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Pinkerton: Making American Healthcare Great Again

In this Friday, Dec. 9, 2016, file photo, President-elect Donald Trump throws a hat into the audience while speaking at a rally in a DOW Chemical Hanger at Baton Rouge Metropolitan Airport, in Baton Rouge, La.
Andrew Harnik/AP Photo
JAMES P. PINKERTON

First of a series.

On March 25, we learned that the Trump administration would be supporting a lawsuit aimed at overturning the entirety of the Affordable Care Act, also known as Obamacare.

Sensing an opportunity to stand up for their treasured healthcare law, Democrats pounced. Sen. Kirsten Gillibrand, also now a presidential hopeful, tweeted later that day: If it’s a fight for healthcare this administration wants, it’s a fight they’ll get—and we will win.

Not surprisingly, in response, President Trump chose to double down; he tweetedThe Republican Party will become “The Party of Healthcare!”

The next day, Democrat Sen. Bob Casey, freshly reelected in a state that Trump carried in 2016, jumped in with a counter-tweetIt’s now the official position of @realDonaldTrump’s administration that they want to rip health care coverage away from the 30 million Americans that receive theirs under the ACA marketplace and Medicaid expansion.

And then Casey addedIt’s now the official position of @realDonaldTrump’s administration that we should no longer protect people with preexisting conditions.

Tough stuff. In fact, even as Democrats were advancing, most Republicans were retreating. Notably, congressional GOPers evinced no desire to reopen the healthcare debate, which in 2017 proved to be such a disappointing slog; at that time, I compared it to World War One trench warfare. 

In fact, the repeal effort two years ago only served to raise the salience of the healthcare issue—and that was a boost to the Democrats. In 2018, the Democrats hammered the GOP on healthcare; according to the exit polls, a full 41 percent of voters said that it was their top concern. And so the Democrats flipped the House.

To be sure, plenty of people will argue that other issues, cumulatively, were more important last year, and some might even argue that the ’18 midterm results weren’t so bad—although the 295 GOP state legislators across the country who lost their seats might disagree. 

In any case, top dogs of Capitol Hill soon put a stop to the thought of any new Republican “repeal and replace” health plan. Both House Minority Leader Kevin McCarthy and Senate Majority Leader Mitch McConnell said, in effect, No way on another go at Obamacare; we’ve got stronger platform planks on which to run in ’20, including the economy, the resurgent Right to Life issue, and, of course, opposing socialism.  

For a day or two, Trump argued for a healthcare focus. On April 2, Breitbart News headlined a piece, “Donald Trump Torches Republicans for Running Away from Health Care.” As the President told a House GOP fundraiser: 

We have to win, we have to take back the House. What really lost it and really helped us lose it was health care because we didn’t have an alternative. You got to confront it!  Republicans should not run away from health care, you can’t do it, you’re going to be clobbered.

Without a doubt, Democrats look forward to running on healthcare, again, in 2020. And from their point of view, why shouldn’t they? According to a poll from PPP, a Democrat firm that is, nevertheless, taken seriously on both sides of the aisle:

The Affordable Care Act continues to enjoy the newfound popularity it’s had since Trump took office.  49% of voters support it to just 30% now who are opposed.  There’s strong opposition to the Justice Department’s recently expressed support for striking down the Affordable Care Act—just 34% of voters agree with them on that to 53% who disagree.

Yes, a 19-point margin in support of Obamacare is something for Republicans to ponder. (Other polls show lesser levels of support, albeit still healthy margins in favor of the law. The Kaiser Family Foundation, for example, shows an 11-point advantage.) 

In the meantime, yet another poll, from Politico, found that 59 percent of Americans “don’t have much trust or any trust at all in Trump on health care.” 

No wonder Republicans want to change the subject to something else. In the stern words of Joseph Antos and James Capretta, health experts at the American Enterprise Institute, a conservative, establishmentarian, D.C. think tank: 

By backing a flimsy, state-initiated lawsuit to throw out the entirety of the Affordable Care Act, President Trump has made himself and Republican candidates in 2020 vulnerable to attacks that they want to take health insurance away from millions of people.

Soon, Trump indicated that he had been misunderstood. In a pair of tweets on April 3, he said:

I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party.  It will be on full display during the Election as a much better & less expensive alternative to ObamaCare…

…This will be a great campaign issue.  I never asked Mitch McConnell for a vote before the Election as has been incorrectly reported (as usual) in the @nytimes, but only after the Election when we take back the House etc.  Republicans will always support pre-existing conditions!

Okay, so it was all a big misunderstanding. Now Republicans have 18 months, till the ’20 election, to tee up a plan for Making American Healthcare Great Again. (Unless, of course, that anti-Obamacare lawsuit prevails in the courts; if so, the need for a replacement plan could come sooner.)  We’ll consider some possible MAHGA items in future installments.

Interestingly, it will include, according to Trump’s tweets, a guarantee of health insurance to those with preexisting medical conditions. That is, of course, a big change from the Republican position of a decade ago.

In fact, there have been quite a few changes in Republican thinking in the last few years. We’ll take a look at those in the next installment.

Next: What a difference a decade makes.

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