My hunch? If some crafty Democrat drafts legislation to keep the Affordable Care Act as is but rechristen it Trumpcare, he’ll sign the bill in a nanosecond. He’s a man in thrall to ego, not policy.
.. Trump is reportedly seeking security clearances for his children, who will be running his business, and a former State Department official watching an increasingly messy transition process took to Twitter to warn other Republicans to “stay away” from Trump’s “angry, arrogant” team.
.. And he’s a patriot, always has been, which is what’s so rich here. Trump bangs on about putting America first, when he really puts himself before all else. That shriveled, unhinged hood ornament of his, Rudy Giuliani, is on the record questioning Obama’s love for America.
What Could Be Worse Than Repealing All of Obamacare?
In that world, the primary source of profit for insurers was not providing better care so that patients stayed healthy, or negotiating better prices with hospitals and drug companies; it was their ability to avoid the sick and insure only the healthy. And insurers had three tools for doing so:
- denying coverage to the insured for any costs associated with pre-existing conditions;
- denying insurance entirely to sick people;
- and charging the sick much higher prices than the healthy, a practice called health underwriting.
.. Suppose a breast-cancer survivor applied for insurance in Mr. Trump’s post-Obamacare world. It’s true that the insurer could not offer her coverage that didn’t include breast-cancer treatments. But the insurer could simply not sell her coverage at all.
.. Alternatively, the insurer could offer coverage, but say that any breast-cancer survivor had to pay, say, five times more than everyone else. Both would be perfectly legal if the Affordable Care Act was repealed and replaced under Mr. Trump’s principles.
.. Back then, an otherwise-healthy breast-cancer survivor could at least get insurance coverage for medical expenses not related to her cancer.
.. The single most important accomplishment of the Affordable Care Act was to bring the United States into line with the rest of the developed world, as a place where people were not one bad gene or one bad traffic accident away from bankruptcy.
When Republicans Take Power
the conservative ideology that pervades much of the party is based on the belief that government is the enemy. What will Republicans do with their newfound power? And how will the exercise of that power change the party?
.. It doesn’t require a huge stretch of the imagination to envision Mr. Trump’s trying to use the power of the presidency to punish his enemies, withdraw from military and diplomatic alliances, start trade wars, and engage in a wide-scale roundup of illegal immigrants that would call to mind Operation Wetback in the 1950s crossed with the internment of Japanese-Americans during World War II. However, such a divisive policy inevitably would split the country and the Republican Party as well, leading to a crushing loss in the 2018 midterm elections.
.. anti-deportation protections for the children of undocumented immigrants. (Mr. Trump may not pursue those children, but he won’t protect them.)
.. Party strategists are well aware that the G.O.P. has now lost the popular vote in six of the last seven elections. Despite Mr. Trump’s ability to maximize the white vote, and his more surprising ability to bring some minority voters along, it’s still not in the party’s long-term interest to write off the minorities, particularly Hispanics, who are a growing part of the country’s population.
.. The demands of the G.O.P.’s constituents may force a revision on issues such as trade and climate change, particularly if the waters continue to rise in coastal red states like South Carolina, Georgia and Florida.
.. Republicans in Congress have voted more than 60 times to repeal the Affordable Care Act, but they’ve spent far less time thinking about how to replace it. Would the 20 million Americans who have gained health insurance lose it? Would a Republican version of the law retain its prohibitions against insurance companies’ denying coverage to patients with pre-existing conditions?
Throughout the Obama administration, the G.O.P. has had the mind-set of an opposition party, condemning policies without thinking deeply about how to reform them.
.. Now that the common enemy has been vanquished (at least temporarily), the rival conservatives will be tempted to go to war with one another.
Rogue Republican factions in Congress like the House Freedom Caucus could even use the threat of a government shutdown or debt default against their own administration.
The need to keep order in his ranks may encourage Mr. Trump to become a Richard Nixon-style leader, pursuing an agenda that gives enough to each faction that it remains sullen but not mutinous.
.. The establishment may now be forced, at long last, to stand up to those on the right who are calling for Republicans to repeal the institutions of the New Deal and the Progressive era.
.. Those who anticipate only a two- or four-year window will press for the rapid enactment of a maximalist conservative program, even at the risk of an intense backlash. Others, however, will focus on the long game.
.. Mr. Trump will not be able to bring back the manufacturing jobs he promised, but he could put his supporters to work building roads and bridges instead.
.. Other policies aimed at improving life for working-class Americans could include efforts to combat the epidemic of opioid addiction and improve our mental health system.
.. Mr. Trump could invoke the tradition of national greatness by asking Americans to join him in pursuing a cure for Alzheimer’s disease, which may present the single greatest threat to our physical and fiscal health in the 21st century. Or he could rally our national energies around the construction of the world’s first driverless highway
.. The success of Mr. Trump’s administration ultimately will be determined more by its ability to persuade than compel.
A Blueprint for Repealing and Replacing Obamacare with Bipartisan Support
It was hubristic of President Obama to think that after enacting a monumental law, without any bipartisan buy-in, opponents would simply fall in line. As history played out, Republicans had no problem undermining a law they had no part in enacting and felt no attachment to. Senator Max Baucus, chairman of the Finance Committee that drafted the health-care bill, “fret[ted]” about the ACA’s origin. “It is my belief,” he said in December 2013, “that for major legislation to be durable, sustainable, it has to be bipartisan.
.. “The partial repeal bill does not get rid of Obamacare’s tens of thousands of pages of insurance regulations,” Roy explains, as well as “the regulations that are responsible for the law’s drastic premium hikes.”
.. If Republicans choose the reconciliation path, as some members are already considering, we would be stuck with Obamacare’s hollow shell. Gutting the subsidies, without eliminating the regulations that make insurance expensive, would be counterproductive: Premiums would continue to increase
.. In 2014, Senate Majority Leader Reid invoked the so-called “nuclear option” to remove the 60-vote threshold for confirming judges and other executive-branch appointments, with the exception of Supreme Court nominees. I fully expect Majority Leader McConnell to use the same parliamentary procedure to confirm President Trump’s first nominee to the high court — it is simply the next step in the downward spiral of our confirmation process.
.. In 2014, Senate Majority Leader Reid invoked the so-called “nuclear option” to remove the 60-vote threshold for confirming judges and other executive-branch appointments, with the exception of Supreme Court nominees. I fully expect Majority Leader McConnell to use the same parliamentary procedure to confirm President Trump’s first nominee to the high court — it is simply the next step in the downward spiral of our confirmation process.
.. In this game of mutually assured destruction, Republicans may be tempted to move first. And if there was ever a single goal that would unify Republicans to take this extreme step, it would be the elimination of Obamacare.
.. In this game of mutually assured destruction, Republicans may be tempted to move first. And if there was ever a single goal that would unify Republicans to take this extreme step, it would be the elimination of Obamacare.
.. There were rumors that House and Senate staffers would resign if they were forced to pay full fare for their insurance. It is beyond ironic that employees who labored to pass Obamacare threatened to leave government if they had to actually use it.