But it doesn’t quite pull on the heartstrings like the simultaneously nostalgic and optimistic MAGA. And it puts Trump on the hook for, you know, actually accomplishing something great.

Trump seems to understand that. After some scary talk suggesting that “greatness” has a lot to do with military displays (“That military may come marching down Pennsylvania Avenue. That military may be flying over New York City and Washington, D.C., for parades. I mean, we’re going to be showing our military”), he told Tumulty he needed some steak to go with the sizzle:

“’I think they have to feel it,’ Trump acknowledged. ‘Being a cheerleader or a salesman for the country is very important, but you still have to produce the results.'”

Taking office with the lowest approval ratings ever for an incoming president, while possessing a campaign platform based on magic and Big Man posturing, and facing a common fate with congressional “allies” he plainly mistrusts, it’s not clear how Trump thinks he will “produce the results.” Quite possibly, he thinks that as a marketing genius he can convince voters in 2020 — and earlier, when his administration gets its first public feedback in off-year and midterm elections — that life is better through sheer rhetorical enchantment.

It arguably happened once. Happening twice is far less likely.


Trump’s Reelection Slogan

Even as we all try to understand how Donald Trump’s election as president, he’s looking ahead. I noted this, with awe, at New York this week:

The most visible symbol of Donald Trump’s implausibly successful presidential candidacy — with the possible exception of his hair — were the red hats he and many of his supporters routinely wore, emblazoned with the slogan “Make America Great Again.” In an interview with the Washington Post’s Karen Tumulty, Trump discussed how he came up with and quickly trademarked the MAGA slogan back in 2012. His lawyers actually fired off cease-and-desist letters whenever GOP rivals used the phrase in speeches.

The president-elect, a man whose convictions about the value of “branding” are clearer than those he possesses about almost any other topic, is undoubtedly convinced his alleged origination and fierce flogging of MAGA was key to his political success. And perhaps he is right: Its plainly reactionary, yet policy-flexible nature made it a lot more compelling than the straddling stances on the past and present all his opponents assumed. That definitely included Hillary Clinton, who could never overcome the sense she was running for a third term for her husband or for Barack Obama, or both. And it put the Trump campaign in touch with an important strain of right-wing sentiment that is not strictly about limited government — viz. the efforts of David Brooks and William Kristol to promote something they called “National Greatness Conservatism” just before the turn of the millennium.

In any event, the shelf life of MAGA is limited, and as this remarkable moment in the interview with Tumulty shows, Donald Trump is thinking ahead:

“Halfway through his interview with The Washington Post, Trump shared a bit of news: He already has decided on his slogan for a reelection bid in 2020.

“‘Are you ready?” he said. “ ‘Keep America Great,’ exclamation point.’

“‘Get me my lawyer!’ the president-elect shouted.

“Two minutes later, one arrived.

“’Will you trademark and register, if you would, if you like it — I think I like it, right? Do this: ‘Keep America Great,’ with an exclamation point. With and without an exclamation. ‘Keep America Great,’ ” Trump said.

“‘Got it,’ the lawyer replied.”

It’s news indeed that a few days before he becomes president Trump is already thinking about his reelection. And there’s an obvious logic to KAG. But it doesn’t quite pull on the heartstrings like the simultaneously nostalgic and optimistic MAGA. And it puts Trump on the hook for, you know, actually accomplishing something great.

Trump seems to understand that. After some scary talk suggesting that “greatness” has a lot to do with military displays (“That military may come marching down Pennsylvania Avenue. That military may be flying over New York City and Washington, D.C., for parades. I mean, we’re going to be showing our military”), he told Tumulty he needed some steak to go with the sizzle:

“’I think they have to feel it,’ Trump acknowledged. ‘Being a cheerleader or a salesman for the country is very important, but you still have to produce the results.'”

Taking office with the lowest approval ratings ever for an incoming president, while possessing a campaign platform based on magic and Big Man posturing, and facing a common fate with congressional “allies” he plainly mistrusts, it’s not clear how Trump thinks he will “produce the results.” Quite possibly, he thinks that as a marketing genius he can convince voters in 2020 — and earlier, when his administration gets its first public feedback in off-year and midterm elections — that life is better through sheer rhetorical enchantment.

It arguably happened once. Happening twice is far less likely.


January 12: Trump Can’t Leave Republicans Alone To Repeal Obamacare

After watching Donald Trump’s first press conference as president-elect, I spent some time trying to refix my dropped jaw, and then wrote at New York about the damage the man had done to his party’s plans to repeal and replace the Affordable Care Act:

Yesterday, President-elect Donald Trump, in an interview with the New York Times, threw all sorts of sand into the gears of the congressional GOP effort to repeal and replace Obamacare. As Jonathan Chait explained, what he was saying made absolutely no sense:

“Trump stated that the Senate must repeal Obamacare ‘probably some time next week,’ and that ‘the replace will be very quickly or simultaneously, very shortly thereafter.’ That is completely impossible. It takes months to design a comprehensive reform plan for one-seventh of the economy, even if you have a party committed to a shared vision. And Republicans aren’t remotely committed to a shared vision: They’re promising wildly different things, from covering everybody (a promise they have no way to pay for) to a bare-bones dog-eat-dog free-market system where the poor and sick are mostly left on their own.”

So unsurprisingly, at today’s bizarre press conference, the first he has held since being elected president, Trump was asked to restate his basic views on how Congress should deal with Obamacare. And he responded with a somewhat different but equally screwed-up scenario:

“We’re going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously.

“It will be various segments, you understand but will most likely be on the same day or the same week — but probably the same day — could be the same hour. So we’re going to do repeal and replace — very complicated stuff. And we’re going to get a health bill passed — we’re going to get health care taken care of for this country.”

The new criterion Trump threw into the mix is that nothing at all will happen until Tom Price is confirmed as secretary of HHS. Price has to go through two confirmation hearings. The first is on January 18, at the Health, Education, Labor, and Pensions Committee. The second and “voting” committee on his confirmation is Finance, which hasn’t even scheduled a hearing. But the Senate is voting on amendments to the basic blueprint for Obamacare repeal right now; final passage in that chamber will probably occur tomorrow after votes today and tonight on literally more than a hundred amendments that could shape the repeal. If Trump thinks nothing should happen for weeks, he should have probably shared that sentiment with congressional Republicans, who have been talking for months, publicly and privately, about moving on Obamacare before Trump’s inauguration.

Beyond that new problem, Trump is also suggesting “we” will be “submitting” a “plan” for the whole set of problems. Who is “we?” HHS? The White House? The Republican Party? That’s unclear. Again, if he has policy preferences he has not yet shared with congressional Republicans, why aren’t they awaiting them obediently?

Finally, Trump went out of his way to confirm some of the craziness from the Times interview. “Repeal” and “replace” will happen “most likely on the same day or the same week — but probably the same day — could be the same hour.” Surely someone has told him by now that anything worth calling a “replacement” for Obamacare, with its many insurance regulations and other non-budget features, cannot be done via a budget measure, and thus will require 60 Senate votes. How is that going to happen? It won’t if it resembles any of the plans that Republicans are currently discussing.

Now maybe Trump is alluding to some talk from Paul Ryan about handling repeal and replace “concurrently” — which seems to mean including a few budget-germane elements of a replacement in a bill that repeals Obamacare. According to one report, that eternal conservative policy hobbyhorse, Health Savings Accounts (HSAs), could get some new money as a sort of down payment on a replacement plan that could be part of a package that needed no Democratic votes.

If HSAs are to represent the “replacement” that’s not delayed significantly, Trump may have created another problem in today’s press conference in a complaint about Obamacare:

“You have deductibles that are so high that after people go broke paying their premiums, which are going through the roof, the health care can’t even be used by them because the deductibles are so high.”

HSAs are a central part of a standard conservative health-care-policy scheme encouraging “personal responsibility” for routine medical expenses. That means paying for them not through insurance, but through out-of-pocket spending supplemented by HSAs. High deductibles and other cost-shifts from insurance companies to consumers are indeed a major complaint you hear about Obamacare. But the problem is going to get a lot worse under any GOP replacement plan we have seen so far.

So Trump cannot open his mouth without complicating the already near-impossible job his party faces in satisfying conservative demands that Obamacare be repealed immediately, while dealing with the objective reality that it cannot be done without huge and politically damaging fallout.


Trump Can’t Leave Republicans Alone To Repeal Obamacare

After watching Donald Trump’s first press conference as president-elect, I spent some time trying to refix my dropped jaw, and then wrote at New York about the damage the man had done to his party’s plans to repeal and replace the Affordable Care Act:

Yesterday, President-elect Donald Trump, in an interview with the New York Times, threw all sorts of sand into the gears of the congressional GOP effort to repeal and replace Obamacare. As Jonathan Chait explained, what he was saying made absolutely no sense:

“Trump stated that the Senate must repeal Obamacare ‘probably some time next week,’ and that ‘the replace will be very quickly or simultaneously, very shortly thereafter.’ That is completely impossible. It takes months to design a comprehensive reform plan for one-seventh of the economy, even if you have a party committed to a shared vision. And Republicans aren’t remotely committed to a shared vision: They’re promising wildly different things, from covering everybody (a promise they have no way to pay for) to a bare-bones dog-eat-dog free-market system where the poor and sick are mostly left on their own.”

So unsurprisingly, at today’s bizarre press conference, the first he has held since being elected president, Trump was asked to restate his basic views on how Congress should deal with Obamacare. And he responded with a somewhat different but equally screwed-up scenario:

“We’re going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously.

“It will be various segments, you understand but will most likely be on the same day or the same week — but probably the same day — could be the same hour. So we’re going to do repeal and replace — very complicated stuff. And we’re going to get a health bill passed — we’re going to get health care taken care of for this country.”

The new criterion Trump threw into the mix is that nothing at all will happen until Tom Price is confirmed as secretary of HHS. Price has to go through two confirmation hearings. The first is on January 18, at the Health, Education, Labor, and Pensions Committee. The second and “voting” committee on his confirmation is Finance, which hasn’t even scheduled a hearing. But the Senate is voting on amendments to the basic blueprint for Obamacare repeal right now; final passage in that chamber will probably occur tomorrow after votes today and tonight on literally more than a hundred amendments that could shape the repeal. If Trump thinks nothing should happen for weeks, he should have probably shared that sentiment with congressional Republicans, who have been talking for months, publicly and privately, about moving on Obamacare before Trump’s inauguration.

Beyond that new problem, Trump is also suggesting “we” will be “submitting” a “plan” for the whole set of problems. Who is “we?” HHS? The White House? The Republican Party? That’s unclear. Again, if he has policy preferences he has not yet shared with congressional Republicans, why aren’t they awaiting them obediently?

Finally, Trump went out of his way to confirm some of the craziness from the Times interview. “Repeal” and “replace” will happen “most likely on the same day or the same week — but probably the same day — could be the same hour.” Surely someone has told him by now that anything worth calling a “replacement” for Obamacare, with its many insurance regulations and other non-budget features, cannot be done via a budget measure, and thus will require 60 Senate votes. How is that going to happen? It won’t if it resembles any of the plans that Republicans are currently discussing.

Now maybe Trump is alluding to some talk from Paul Ryan about handling repeal and replace “concurrently” — which seems to mean including a few budget-germane elements of a replacement in a bill that repeals Obamacare. According to one report, that eternal conservative policy hobbyhorse, Health Savings Accounts (HSAs), could get some new money as a sort of down payment on a replacement plan that could be part of a package that needed no Democratic votes.

If HSAs are to represent the “replacement” that’s not delayed significantly, Trump may have created another problem in today’s press conference in a complaint about Obamacare:

“You have deductibles that are so high that after people go broke paying their premiums, which are going through the roof, the health care can’t even be used by them because the deductibles are so high.”

HSAs are a central part of a standard conservative health-care-policy scheme encouraging “personal responsibility” for routine medical expenses. That means paying for them not through insurance, but through out-of-pocket spending supplemented by HSAs. High deductibles and other cost-shifts from insurance companies to consumers are indeed a major complaint you hear about Obamacare. But the problem is going to get a lot worse under any GOP replacement plan we have seen so far.

So Trump cannot open his mouth without complicating the already near-impossible job his party faces in satisfying conservative demands that Obamacare be repealed immediately, while dealing with the objective reality that it cannot be done without huge and politically damaging fallout.


January 6: White Working Class Trump Voters Who Hate Obamacare Will Hate Its Replacement Even More

As congressional Republicans vacillated and argued over how long to delay the effective date of an Obamacare repeal, they may not realize they have a bigger problem than how to transition into some ultimate “replacement” plan. Their own voters are going to be shocked when the see what GOP health care policy means for them. I wrote about this at New York:

[T]here is abundant evidence the white working-class voters whose sudden tilt toward the GOP in Rust Belt battleground states rewarded Donald Trump with the presidency and helped Republicans hang on to Congress really do dislike the Affordable Care Act disproportionately.

Here’s the problem, though: What these key Trump voters most dislike about life under the Affordable Care Act will get even worse under any plausible GOP replacement plan.

As the Kaiser Family Foundation’s Drew Altman reports in a New York Times op-ed, focus groups among Trump-voting Rust Belt white working-class voters who have obtained health insurance through Obamacare — i.e., those most familiar with the ACA — show a very consistent pattern:

“They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered … When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief.”

Here’s what they’d rather have:

“If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs.”

The trouble is, of course, that keeping out-of-pocket costs high and letting market forces control drug prices are fundamental principles of conservative health-care policy, which have been reflected in every Republican health-care proposal for years. To conservative policy thinkers, overutilization of health services, encouraged by government subsidies and regulations (along with “defensive medicine” caused by consumer lawsuits), is the primary source of rising health-care prices and virtually every sin of the health-care system.

So when Republican policymakers talk about “personal responsibility” being critical to heath reform, that’s code for making sure Americans feel some pain every single time they access health services. The way you do that is by increasing exposure to out-of-pocket costs via premiums, deductibles, copays, and exposure to big bills if you don’t strictly obey your insurance company’s arcane rules. You can sugarcoat this a bit by offering a tax subsidy for personal savings so that you have more money for those out-of-pocket expenses; that’s the basic point of the Health Savings Account idea, a feature of every conservative health-care proposal since time immemorial, and a particular favorite of Vice President-elect Mike Pence. Indeed, the goal many Republicans have long embraced is a system where everybody gets a high-deductible insurance policy covering catastrophic health conditions, with no insurance at all for routine services, which consumers would handle themselves with some help from an HSA.

But if the KFF research is correct, it’s the routine services that Trump’s white working-class base thinks they should have access to without emptying their wallets or being hassled by an insurance company. That is partly why so many of these people exhibit resentment toward Medicaid beneficiaries who don’t have the same problems in obtaining routine services. Given the chance, of course, Republican pols would introduce “personal responsibility” requirements to Medicaid as well, as GOP governors like Mike Pence have shown in the deals they’ve cut with the Obama administration to expand eligibility in exchange for generous new federal dollars. In the ideal GOP world, everyone would be paying more for routine services — even the very wealthy, who would have to shell out large premiums for concierge services to keep them from rubbing elbows with the hoi polloi in waiting rooms.

So will white working-class Trump voters realize this conflict between their views and those of their party before an Obamacare replacement plan goes into effect? Nobody knows. But it’s not like they won’t be paying attention. As Ron Brownstein notes, the savage antipathy these folks feel for Obamacare is based on an intimate familiarity with the law, because so many of them receive health insurance via the ACA:

“[I]n practice millions of blue-collar whites have gained coverage under the law, particularly in states critical to the Republican electoral map. Using census data, the Urban Institute recently calculated that from 2010 through 2015, more non-college-educated whites gained coverage than college-educated whites and minorities combined in all five of the key Rustbelt states that flipped from Obama in 2012 to Trump in 2016: Iowa, Ohio, Michigan, Wisconsin, and Pennsylvania. Whites without a college degree also represented a majority of those gaining coverage under the law in core Trump states like Indiana, West Virginia, Kentucky, Arkansas, and Oklahoma.

“These states often saw enormous reductions in the number of uninsured working-class whites: about 40 percent in Indiana, Pennsylvania, and Wisconsin; roughly 50 percent in Ohio, Iowa, and Michigan; and 60 percent in West Virginia and Kentucky.”

So if they lose insurance altogether or are forced into new health-insurance plans that double-down on the very features they hate about Obamacare, these key Trump voters will not be very happy. And Trump tweets about how “terrific” the post-Obamacare world of health-care policy has become won’t help.


White Working Class Trump Voters Who Hate Obamacare Will Hate Its Replacement Even More

As congressional Republicans vacillated and argued over how long to delay the effective date of an Obamacare repeal, they may not realize they have a bigger problem than how to transition into some ultimate “replacement” plan. Their own voters are going to be shocked when the see what GOP health care policy means for them. I wrote about this at New York:

[T]here is abundant evidence the white working-class voters whose sudden tilt toward the GOP in Rust Belt battleground states rewarded Donald Trump with the presidency and helped Republicans hang on to Congress really do dislike the Affordable Care Act disproportionately.

Here’s the problem, though: What these key Trump voters most dislike about life under the Affordable Care Act will get even worse under any plausible GOP replacement plan.

As the Kaiser Family Foundation’s Drew Altman reports in a New York Times op-ed, focus groups among Trump-voting Rust Belt white working-class voters who have obtained health insurance through Obamacare — i.e., those most familiar with the ACA — show a very consistent pattern:

“They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered … When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief.”

Here’s what they’d rather have:

“If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs.”

The trouble is, of course, that keeping out-of-pocket costs high and letting market forces control drug prices are fundamental principles of conservative health-care policy, which have been reflected in every Republican health-care proposal for years. To conservative policy thinkers, overutilization of health services, encouraged by government subsidies and regulations (along with “defensive medicine” caused by consumer lawsuits), is the primary source of rising health-care prices and virtually every sin of the health-care system.

So when Republican policymakers talk about “personal responsibility” being critical to heath reform, that’s code for making sure Americans feel some pain every single time they access health services. The way you do that is by increasing exposure to out-of-pocket costs via premiums, deductibles, copays, and exposure to big bills if you don’t strictly obey your insurance company’s arcane rules. You can sugarcoat this a bit by offering a tax subsidy for personal savings so that you have more money for those out-of-pocket expenses; that’s the basic point of the Health Savings Account idea, a feature of every conservative health-care proposal since time immemorial, and a particular favorite of Vice President-elect Mike Pence. Indeed, the goal many Republicans have long embraced is a system where everybody gets a high-deductible insurance policy covering catastrophic health conditions, with no insurance at all for routine services, which consumers would handle themselves with some help from an HSA.

But if the KFF research is correct, it’s the routine services that Trump’s white working-class base thinks they should have access to without emptying their wallets or being hassled by an insurance company. That is partly why so many of these people exhibit resentment toward Medicaid beneficiaries who don’t have the same problems in obtaining routine services. Given the chance, of course, Republican pols would introduce “personal responsibility” requirements to Medicaid as well, as GOP governors like Mike Pence have shown in the deals they’ve cut with the Obama administration to expand eligibility in exchange for generous new federal dollars. In the ideal GOP world, everyone would be paying more for routine services — even the very wealthy, who would have to shell out large premiums for concierge services to keep them from rubbing elbows with the hoi polloi in waiting rooms.

So will white working-class Trump voters realize this conflict between their views and those of their party before an Obamacare replacement plan goes into effect? Nobody knows. But it’s not like they won’t be paying attention. As Ron Brownstein notes, the savage antipathy these folks feel for Obamacare is based on an intimate familiarity with the law, because so many of them receive health insurance via the ACA:

“[I]n practice millions of blue-collar whites have gained coverage under the law, particularly in states critical to the Republican electoral map. Using census data, the Urban Institute recently calculated that from 2010 through 2015, more non-college-educated whites gained coverage than college-educated whites and minorities combined in all five of the key Rustbelt states that flipped from Obama in 2012 to Trump in 2016: Iowa, Ohio, Michigan, Wisconsin, and Pennsylvania. Whites without a college degree also represented a majority of those gaining coverage under the law in core Trump states like Indiana, West Virginia, Kentucky, Arkansas, and Oklahoma.

“These states often saw enormous reductions in the number of uninsured working-class whites: about 40 percent in Indiana, Pennsylvania, and Wisconsin; roughly 50 percent in Ohio, Iowa, and Michigan; and 60 percent in West Virginia and Kentucky.”

So if they lose insurance altogether or are forced into new health-insurance plans that double-down on the very features they hate about Obamacare, these key Trump voters will not be very happy. And Trump tweets about how “terrific” the post-Obamacare world of health-care policy has become won’t help.