Is House Speaker Paul Ryan As Delusional As President Trump On Health Care Issues?


(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

“We’re making very good progress, we’re going to go when we have the votes,” House Speaker Paul Ryan (R-Wis.) said about the GOP’s plans to push forward a health-care plan on April 26.(Reuters)

THE MORNING PLUM:

Republicans have once again shelved their plan to vote on replacing Obamacare, depriving Donald Trump of a fake accomplishment he had hoped to tout on the 100th day of his presidency (even if it had passed the House on the 100th day, there’s no telling what would have happened in the Senate). A lot of explanations are circulating: A rushed vote would have complicatedkeeping the government open; Republicans balked at opposition from the powerful AARP; poor messaging and GOP infighting; and so forth.

I’d like to propose another explanation. What if the GOP repeal effort once again failed because the Affordable Care Act has actually helped a lot of people, and this whole process has made that a lot harder for Republicans to deny?

GOP leaders said they put the latest version on hold because the votes weren’t there for it. The new changes had won over House conservatives who had previously objected, but many of the more moderate or pragmatic Republicans were still opposed. Indeed, the changes that swayed conservatives — which would have allowed states to scrap the requirement that insurers cover Essential Health Benefits and gut protections for people with preexisting conditions — appear to have made it harder for Republicans from less conservative and more contested districts (such as Colorado’s Mike Coffman) to support it.

If you read through the public statements of many of the Republicans who objected to the latest version, you’ll see a common thread. They say either that passing the new bill would drive up premiums for people with preexisting conditions (because it would allow insurers to jack them up); or that too many would lose coverage, partly because of the phaseout of the Medicaid expansion. A number of the Republicans who opposed it this time had previously made statements to this effect about the older version, and those objections were still operative.

“The reality is most of the moderate hard Nos were already opposed,” Matt Fuller, a reporter for HuffPost who has followed this more closely than anyone, told me today. In short, many Republicans objected to the new version on the grounds that it would take coverage away from untold numbers of poor and sick people.

Pelosi: A vote for Trump’s health-care push is ‘doo-doo’ on the shoe

 

House Minority Leader Nancy Pelosi (D-Calif.) criticized the first 100 days of the Trump administration, grading him poorly on health care. (Reuters)

At the same time, though, many of these Republicans avoided openly crediting Obamacare with achieving the very protections for those with preexisting conditions and the vast coverage expansion via Medicaid that they now want to preserve. And they pledged to continue trying to repeal the law. These Republicans cannot affirmatively applaud Obamacare’s success in accomplishing ends they now recognize as imperatives, but they can stand up and say they won’t remove or badly weaken the provisions of it that are accomplishing those ends, provided they also say they’ll replace the law whenever some more acceptable alternative — which would also accomplish those ends — comes along.

The absurdity of this basic dynamic continues to elude direct recognition. Byron York reports that Republicans privately say that as many as 40 or 50 House Republicans secretly don’t want to repeal the ACA, and one key reason appears to be a lack of political courage. As one Republican puts it: “We have members in the Republican conference that do not want Obamacare repealed, because of their district.”

But the reason for this is not stated as forthrightly as I think it should be. Even if the primary motive here is that taking coverage away from people — and gutting protections for those with preexisting conditions — will alienate voters, this is just another way of saying that voters will recoil from efforts to roll back the help the law is providing to countless numbers of people. It is often said that taking away “entitlements” is politically difficult, which is true as far as it goes. But another way to say this is that even many Republicans now recognize that sustaining the law’s achievements is now imperative — and that Republicans have not come up with an alternative that would do this in a way that their public ideological pre-commitments permit. Of course, they can’t put it quite this way out loud.

No, Obamacare is not in a ‘death spiral’ — at least for now

 

Health-care experts say the Affordable Care Act is stable, but President Trump and congressional Republicans could push it over the cliff into a “death spiral.” (Daron Taylor/The Washington Post)

The GOP replacement is a non-starter for these Republicans partly because it is wildly regressive. It would roll back coverage for millions of people — 24 million in total; 14 million on Medicaid — while delivering an enormous tax cut to the rich. The polls and the angry town halls suggest that the public clearly decided it prefers the ACA — which is now in positive polling territory — to this alternative. Whether moderate Republicans are refraining from this alternative for moral, substantive or political reasons, the deeply regressive outcome that it would bring about is a key driving factor.

My point here is not that Obamacare doesn’t still have plenty of problems — it does — or that the GOP repeal push will never succeed. It very well may. But if it does, it will be either because Republicans finally figured out how to make their alternative less damaging to the ACA’s coverage expansion — which would be hard to do without alienating conservatives — or because enough moderate Republicans decided the moral or political risk of scuttling the law’s accomplishments on behalf of their own constituents is worth taking, for other reasons entirely.


* HEALTH BILL FAILURE IS A BLOW TO PRIEBUS: An interesting nugget buried in the New York Times overview of the collapse of the latest GOP health bill:

The lost opportunity was perhaps the biggest blow to the future prospects of Reince Priebus, Mr. Trump’s chief of staff, who has a long relationship with Speaker Paul D. Ryan of Wisconsin. Mr. Priebus had pushed aggressively for the House to schedule a vote this week, according to several people who spoke with him within the West Wing and on Capitol Hill.

Awww. This diminished a guy who demanded a rushed vote on a bill that would impact millions, solely so that Trump could boast of a fake achievement on his 100th day. So sad!

* TRUMP’S EXECUTIVE ORDERS DON’T AMOUNT TO MUCH: The Post takes a comprehensive look at the executive orders that Trump has signed, and finds there is less there than meets the eye:

More than half of the 29 orders issued as of Thursday have merely called for reviews, have commissioned reports or established panels to issue recommendations. The documents lay out a dizzying schedule of 90-, 120- and 180-day increments for federal agencies to evaluate the feasibility of White House policy goals and report to the president. They hardly represent the immediate action the president and his aides had heralded they would bring to Washington.

Trump really should hurry up and sign a half-dozen more between now and tomorrow (his 100th day).

* TRUMP SAYS ‘MAJOR CONFLICT’ WITH NORTH KOREA IS POSSIBLE: Trump, in an interview with Reuters, said this:

“There is a chance that we could end up having a major, major conflict with North Korea. Absolutely … We’d love to solve things diplomatically but it’s very difficult.”

One imagines that Trump sees this as shrewd positioning in an ongoing negotiation.

* TRUMP SAYS SHUTDOWN WOULD BE THE FAULT OF DEMOCRATS: Also in the Reuters interview, Trump had this to say about a possible government shutdown:

“If there’s closure, there’s closure. We’ll see what happens. If there’s a shutdown. It’s the Democrats’ fault. Not our fault. It’s the Democrats’ fault. Maybe they’d like to see a shutdown.”

A frequent Trump tactic is to always assert he has the upper hand regardless of reality, in order to make it so, but given that Republicans control everything, it’s hard to see how they’d skirt blame.

* IT’S ALWAYS ABOUT HUMORING TRUMP: Paul Krugman looks at all the ways in which Trump’s staff props up his falsehoods and fantasies — searching for “proof” Barack Obama tapped his phones; rushing out a one-page tax “plan” before the 100-day mark — and concludes:

Every report from inside the White House conveys the impression that Trump is like a temperamental child … being an effective staffer seems to involve finding ways to make him feel good and take his mind off news that he feels makes him look bad … Don’t pretend that this is normal … No, what we’re looking at here isn’t policy; it’s pieces of paper whose goal is to soothe the big man’s temper tantrums.

The rot of bad faith runs very deep with this White House, and it starts here.

* AND TRUMP EXPECTED PRESIDENCY TO BE ‘EASIER’: A final tidbit from the Reuters interview: Trump actually claimed that “this is more work than in my previous life. I thought it would be easier.” That’s bad enough, but then this happened:

Midway through a discussion about Chinese President Xi Jinping, the president paused to hand out copies of what he said were the latest figures from the 2016 electoral map.

“Here, you can take that, that’s the final map of the numbers,” the Republican president said from his desk in the Oval Office, handing out maps of the United States with areas he won marked in red. “It’s pretty good, right? The red is obviously us.”

It was always about winning, and never about what would happen after

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