Trumpcare is caught in a political vise in Congress. On the left, roughly a half-dozen Senate Republicans have expressed concern that the bill is too disruptive, throwing millions of Americans off their insurance and wreaking havoc in the medical industry. On the right, ultraconservatives oppose the bill for not being disruptive enough, phasing out the Medicaid expansion too slowly and still leaving some form of tax credits to subsidize insurance. It has been difficult for me to take the latter seriously, given that their only leverage is to threaten to leave the hated Obamacare status quo in place. But there are growing signs they are truly crazy enough to do it.
The House Freedom Caucus, which represents the 40 or so right-wing members who frequently oppose the leadership and refuse to compromise, is meeting with Trump today. A source tells Mike Allen the caucus needs major changes to support Trumpcare, like eliminating the tax credits and a faster phase-out to the Medicaid expansion. A bill they could support is “not going to look anything like what the leadership wants,” says one aide.
Meanwhile, Rand Paul — who last week embarrassed Republicans by holding a public hunt for their still-secret bill — is growing more adamant in his opposition to Trumpcare. “Now I’m thinking we’re so far apart,” he tells Politico. “I never believed in my wildest nightmares that we’re going to keep the Obamacare taxes or that we’re going to have a new entitlement program or that we’re going to keep the individual mandate in another form.” And Breitbart, which has lambasted the bill, appears to be completely earnest in its opposition. Steve Bannon is reportedly furious with the alt-right publication, but its current editorial leadership does not care. “We are Breitbart,” editor Matt Boyle wrote in an internal Breitbart editorial chat, according to a screenshot obtained by Business Insider. “This is war. There are no sacred cows in war.”
It is possible that some of these right-wing critics of Trumpcare are merely bluffing in order to maximize their leverage. But even that puts the bill at risk. The changes at stake in this law mainly fall on a simple spectrum of more or less. The ultraconservatives oppose a bill that provides too little care to pass the Senate on the grounds that it already provides too much care. Almost any change that makes the bill more acceptable to the right flank makes it even less acceptable to the center.
So, would the far right really kill the bill? Would they rather keep Obamacare in place than pass Trumpcare? It still seems unlikely, but there are reasons to imagine why a putatively insane course of action might make some degree of sense. The right-wing dissidents are correct that Trumpcare leaves Obamacare’s structure in place, but simply funds much less of it. It is Obamacare lite. Now, the bill is far too lite for liberals or even moderates, leaving wholly inadequate funding levels to insure the poor and sick.
But it is precisely that gap between promise and reality that raises suspicions on the right. If the GOP has given its imprimatur to a plan to cover the uninsured, after having promised repeatedly that they would take care of the uninsured, then what happens if and when people discover they can no longer afford insurance? They’ll take out their frustrations on the party that passed it and whose president bears its name. And then, eventually, Congress will ease or restore the cuts to funding, and Obamacare will live on. It might be easier for conservatives to sustain their opposition to funding and operating the program if they haven’t embraced a version of it in their party’s name.
A glimpse into the right’s mentality can be seen in this telling quote from Ryan Williams, a former Mitt Romney aide, who explains why the term “Trumpcare” hurts the bill’s standing with the far right: “Pretty much anything with the pejorative suffix on it — ‘care’ — is going to be viewed unfavorably by conservatives.”
This sounds a bit like the old joke about a police officer who beats a protester at a left-wing rally, and when the protester insists, “Officer, I’m anti-communist,” replies, “I don’t care what kind of communist you are!” But there is some real meaning to this linguistic preference. Williams is not calling the prefix, Trump, a pejorative. He’s calling the suffix, “care,” pejorative. Yes: Conservatives hate the term “care.” It implies, after all, that they’re taking care of people. They truly do not believe the government should claim such a responsibility, and they have reason to suspect that making such a promise and failing to follow it through will lead to it being followed through anyway.
To be sure, an American liberal — or a conservative or liberal in any other industrialized country, where universal health insurance is taken for granted — would consider these sentiments monstrous. But there is something appealing about a faction of a party that is willing to state its principals openly rather than conceal them behind obfuscatory jargon.