Donald Trump recently discovered that reforming health care is complicated. And, wouldn’t you know, governing is complicated too, as Trump’s party began to recognize this week during its flailing first attempt to put legislative language to its longstanding promise to repeal and replace Obamacare. Under ideal circumstances, making dramatic changes to a policy that deeply affects every American requires exceptional political skill, and Republicans most certainly are not operating under ideal circumstances.
Victory can paper over a lot of disagreements, but the fault lines that divide a party inevitably reemerge when irrevocable decisions have to be made. And, let’s be clear—the Republican Party was on the verge of imploding before Trump’s improbable win gave it control of the entire federal government. Those fissures cracked wide open this week as congressional leaders unveiled a plan to dismantle the Affordable Care Act that pleased precisely no one and met with resistance from all corners of the Republican Party and unified opposition from Democrats. To push back against this pushback, Paul Ryan and Mitch McConnell decided their best option was to ram the bill through congress before opposition could coalesce, staging marathon all night hearings on Thursday while Sean Spicer, the voice of truth in the Trump administration, reassuringly offered that “we’re not jamming this down people’s throats.”
But it may already be too late to save the legislation from the storms roiling the party, which is confronting several intractable problems of its own creation:
- Slogans are not policies. For seven years, Republicans have been in the “repeal and replace” business. They voted more than 60 times to scrap Obamacare, demonstrating a unity of purpose that transcended divisions in their caucus—provided a Democrat sat in the White House and could veto their outbursts. As a political slogan, repeal and replace worked wonders to animate the Republican base and give them reason to vote. And of course when you don’t have the power to make it happen, it’s easy to say the “replace” part is going to provide more comprehensive and less expensive coverage than the plan they were trashing. But for seven years, they were evasive about the replacement. No surprise here: Republicans kept promising a market-based alternative to Obamacare as if it were the elusive Medicare-for-all plan that progressives had fought for unsuccessfully. When faced with the prospect of a Republican president who will sign whatever lands on his desk, they were called to account for their promises without having an actual policy that could undo the things Republicans despise about Obamacare without risking dire political consequences, because such a policy does not exist.
- People are angry. Then there are all those town meetings where constituents, even in red districts, implored their representatives not to unravel a policy that’s keeping them healthy and in some cases keeping them alive. Add this to the ongoing string of public protests against the administration, layer over that the number of representatives who spent their recess running away from their constituents to avoid hearing them yell “do your job,” and you have a picture of a party that’s retreating from the electorate. No wonder. Democrats learned in 2009 that to make social policy is to bear the burden of people’s fears, to convince them to relinquish what they know for the uncertain prospect of getting something better. Republicans are finding that to unwind social policy is to take from people what they have, to convince them to trade tangible benefits for abstract promises of liberty. Apparently liberty doesn’t pay for ER visits.
- There’s a vacuum at the top. In matters of domestic policy, only the president has the institutional prerogatives needed to build broad political coalitions. Presidents have approached coalition-building in a variety of ways but at minimum they have all started with an objective, which is to say they knew what they wanted to accomplish. It’s probably safe to say that Donald Trump has given this very little thought, choosing instead to issue vague pronouncements about how everything is great and we’re going to have a “beautiful” healthcare policy, while offering his support to the ideas of the last person who talked to him. Compounding matters is that Trump campaigned as a populist but he has chosen to govern as a nationalist, investing his energy in travel bans and deportation while allowing congressional leaders to advance a one-percent agenda at odds with the promises he made to protect middle class entitlements.
The conflicts inherent in this jumble of interests are surfacing as Republicans face a binding decision on healthcare without presidential leadership and with a political backlash threatening to undermine their grandest desires to trash the welfare state and hand a policy victory to their wealthiest supporters. While policy changes of this magnitude are always problematic, the process works best when a party offers a real plan, makes the case for it during the election, and has a president who can sell it to the public and win over reluctant congressional partisans. Republicans have none of this and likely never would have won an honest policy debate, so they are left trying to move quickly before people discover what they’re doing. Their best hope is that the prospect of failing to deliver on their biggest promise will disable the remainder of their agenda, forcing reluctant members to sign on to a plan they dislike while the political fallout gets kicked down the road. But that fallout can’t be avoided entirely or spun away with slogans. Rhetoric is crashing into reality as Republicans attempt to govern, putting enormous pressure on a coalition struggling to remain united.