President Donald Trump ran for office as a heterodox conservative, mixing far-right nationalism with promises to protect the safety net for the poor and middle class. But his first 50 days show glimpses of a fairly traditional conservative policy, which often puts the interests of the rich over the needs of the poor and middle class.
Before signing any major pieces of legislation, Trump has put his name to several executive orders that have frozen or reversed regulations on large banks and energy companies. One of his first executive orders was an “opening salvo” against Dodd-Frank’s financial reform, which he signed because, in his words, his investor friends “with nice businesses” had trouble getting loans. Another executive order stalled the so-called “fiduciary rule” that requires financial advisers to act in their clients’ best interest when providing advice on retirement planning. That $1-trillion infrastructure bill that was going to rebuild the rust belt long overlooked by coastal elites? It’s becoming a more modest public-private partnership, which infrastructure experts say will pay construction companies to make repairs they were already going to fund. Notably, his executive orders banning immigration from a handful of majority-Muslim countries do not directly impact the bottom line of most companies.
Nothing encapsulates the metamorphosis from Trumpian populism to traditional plutocracy quite like the Trump-approved proposal to replace Obamacare. The health care bill doesn’t just step back from Trump’s campaign promises to protect Medicaid and cover all Americans. It does an ostentatious reverse-triple backflip away from those promises, in a manner that seems almost deliberately designed to call attention to their hollowness. Trump once pledged “insurance for everybody,” but this plan will result in 24 million fewer people covered by insurance, perhaps the largest single social-welfare cut in American history. The president promised to “save Medicare, Medicaid, and Social Security without cuts,” but the plan cuts $880 billion from Medicaid over the next 10 years. For good measure, the bill cuts taxes by $600 billion, and the savings go disproportionately to the top 1 percent.
Even the bill’s supposed strengths serve mostly to highlight Trump’s populist mirage. House Speaker Paul Ryan has boasted about the Congressional Budget Office’s finding that “American Health Care Act (AHCA) will lower premiums [and] improve access to quality, affordable care.” But the devil is in the details, and these details are indeed wicked. CBO concluded that overall premiums would fall in large part because older, poorer Americans who aren’t yet on Medicare would be priced out of insurance. Under the proposal, a 64-year-old making less than $30,000 would have to pay about $15,000 for insurance—or $13,000 more than under Obamacare. This is not a healthcare policy but an immiseration policy, in which the world’s largest economy would force older Americans to choose between their house and their insurance.
The Republican plan has not discovered a magic bullet to fix public insurance programs so much as it’s discovered that coverage is cheaper when insurance companies don’t have to suffer the inconvenience of actually insuring old, sick people. By cutting off insurance to the old, sick, rural, and poor, the AHCA seems to reserve its most severe punishment for the demographic that was core to Trump’s national support. If only the CBO could score for irony.
The future of the Republican healthcare bill will be an interesting test for Trump’s presidency and the president’s own priorities. It pits Trump between small government conservatives who just want to cut taxes and spending, other Republicans who are concerned about kicking 20 million Americans off coverage, and his own promises to protect the white working class. For now, the Republican Party is united around a semantic objective—to vilify and destroy a thing known as “Obamacare”—and deeply divided on just about every detail in a replacement.
This would seem to be the perfect opportunity for the negotiator-in-chief to fill the vacuum with his own priorities, so clearly elucidated on the campaign trail: more coverage, not less; Medicaid guarantees, rather than cuts. The White House could seize this opportunity to define a new kind of nationalist Republicanism. But if the GOP healthcare bill follows the trend set in the first seven weeks, Republicans will ultimately go forward with a predictable agenda, where lower taxes take precedence over any serious attempt to use the vast wealth of the U.S. economy to solve its most pressing problems.