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Republicans must challenge Trump on health care

President Trump spoke with Senators John Barrasso and Marco Rubio on July 19.Michael Reynolds/Pool/Getty Images

Despite months of Republican futility on health care, President Donald Trump is obsessed with pushing his party to fulfill its campaign promise to repeal the Affordable Care Act. Thus he is urging Senate Republicans to delay any summer recess until they have gotten that done.

The president should be more concerned about keeping his own campaign and post-campaign commitments on health care. Candidate Trump promised to replace Obamacare with coverage that is much better and much less expensive. He also said repeatedly that everyone would be covered. And he promised not to cut Medicaid.


But though he has browbeaten Republican senators for failing to follow through on repealing the Affordable Care Act, abandoning his own campaign commitments doesn’t seem to bother him at all. Months into the GOP’s repeal-and-replace effort, not one piece of legislation Trump has backed, in either the House or the Senate, would keep all of those promises. Not by a country mile. To see that, one need only look at the various Congressional Budget Office analyses of those plans.

They would all leave many millions more without health insurance. And they would all make deep cuts to Medicaid when measured against the spending projected under current law. You obviously can’t reduce Medicaid spending by hundreds of billions of dollars without cutting people from the rolls or reducing the quality of their coverage, or both.

That is hardly keeping the faith with voters. Most Americans, and indeed, even most of Trump’s own supporters, realize as much. Overall, it’s not even close: By a 2-to-1 margin, Americans prefer the Affordable Care Act to the Republican replacement plans.

So it’s time for serious Republicans to push back against an insistent president with a simple question: Where is the detailed health care plan from the administration that fulfills the commitments Trump made during the campaign about cost, quality, and universality of coverage?


It’s difficult for reporters to press the president on such matters, given that he is both inaccessible and adept at offering blandishments that duck or dodge the very real tensions and trade-offs in health care policy. And Trump, of course, dismisses Democratic objections as mere obstructionism, though that doesn’t mean they should cease to point out the various ways he has backtracked on those important commitments.

Republicans, however, could truly get attention here. Now, sadly, many congressional conservatives are willing to go along with any charade that lets them repeal the ACA, no matter what the consequences. Still, as we saw this week, some Senate moderates aren’t. And though smaller, that band has demonstrated the power they wield when they stand up and object.

Trump will gladly shift to their shoulders the blame for failing to keep the GOP’s Obamacare-repeal campaign promise. Thus it’s important for them to say, loudly and clearly, that if this president wants the Affordable Care Act repealed, he must deliver on his promise of a plan that provides better care, is less expensive, and doesn’t leave people uninsured.

And if he doesn’t? Then Republicans should forthrightly declare that if the president of the United States can’t deliver on some of his core campaign commitments, he shouldn’t expect them to join him in violating them.