The initial reactions from Republicans to the long-awaited plan from House GOP leadership to repeal and replace Obamacare have been less than enthusiastic. Conservatives believe, not without reason, that Speaker Paul Ryan’s scheme is Obamacare Light, since it preserves much of the infrastructure of the misnamed Affordable Care Act. Democrats — who may understand that Obamacare needs to be fixed but want no part of a measure that they think guts it — cannot be expected to bail Ryan out by giving him the votes to pass it in the House to make up for conservative defections.
Under these circumstances, there seems to be only one reason to believe Ryan can make good on his Joe Namath-like guarantee that he will have the 218 votes to pass the bill in the House. That reason is Donald Trump.
While the administration, which is backing the House leadership on the issue, says it is open to discussion about improving the plan, as Vice President Mike Pence put it, “this is the bill.” To prevent Senate Democrats from filibustering their efforts, the Obamacare replacement will have to be passed as part of a budget-reconciliation bill, which limits their ability to revise the ACA’s insurance rules and regulations. This effectively means that in order to fulfill the pledges that congressional Republicans and Trump made about Obamacare, the president will have to use the bully pulpit of the White House to get this bill passed.
But while the future of American health care is on the line in this battle, there’s actually more at stake than whether the GOP can alter or fix Obamacare before it collapses of its own weight. The outcome will also determine whether Trump can really be said to be the leader of his party. If not, then the chances for a successful presidency will be essentially nil — regardless of whether Trump continues to run off the rails with tweets and conspiracy theories.
When Donald Trump clinched the Republican presidential nomination last year, the party became, for all intents and purposes, his personal vehicle. Its leaders were initially horrified by the prospect of someone like Trump’s assuming the mantle of the party’s standard-bearer, even if few thought he could win in November. And they were just as appalled by the prospect of his populist positions’ replacing the conservative beliefs on both domestic and foreign policy that had guided Republicans in the decades since the Reagan revolution took place. But with no viable alternative, the Republican National Committee fell into line as their nominee’s loyal soldiers, and eventually so did the rest of the GOP. And that fact, along with Hillary Clinton’s poor performance and Trump’s appeal to white working-class voters, gave him his victory.
The natural assumption on the part of Trump and his followers was that this meant the Republicans had become a Trumpist party. And to some extent that is already true. Elements of Trump’s populist creed, such as his views on trade, which were once heretical to most conservatives, have become normative in the GOP. It’s not illogical to assume that congressional Republicans will also follow Trump’s lead when it comes to preserving rather than reforming entitlements, and producing a health-care fix that will allow the president to claim that he hasn’t harmed anyone who benefited from Obamacare.
But the congressional Republicans who must pass Ryan’s compromise are the same people who spent the last several years complaining about how the health-care law was a massive expansion of federal power, and how Democrats shoved it down the nation’s throat via a budget-reconciliation vote with an insufficient understanding of how it would work, and are now being asked to do the same thing by their leadership. That would require the House Freedom Caucus and staunch anti-statist conservatives in the Senate, such as Mike Lee and Ted Cruz, to check their principles at the door in order to pass a bill that is something of a mess.
Governing means accepting dismal compromises like this bill because standing on principle and simply returning to the pre-Obamacare world would mean taking an entitlement away from millions of people.
Why would they do that? Having nearly driven their party off the political cliff over Obamacare repeal in the last four years, it seems unlikely that they would pass what is, in effect, a slimmed-down version of the same law they were once prepared to shut down the government over rather than accept as an unalterable fact of political life.
The only rationale for doing so is if they accept the premise — as Ryan does — that once you win control of the government, you have to govern. Governing means accepting dismal compromises like this bill because standing on principle and simply returning to the pre-Obamacare world would mean taking an entitlement away from millions of people. That is something that parties that intend to go on governing can’t afford to do. Seen in that light, and for all the inherent contradictions involved in trying to replace Obamacare while preserving the advantages for those who were its net winners, something like the Ryan compromise plan was probably inevitable.
We already knew that Trump was no conservative and that, for all his outlier qualities and refusal to behave in the manner we expect from members of our governing class, this kind of compromise is very much in keeping with his essentially pragmatic approach to decision-making. Moreover, the same voters who reelected the staunch conservatives who are balking at the health-care bill are also very enthusiastic about Trump — which means the president has, at least in theory, the ability to apply the kind of pressure that might force the GOP caucus in both the House and the Senate to surrender and do as he bids.
A Trumpian party would be a place where conservative groups like Heritage Action and Club for Growth — which are mobilizing against Ryan’s plan — no longer call the tune. But if, in spite of what we’ve heard from the White House since the bill was rolled out, the president either won’t or can’t force conservatives to bow to his will, then the belief that the GOP has been transformed from a conservative party to a wholly owned and operated subsidiary of Trump, Inc., will have turned out to be false.