Health Care

Why Republicans Will Pass Trumpcare

The GOP is getting what it wants. What loyalist would wish to resist that?

Stronger together.

Photographer: Olivier Douliery/Pool via Bloomberg

No one seems to like the Senate health-care bill. Liberal wonks detest it. At least four Republican Senators claim they aren't prepared to support it, while other colleagues grumble about it. The White House, whose chief executive promised he wouldn't cut Medicaid, as this bill does, is balking.

But the Senate bill is very similar to the bill passed last month by the House. And the reason for that similarity is pretty basic: Both bills accomplish what Republicans want.  

Despite the periodic dramas of reactionary versus conservative factions, Republicans are united around a couple key goals. Both versions of the Republican health-care legislation accomplish those goals, albeit in slightly different ways along slightly different timelines. That's why, all the wailing aside, Congress will probably put a bill on President Donald Trump's desk that grievously damages Obamacare, if not precisely repealing it.

Both Senate and House versions will transfer hundreds of millions of dollars from poor and middle-class people, in the form of health care, to rich people in the form of tax cuts.

The wealthiest Americans, who have a disproportionate role in managing the economy, have famously awarded themselves a gargantuan share of its gains in recent decades. However, Republicans continue to insist that gargantuan is less than sufficient. According to the liberal (and reliable) Center on Budget and Policy Priorities, the House health-care bill would provide the 400 highest-income families in the U.S. with tax cuts worth about $7 million annually.

Thus health-care legislation is a vehicle to achieve a preeminent goal of the Republican Party -- transferring more wealth to the wealthy. In addition, by changing the baseline for federal revenues, the legislation will facilitate another round of tax cuts later this year. 

Another paramount goal is destroying Barack Obama's presidency. Since Republicans were unable to accomplish that in real time, they hope to do it retroactively. The Republican legislation keeps much of the architecture of Obamacare. But by cashing in its funding base, Republicans can seriously damage it.

More important, their "repeal" of Obamacare, however compromised in detail or drawn out over multiple election cycles, serves as a repudiation of Obama himself. Argue among yourselves whether the driving force behind GOP animus is Obama's liberal, multicultural, cosmopolitanism or something even more atavistic. But after spending years voting to smite Obama symbolically, Republicans are now poised to deliver a blow for the history books.

The third goal the Republican legislation accomplishes is the rollback of an "entitlement" and a reversal of the trend toward universal health care.

Government support -- Medicare, Social Security, Medicaid -- tends to go on and on. Historical Republican opposition to all three of those programs long precedes their obsession with high-end tax cuts. If Obamacare laid the track for universal health care, Trumpcare promises to blow up the railroad bridge and send the whole enterprise plunging into a ravine, albeit in slow motion.

The Republican Senators currently expressing their displeasure with the plan could easily thwart it. But will they? Majority Leader Mitch McConnell knows his troops. He knows what they want and, more important, what they will settle for. Opioid treatment funding, maybe, for Senators Rob Portman of Ohio and Shelley Moore Capito of West Virginia, whose states have serious addiction problems. Perhaps a more aggressive retreat from Obamacare regulations for Senator Mike Lee of Utah. 

The chorus of boos heightens the political drama but it doesn't stop the play. Concessions are made. Victories are claimed. The legislation moves toward conclusion.

How many Republicans will really abandon the twin pillars that have upheld the GOP for nearly a decade -- tax cuts for the rich and the repudiation of Obama? How many will walk away from the cause of multiple generations of Republicans -- rolling back the welfare state?

I'm betting fewer than three.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

    To contact the author of this story:
    Francis Wilkinson at fwilkinson1@bloomberg.net

    To contact the editor responsible for this story:
    Jonathan Landman at jlandman4@bloomberg.net

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