House Speaker Paul Ryan is a brilliant policy wonk, but he seems oblivious to the populist political forces that propelled Donald Trump to the presidency. And after this month’s display of uneven health care salesmanship by the White House, it’s not clear that Trump appreciates how the speaker’s health care legislation threatens to alienate the working-class voters who provided his narrow margin of victory in last year’s presidential election.
The emerging mess over selling Ryan’s version of health care reform is exposing an unpleasant political reality for the fiscally responsible wing of the Republican Party: People like free stuff, and it’s awfully difficult to take entitlements away after they’re granted. Ryan’s entire career has been based on the sunny belief that well-intentioned reforms have a sizable constituency of voters worried about budget-busting government giveaways. But there’s a long trail of evidence that points the other way. Just look at Trump’s winning campaign message, unique for a Republican, pledging to protect entitlements.
President George W. Bush learned that the hard way when he tackled Social Security reform at the beginning of his second term. Although Bush claimed a mandate from his reelection, many nervous Republicans quickly defected as Democrats effectively exploited voter anxiety about privatizing a long-standing public program. In 2012, when Ryan was tapped as Mitt Romney’s running mate, Romney distanced himself from the “Path to Prosperity” budget blueprint that Ryan had championed in the House. That didn’t stop Democrats from slamming the ticket for supporting cuts to Medicare—one major reason why the Romney-Ryan ticket ran poorly among working-class voters, especially in the Midwestern swing states that would go on to support Trump in 2016.
Even President Obama’s signature health care legislation created both political winners and losers, which is the main reason it became such a polarizing law. Politically speaking, its fatal flaw was that it redistributed benefits from the young to the old, and from the wealthy to the poor. It placed inflexible mandates on younger Americans and small businesses, while raising premiums for many who bought insurance on the individual market. All that disruption came at a massive political cost, including both chambers of Congress.
So it’s surprising that Ryan didn’t pick up any political lessons despite having a front-row seat to appraise the defects of Obamacare. For all the attention being paid to the 29 disruptive Freedom Caucus members in the House, it’s the 36 Republican members in competitive districts who are much more important to the speaker’s future. While many are remaining tight-lipped now, there’s palpable nervousness that they’re being forced to cast a politically poisonous vote for legislation that has little chance of passing through the Senate.
Remember: It’s the House that is potentially in play for 2018, not the Senate. Ryan is risking his party’s comfortable control of the lower chamber on a bet that repealing and replacing Obamacare is the top priority for Americans. And he’s doing it without energetic backing from President Trump, and without even attempting to win over red-state Democrats up for reelection in 2018.
Rep. Darrell Issa of California, regarded as the most vulnerable House Republican, has already come out against the legislation in its current form. Sen. Tom Cotton of Arkansas, one of the most pro-Trump voices in the Senate, has been an outspoken conservative critic of Ryan’s plan. It’s no coincidence that his home state has seen the largest reduction in the uninsured between 2013 and 2015. Sen. Shelley Moore Capito of West Virginia, representing the Trumpiest state in the country, was one of the first four GOP senators to criticize the Ryan legislation over concerns about Medicaid funding.
The fact that the criticisms are coming from states where Trump won overwhelmingly should be especially concerning to the White House. The most outspoken senatorial critics of Ryan’s legislation hail from Ohio, Kentucky, Arkansas, Texas, West Virginia, and Utah—all solidly GOP states in last year’s election. The fact that economic self-interest is trumping political partisanship on this issue should be a major red flag to Republicans. In fact, a new Democratic survey of Obama-Trump voters (conducted by Anzalone-Liszt Grove Research) found that 58 percent of them viewed Obamacare favorably. This is the new GOP constituency that championed Trump’s populism but never was comfortable with traditional Republican orthodoxy.
As one dejected Democratic pollster told me after the election: “The only way we can win back Obama-Trump voters is on Planned Parenthood cuts or if they overreach on health care.” The GOP strategy is playing right into Democratic hands. It’s the equivalent of the Atlanta Falcons getting pass-happy despite holding a 25-point lead over the New England Patriots in the Super Bowl. The GOP’s political maxim should be akin to the Hippocratic Oath: First, do no harm. Instead, they are endangering their most vulnerable members.
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