The last thing the imperiled GOP effort to repeal and replace Obamacare needs right now is confusion at the very top. But that’s what they have, thanks to the mixed signals coming out of the White House about the president’s willingness to deal away major provisions of Trumpcare involving the speed with which the Affordable Care Act’s Medicaid expansion is canceled.
At a meeting with conservative leaders and OMB director Mick Mulvaney earlier this week, Trump heard complaints about the House bill’s generous two-year grace period for states to continue the Medicaid expansion before federal support starts to wither away and a cap on spending is imposed. According to one account from House Majority Leader Kevin McCarthy, Trump indicated such changes in policy might be accommodated in a later bill — in other words, mañana. But according to “two senior administration officials and a senior House conservative aide” who spoke to CNN yesterday, Trump is “privately lining up” behind demands from the party’s right that the original Trumpcare bill be changed to kill the Medicaid expansion right away, by the end of 2017.
If the latter report is accurate, Trump could be playing with fire, and perhaps making passage of the bill in the Senate impossible. Republican Senators representing states that expanded Medicaid were already in danger of defecting on Trumpcare because of complaints from GOP governors that its Medicaid provisions might endanger coverage for many beneficiaries added to the rolls up until now. Accelerating the disruption of Medicaid certainly won’t help. And the longer conservatives are given the impression that they can secure concessions from Trump — with or without the knowledge or consent of Paul Ryan or Mitch McConnell — the less likely they will salute if congressional leaders order them to maintain discipline and vote for the bill as introduced.
So deliberately or accidentally, and consciously or ignorantly, POTUS is making a bad situation worse. Either way, he’s blindsiding his congressional allies:
A senior Republican aide said of the White House that this would deliberately undercut the process that the House is pursuing — a process the White House was both full looped in on “and in full agreement with after last weekend.”
They should have gotten it in writing.