In the wake of Donald Trump’s crowd- and media-pleasing address to Congress, much is being made of the “signals” the president supposedly sent about the many issues dividing congressional Republicans on how to repeal and replace Obamacare. It is true that in a largely detail-free speech, Trump did mention some specific health-care policies he embraced, though most of them were conservative boilerplate prescriptions like tort reform, health savings accounts, and interstate insurance sales that actually do not divide Republicans. But for those parsing every presidential word for a clue about his imperial will on Obamacare, this passage was dynamite:
[W]e should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts — but it must be the plan they want, not the plan forced on them by the Government.
This, we were told, meant Trump was siding with House Republican leaders against conservative opponents who feared a new system of tax credits for purchasing insurance (replacing Obamacare’s tax credits) would represent another “entitlement,” this time one the GOP would “own.”
Trouble is, those self-same conservative opponents of leadership plans for Obamacare sat there and listened to the same speech and did not come away chastened. When House Majority Leader Kevin McCarthy proudly interpreted Trump’s words as endorsing his team’s efforts, Representative Mark Sanford begged to differ:
“We all hear what we want to hear in life,” Sanford said of McCarthy’s comments. “What I heard Trump say was something very similar to what Sen. Paul and I introduced. The leader must be hearing something a little different.”
Rep. Jim Jordan (R-Ohio) was equally adamant that Trump did not sign off on the leadership Obamacare proposal.
“No, I did not hear that. I heard repeal and replace, which is what we all campaigned on,” Jordan said.
Senate conservatives were not moved, either.
Sen. Ted Cruz (R-Texas), who along with Paul and Sen. Mike Lee (R-Utah) has prodded their leadership to repeal as much of Obamacare as possible, also said he didn’t hear Trump specifically back leadership’s plan. The trio of Senate conservatives plan to oppose any measure that provides refundable tax credits to help people purchase insurance — a plank of the leadership proposal.
More than likely, it would only take three Republican senators to derail any Obamacare plan.
Right-leaning health-care expert Philip Klein also noted that the “refundability” of tax credits — the ability of those too poor for income-tax liability to get federal subsidies in cash, making it “welfare” in the eyes of many conservatives — was not endorsed by Trump, giving conservatives hope the administration would ultimately side with them on the structure of any assistance in purchasing insurance.
The dog that is not barking here, of course, is that even as congressional Republicans examine the president’s words as though he is a latter-day Oracle of Delphi, the normal channels for communicating an administration’s policy preferences seem to be empty. Yes, HHS Secretary Tom Price is new at his job, but unless they have not yet given him a telephone or an email account, you’d think he’d be letting his former colleagues in Congress know what Trump wants in the way of an Obamacare repeal-and-replace bill directly, and every other minute. The fact that rebellious conservatives see no reason to stand down is an indication that Trump’s real position on the many outstanding problems Republicans are having on this subject ranges somewhere on a scale that runs from “Huh?” to “Check back later.”