On Monday, Trump adviser Kellyanne Conway was on Morning Joe and was asked about Obamacare. Her recitation of her boss’s position likely filled congressional Republicans with dread.
This is simply not realistic under any conceivable Obamacare replacement, as Republicans who work on health care policy understand. pic.twitter.com/h1IpebFi7T— Sahil Kapur (@sahilkapur) January 3, 2017
This raises one of the central unanswered questions about Donald Trump. We know he wants to repeal Obamacare. But why does he want to repeal it? And how much of a political price is he willing to pay to repeal it?
Congressional Republicans are willing to pay a huge political price to repeal Obamacare, just as congressional Democrats paid a political price for enacting it. They’re willing to pay this price because they think repealing Obamacare is important; for years, they have heard, and said, that Obamacare is socialism, it’s a job killer, it’s a government takeover, it’s endless debt, it’s the ruination of the best health care system in the world, it’s free stuff that will create a dependent underclass permanently loyal to the Democratic Party.
Yes, taking health insurance from tens of millions of people will be unpopular, but it needs to be done. Sacrifices must be made.
With Trump, it’s less clear. Sometimes he seems like a standard-issue Republican here. He says Obamacare is a disaster that he wants repealed, the plan his campaign released is an orthodox conservative repeal plan, and his pick for secretary of health and human services is one of the House’s most ardent Obamacare foes.
But there’s always been a divergence between Trump’s official actions and his off-the-cuff rhetoric. In the past, Trump praised Canada’s single-payer system. In an interview with 60 Minutes, he said he believe that “everybody’s got to be covered” and under Trumpcare, “the government’s gonna pay for it.” And now we have Conway saying, “We don’t want anyone who currently has insurance not to have insurance” — a principle that wipes out every Republican repeal plan, including Trump’s own.
Republicans think Obamacare is bad, and Trump thinks Obamacare is bad. But it’s possible they don’t think it’s bad for the same reasons. Republicans think Obamacare is bad because it’s a liberal approach to health reform — it raises taxes on the rich to give subsidies to the poor, heavily regulates the private insurance industry, and uses the IRS to penalize anyone who doesn’t buy coverage that meets the government’s standards.
Donald Trump, by contrast, might think Obamacare is bad mainly because it’s unpopular, and because people at his rallies cheer when he says it’s bad. And if that’s the case, he is not going to want to replace it with something that’s less popular, that leaves fewer people uninsured, and that creates nationwide chaos that he gets blamed for. But that’s going to put him at odds with Republicans who want to roll back the law for ideological reasons, and who are willing to pay the price.
Or it’s possible Trump will go along with his HHS pick and his party on this one and pass a law that rips health insurance from tens of millions of people and throws state health systems into chaos. But if he does that, then this clip of Conway, and his own words on 60 Minutes, is going to haunt him.