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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Editor’s Corner

February 15: GOP Struggling To Escape Self-Imposed Trap On Obamacare

The agony of congressional Republicans as they try to figure out how to keep various promises on repealing and replacing Obamacare is becoming fascinating to watch. I tried to explain their plight this week at New York:

[T]he GOP congressional leadership seem[s] to be coalescing around a strategy sometimes called “repeal-plus”— using the pending budget-reconciliation bill they authorized last month to repeal the non-regulatory portions of the Affordable Care Act and at the same time enact those elements of a replacement plan on which most Republicans can agree.

But the strategy must somehow thread the needle between the desire of the public (reinforced by Donald Trump’s promises) for maintaining Obamacare levels of health coverage, and conservative pressure to get rid of as much of the socialist abomination as is possible. This latter pressure point is gaining strength as House conservatives threaten to vote against anything that’s not a straight repeal of Obamacare, while the venerable tea party group FreedomWorks plans to mobilize grassroots support for the least Obamacare-like alternative out there, Rand Paul’s let-’em-eat-markets approach.

As Politico reports, as many as 50 House Republicans are prepared to demand a vote on the “dry run” Obamacare repeal legislation Congress sent to Barack Obama for a certain veto early last year. It was a straight repeal without replacement provisions, and, for dessert, also included defunding Planned Parenthood. This is the same bill, it should be remembered, that the Congressional Budget Office recently estimated would cost 18 million Americans their health coverage almost immediately (and 32 million within ten years), while boosting individual insurance-policy premiums by more than 20 percent.

The odds of such legislation getting through the Senate are vanishingly small, even though (a) no Democratic votes would be necessary and (b) all non-freshman Senate Republicans voted for it last year, when of course they knew it would not become law. This latter factor means that Mitch McConnell would use all his leverage with Paul Ryan to avoid such a bill coming over from the House and showing up GOP senators as having something less than the courage of their alleged convictions.

Everybody understands these dynamics, so it’s likely the real purpose of the House conservative gambit in pushing a politically disastrous repeal-without-replace plan — aside from signaling impatience about inaction — is to keep GOP leaders from going too far in the direction of continuing the very Obamacare policies the public (and presumably fearful Republican senators) would like them to continue. Provisions that might lead to a full-scale conservative revolt range from maintenance of the taxes that financed Obamacare coverage (and that would be supremely useful in paying for a GOP replacement), to too-generous subsidies for private insurance purchases, to excessive generosity to states that accepted the Obamacare Medicaid expansion, to inadequate “freedom” for insurers to discriminate against the old and the sick.

That could leave Republicans with not much more in the way of “replacement” items as such hardy GOP perennials as subsidies for Health Savings Accounts, authorization of interstate insurance sales, and sharp reductions in mandatory benefits for those receiving subsidies. As Ron Brownstein pointed out recently, all these ancient conservative health-policy ideas would erode coverage for the older Americans who happen to be most likely to vote Republican, while boosting out-of-pocket costs for the white-working-class voters who think costs are too high under Obamacare.

These cross-pressures to avoid anything that looks like Obamacare Lite but at the same time to avoid disruption of existing coverage are why Republicans are in such disarray on the subject to begin with. Just punting tough decisions down the road with a repeal-and-delay strategy that maintains Obamacare for years no longer seems like a viable option; conservatives hate it and it creates too much uncertainty in markets. But doing a mini-replacement (which is where “repeal-plus” seems headed) in the current budget-reconciliation vehicle means that any further replacement elements will require 60 Senate votes, meaning at least eight Democrats would have to go along.

As budget expert Stan Collender notes, that brilliant GOP plan for a legislative blitzkrieg this year that would repeal and replace Obamacare, slash taxes, and “reform” the welfare state, all through budget vehicles that made Democrats irrelevant, is looking mighty iffy now. Congressional Republicans cannot put off decisions about Obamacare much longer without imperiling the timetable for everything else they need to do. And there is always the possibility they will be caught by some random Trump tweet and forced to change direction. You have to figure Republican discussions on the legislative agenda, which were supposed to be resolved at a GOP retreat nearly three weeks ago, are in danger of descending into sweaty white-knuckled madness.

It would almost be fun to watch, if it did not affect health coverage for tens of millions of Americans.

February 8: GOP Could Be Moving Quickly To End Medicaid As We Know It

Some alarming news is seeping out of Republican circles about designs on a program only Democrats seem to care about anymore, Medicaid. I promptly sounded an alarm at New York.

One of the peculiar aspects of the debate over Republican aspirations to “repeal and replace” Obamacare is how little of it revolves around the provision that has accounted for the majority of uninsured Americans obtaining coverage under the Affordable Care Act: the state option to expand Medicaid eligibility. Instead, most of the talk has been about the private insurance exchanges, and the subsidies that help pay for individual policies, and the purchasing mandates designed to encourage younger and healthier Americans to participate, and the mandated benefit packages, and the regulations against preexisting-condition exclusions and overcharging old folks. That’s understandable due to the incredible complexity of the exchanges and the high visibility of premium increases and insurers pulling out of the exchanges altogether.

But any “repeal and replace” scheme absolutely has to deal with Medicaid. And left to their own devices, Republicans would almost certainly pursue an idea that’s been nestled in various Ryan budgets and was embraced by Donald Trump on the campaign trail: a Medicaid “block grant” that would to a greater or lesser degree shift responsibility for indigent health care to the states, in the process saving the feds a big chuck of change and getting rid of all those headachy policy decisions related to a troublesome, Democratic-leaning constituency.

Unfortunately for the GOP, 31 states — including 16 governed by Republicans — accepted the ACA Medicaid expansion, going in exactly the opposite direction conservatives nationally have supported. Some —including the current vice-president of the United States (who was then governor of Indiana) — rationalized accepting the filthy federal lucre (a much higher federal match rate covering new enrollees) for an expansion because the Obama administration let them conduct conservative-sounding policy experiments, mostly involving the kind of premiums and co-pays Medicaid beneficiaries normally don’t have to deal with.

So the political and substantive complexity of squaring a Medicaid block grant with Medicaid expansion on the ground has helped place Medicaid on the back burner for the Trump administration and congressional Republicans, as something that would probably be handled in a second budget bill later in 2017, or perhaps even in freestanding legislation….

[But] [n]ow Politico’s Jennifer Haberkorn reports that the transformation of Medicaid could be in the very first budget-reconciliation bill aimed at “repealing” Obamacare — the bill already authorized by a budget resolution that was whipped through Congress last month. But the above-mentioned dilemmas have not gone away:

“Medicaid is proving to be the most complex piece of a replace plan in the repeal bill. Republicans want to dramatically overhaul the program by imposing spending caps tied to the number of enrollees in a state. But they are running into problems sorting out such details as whether funding should be allocated based on state enrollment before Obamacare or after.”

My guess is that they will come up with a Solomon-style solution, picking some arbitrary enrollment figure halfway between states that expanded Medicaid and states that did not — recognizing that there were major state variations even before Obamacare. But the key thing to understand is that putting a Medicaid block grant into the “repeal” bill means it can be enacted without Democratic votes. And more generally, doing so successfully would mean Republicans had succeeded in all but abolishing a key Great Society federal-safety-net program by making it “about” Obamacare. For the many millions of Americans who would ultimately be affected — including the majority of Republican voters who have no idea Obamacare repeal will affect Medicaid — it would represent a classic bait and switch.

It would be a very good time for Democrats and others who care about guaranteeing that the poorest and sickest Americans have access to lifesaving health care to stop playing the GOP game of getting down into the weeds of Obamacare’s private-insurance provisions and beginning pointing and shouting about what Republicans may be about to do to Medicaid.

February 3: Trump Revives Call For Tax-Subsidized Politicking From the Pulpit

Since church-state relations are such a complicated and often-misunderstood topic, I decided to take on one of them at New York that Donald Trump has revived in a big and nasty manner:

It is beginning to look like a big week for the Christian right in Washington. On Tuesday night President Trump gave them the SCOTUS nominee most of them wanted, in Neil Gorsuch. Then word got out that the administration had drafted a sweeping executive order on “religious liberty” that could have been drafted by Jerry Falwell Jr. And then on Thursday morning, at the National Prayer Breakfast (itself an annual ritual of presidential deference to conservative Christians), Trump repeated a campaign promise to repeal the so-called Johnson Amendment, a 1954 law preventing open electioneering by tax-exempt nonprofit organizations. Actually, the term he used was not “repeal,” but “totally destroy.” Very presidential of him.

What this would mean in practice is that people employed by religious bodies (and other kinds of nonprofit organizations), most especially ministers of the Christian Gospel, could endorse and exhort support for special candidates and other matters decided at the ballot box right there in the pulpit — or perhaps more importantly, through utilization of church resources (signs, flyers, phone and email lists, and presumably even paid ads). It would save the time and trouble involved in the winking and nodding that often goes on with clerical politicking. But less innocently, the proposed new policy might also pave the way to coerced electioneering statements imposed on individual ministers and congregations by denominational leaders. It would definitely politicize the Sabbath in a big way.

Trump, of course, tries to make this sound like a simple matter of freedom, daring to cite as an authority the predecessor for whom separation of church and state was a first principle:

“Jefferson asked, ‘”Can the liberties of a nation be secure when we have removed a conviction that these liberties are the gift of God?”Among those freedoms is the right to worship according to our own beliefs. That is why I will get rid of and totally destroy the Johnson amendment and allow our representatives of faith to speak freely and without fear of retribution — I will do that.”

Put aside for a moment the fact that religious groups violating the Johnson Amendment practically have to hit the IRS over the head with their views to attract the rare investigation or enforcement action. Even if it were regularly enforced, nothing in the Johnson Amendment keeps anyone from worshiping as they wish; “representatives of faith” could have devoted every 2016 sermon to demanding votes for Donald Trump or excoriating the baby-killing devil-woman Hillary Clinton if they wanted. They just cannot at the same time accept taxpayer subsidies.

That is the real misunderstanding here. Groups demanding the freedom to say and do whatever they want, and/or to violate anti-discrimination laws in the name of God, seem to view tax-exempt status as quite literally a matter of divine entitlement. But it’s a very secular thing conveying crass, material benefits in great abundance. Not only does church property (and some forms of church employee compensation) escape taxation: The dollars placed in the collection plate convey a tax benefit to the contributors. All told, the value of the tax exemptions for churches has been estimated in one recent study as amounting to $71 billion annually. That’s certainly enough to justify a bit of self-control in playing with electoral politics.

Since the Johnson Amendment is a matter of statutory law (enacted, as it happens, by a Republican-controlled Congress and signed by a Republican president), not executive-branch policy, Trump cannot “get rid of and totally destroy it” by fiat. But because it involves the tax code, congressional Republicans can almost certainly nestle a Johnson Amendment repeal into one of the two “budget reconciliation” bills on tap this year — perhaps the first one, mainly aimed at whatever the GOP decides to do with Obamacare, which will supposedly be unveiled this month or next.

One way or another Trump will try to redeem this campaign pledge to the Christian Right. And it’s hard to imagine Republicans standing in his way, whatever their private misgivings.

Democrats need to expose this exercise in clerical welfare before it happens.

February 2: Conservative “Base” Voters Only Have Eyes For Trump

After looking at some public opinion polling about conservative feelings towards Donald Trump, I came to a pretty interesting conclusion and decided to write it up at New York.

The announcement of Neil Gorsuch as SCOTUS nominee represented a new high point in Donald Trump’s relationship with the conservative movement and the GOP. It was a full-on love-fest — and beyond the immediate and overwhelmingly positive response among right-of-center folk, the nomination has established significantly more trust for Trump among serious conservatives.

But before mainstream Republicans get too comfortable with the 45th president, they should consider the bad news: That he is stealing their voter base away from them, even as they cheer him on for nominating Gorsuch.

That is the most obvious lesson to derive from some new large-sample data from Morning Consult (via The Upshot):

“54 percent of registered voters in districts represented by Republicans viewed Mr. Trump favorably compared with only 42 percent who view him unfavorably. More important, people who identify with the party overwhelmingly view him favorably. In districts represented by Republicans, fully 87 percent of registered Republicans view Mr. Trump favorably.

“Support for Mr. Trump in G.O.P. districts is even higher among registered Republicans who are extremely interested in politics (94 percent favorable), identify as strong Republicans (92 percent favorable) or say they are very conservative (94 percent favorable). These groups are especially likely to vote in primaries and are key constituencies in nomination contests for higher office. As a result, they wield disproportionate influence on legislator behavior.”

To put it simply, while Republicans may have assumed their most conservative “base” supporters would help them bend Donald Trump to their will when push came to shove, the opposite may prove true: the GOP base increasingly looks like it may become a whip with which Trump lashes establishment conservative elected officials and opinion-leaders to keep them in line.

It’s been true for quite some time that most Republicans in Congress feared primary challenges from their right more than anything Democrats could throw at them. What has changed is that the voters most likely to participate in Republican challenges seem to have fallen in love with Donald Trump, and could keep elected officials who previously thought themselves safe on their toes and ready to defend Trump even when long-cherished ideological tenets would otherwise have them supporting different policies. The alternative would be to likely face a primary challenge by a more robustly Trumpian politician, with the knowledge that the base would probably be with the populist.

While it’s premature to predict the potentially wild course of events just ahead, friction between Trump and his party could be relatively manageable — and a visible schism might never open up between the president and the party mainstream. We could see an implicit deal where Trump gives the older forces in the GOP most of what they want on economic and fiscal policy so long as they go along with Trump on trade, immigration, crime, and maybe some token “populist” gestures like jobs initiatives or protecting Social Security and Medicare.They can probably reach rough agreement on most national security matters so long as defense spending goes up and the administration doesn’t completely abandon Europe to Putin.

But if there is a rupture that threatens the smooth-functioning machine Republicans need to enact an agenda with little or no Democratic support, don’t assume Trump will have to come hat in hand to Paul Ryan and Mitch McConnell, or beg for support from conservative think-tanks or opinion outlets.

In that context, it’s less surprising, if no less scandalous, that the GOP has surrendered to Trump so quickly.

January 27: Republicans Are Wandering Around in the Dark, Looking For a Legislative Strategy

One of the strangest phenomena of this strange week was to watch congressional Republicans gather in Philadelphia to get their act together, only to wind up more lost than ever. I wrote about the first two days of their “retreat”–and a retreat it was!–at New York:

The congressional Republican retreat in Philadelphia this week was supposed to foster highly efficient private discussions and briefings, and let the solons emerge from their labors revealed as a lean, mean, legislating machine. From reports at the end of the first day, however, they looked more like lost sheep, disappointed at the inability of their leaders to provide clear direction on how they would negotiate the tangle of health care, budget, and tax legislation they’ve committed to enact. There is particular anxiety about the very first item on everyone’s agenda: the repeal and replacement of Obamacare.

“Exact, specific and detailed — that’s what people want,” said Rep. Pete Sessions (R-Tex.), the chairman of the House Rules Committee. “We’re going to own this stuff, and we better be able to explain it.”

They sure didn’t get that kind of guidance. Here’s an example:

“I don’t think you will see a plan,” said Rep. Patrick J. Tiberi (R-Ohio), chairman of a key subcommittee on health care. “I think you will see components of a plan that are part of different pieces of legislation that will make up what will ultimately be the plan.”

That’s clear as mud, isn’t it?

Mitch McConnell and Paul Ryan tried to generate a sense of decisiveness and momentum by talking about the timetable for one reconciliation bill to repeal (and replace?) Obamacare, another to cut taxes, and additional actions required on appropriations. But the content of all this frenetic activity was left maddeningly vague.

The big problem Republicans face, of course (beyond the unpopularity and the fiscal unfeasibility of much of what they want), is that they’ve chosen a partisan strategy to enact their agenda, which means precision timing and, most of all, advance assurances their own president is onboard are critical. Nobody wants to be halfway through an amendment vote-a-rama on a budget-reconciliation bill repealing Obamacare to find out via Twitter that Donald Trump has changed his mind or finally understood some key issue thought to be long resolved. So the Republicans in Philadelphia expected some guidance and feedback from the president, scheduled to address them on the second day.

Instead, Trump gave them a ton of headaches even as they arrived in Philadelphia, with a bunch of executive orders on hot-button issues. It was painfully clear nobody at the gathering had been given a heads-up on what he planned to do while they were away from Washington, and new issues to grapple with were absolutely the last things they needed.

But the senators and congressmen dutifully cheered the new boss during his pithy remarks today, even as many inwardly cringed at his cavalier disregard for their needs, and his insistence on pursuing entirely imaginary priorities like “voter fraud,” a reminder that he is still upset about losing the popular vote last November.

What they did not get from Trump’s speech was even an ounce of guidance. His comments on tax reform amounted to one vague sentence. On Obamacare, he spent most of his time making the strange and incredible claim that he had thought seriously about letting the present system stay in place until it collapsed, but instead decided to “help out” Democrats by putting it to the sword. He did mention his interest in a big fat infrastructure spending binge, which most Republicans, worried about the red ink he seems determined to spill, would love just to go away. All in all, it was a sort of unplugged version of a 2016 Trump campaign speech.

Sure, Trump or his underlings could convey more concrete hopes, wishes, and instructions informally whenever they wanted. But listening to Republicans in Philadelphia and elsewhere, it sure sounds like that’s not happening, at least not yet. And so they rush toward the deadlines they’ve set for themselves, without the slightest assurance any of their complex legislative maneuvers will turn out well.

After I wrote all that, the Washington Post published an account of their discussions on Obamacare, based on a recording of the GOP retreat, and believe it or not, they sound even more confused than I had imagined. They’re not at all in any sort of agreement on timing, substance, procedures, or what kind of health system they think will exist when they are through with their efforts. According to their own budget resolution, they were supposed to start putting together the reconciliation bill that would repeal Obamacare today. They are miles and miles away from that point right now, and may never get there, at this rate.

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.

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!

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.

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.

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.