Trump’s Budget Director Seems to Be Playing a Key Role in the Obamacare Replacement Drama

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Having a guy like Mulvaney around to herd conservative cats and maybe cook a few books could be useful to the Obamacare repeal-and-replace effort. Photo: Brendan Smialowski/AFP/Getty Images

There’s a new elephant in the crowded room of Republicans trying to figure out in the effort to repeal and replace Obamacare: Office of Management and Budget director Mick Mulvaney. According to the Washington Post, Mulvaney was the deal-closer in a key White House meeting on Friday that built (or forced) consensus among congressional Republican leaders who will be jointly unveiling Obamacare legislation any day now — even as the ostensible administration point man, HHS Secretary Tom Price, was hanging out with Paul Ryan and Mike Pence in Wisconsin. Here’s how the Post explained the switcheroo:

On Capitol Hill, Price is seen by some Republicans as more knowledgeable about health-care policy than Mulvaney, given his experience as a physician and his time as chairman of the House Budget Committee. But Mulvaney benefits from the close relationships he has forged with Trump’s top advisers and with the House’s conservative wing.

Aside from his personal credibility from being a member of “the House’s conservative wing” until he was confirmed on February 16, Mulvaney could be useful as a protector of the president’s right flank on Obamacare in two very important ways. He illustrated the first during a wide-ranging interview this morning with radio host and conservative opinion-leader Hugh Hewitt. Mulvaney was questioned closely on two subjects: his commitment to Trump’s defense buildup (he seemed to pass Hewitt’s test despite much grumbling from hawks like John McCain that he cared too much about deficits and too little about giving the Pentagon whatever it wants), and his willingness to buck Trump’s promises to protect entitlement programs. Mulvaney’s rap on entitlements was revealing:

[Y]ou see the AARP ad on television, which many of us have seen, and the speech he gives says he’s going to protect and save Social Security, protect and save Medicare. And that’s exactly what we are going to try and do. So I’ve already started to socialize the discussion around here in the West Wing about how important the mandatory spending is to the drivers of our debt. I think people are starting to grab it. There are ways that we can not only allow the President to keep his promise, but to help him keep his promise by fixing some of these mandatory programs.

You have to appreciate that every proposal to cut and/or privatize Social Security and Medicare is invariably packaged as an effort to “protect and save” the programs. So what Mulvaney is really promising to do is to help show Trump how to invert what everyone understood at the time to be the candidate’s commitment on entitlements and make it a rationale for doing the exact opposite.

Better yet, from the conservative ideological point of view, Mulvaney suggested that the first step toward entitlement reform and the hallowed goal of decimating the New Deal–Great Society legacy would be to repeal and replace Obamacare as quickly as possible:

Well, drill down on one of those. Let’s drill down on one, which is Medicaid. Clearly, you can help fix and solve Medicaid as part of this larger Obamacare replacement, right, that the two things are tied together. So if we get Obamacare replacement right, it might also allow us to fix Medicaid.

To translate this into conservative talk, that means if you want to “protect and save” Social Security and Medicare, you’d better get onboard the first train that comes along to “protect and save” Medicaid via a block grant or per capita cap. And so, conservatives, get over your scruples about any particular Obamacare bill and understand it’s all part of God’s plan to undo the work of FDR and LBJ and get rid of the welfare state. It’s a pitch Mulvaney is well-equipped to make.

But there’s another way in which Mulvaney can be even more useful to the cause of keeping the GOP’s right flank under control as the sausage gets made on Obamacare: as a counter to any inconvenient numbers the Congressional Budget Office might come up with in “scoring” Republican repeal/replace legislation. This has become a huge issue, as explained by conservative writer Christopher Jacobs:

House leadership has yet to release any budgetary scores of their legislation, yet apparently plan on marking up the bill this week—before a CBO score becomes available. Given the ways in which several drafts have prompted CBO to warn about a massive erosion of employer-sponsored health coverage, the phrase Caveat emptor applies. Members who vote for a bill without knowing its full fiscal effects, yet will be held politically responsible for said effects, do so entirely at their own risk.

If CBO winds up projecting that any given Obamacare bill will massively increase the budget deficit or greatly erode health-care coverage — for the country as a whole or for politically important constituencies like older and/or non-college educated white folks — won’t it be useful to have OMB at the ready to dispute the numbers and offer their own, er, alternative facts? Indeed, nothing in law requires Congress to use CBO estimates to begin with. If congressional leaders choose to go with “better” OMB numbers, who is going to stop them? It would not be the first time it’s happened, as those old enough to remember Ronald Reagan’s OMB “cooking the books” can attest.

Perhaps some of the concerns Trump loyalists had about Mulvaney’s selection as OMB director got it wrong. Instead of being a fanatical deficit hawk throwing sand into the gears of the Trump machine, perhaps he is a double agent selling Trump’s agenda to his old allies by hook or by crook.

Trump Budget Director Has Key Role in ACA Replacement Drama