With the election of Donald Trump, it is undeniable the Republican Party’s ideology has changed.
Trump’s positions as a candidate were certainly not conservative in a traditional sense. Despite this, Republican members of congress seem to have gone along with Trump’s agenda since assuming office, unanimously voting to confirm almost every single member of his cabinet. Though Trump’s new Republican ‘establishment’ will face its first real test with its repeal and replace strategy for Obamacare.
During the Republican presidential primaries there was consensus among all the candidates that the Affordable Care Act (Obamacare) needed to be repealed and replaced. While the field was clear over the need to repeal, there was very little offered over what a replacement might look like. It was a debate dominated by rhetoric, with almost no actual policy offerings.
The new American Health Care Act was introduced into the house this week as the replacement to Obamacare. The Bill acts as a simultaneous repeal and replacement. It eliminates the most controversial and divisive part of Obamacare – the individual mandate.
The individual mandate dictated that every person in the United States must purchase healthcare or face a tax. Conservatives have rallied against this hardest, particularly since it was ruled constitutional by a 5-4 vote at the Supreme Court in National Federation of Independent Business vs Sebelius (2012). The bill also gets rid of the employer mandate – dictating that any firm that had more than 50 employees must provide healthcare.
The second major part to the Bill, from a policy aspect, is radical change to Medicaid – the insurance provided by states for those unable to afford insurance. The Bill would lead to a capped contribution from the federal government based on the population receiving Medicaid within the given state, based on 2016 spending. The Bill would also keep the Affordable Care Act’s expansion of Medicaid until 2020.
Though not all Republicans are satisfied with this initial proposal.
The primary problem many conservatives have with the Bill is that, while the individual mandate is repealed, a ghost of it still remains through the bill dictating that insurance firms can add up to 30% onto the healthcare premiums for people who have gone without any coverage for over two years.
Conservatives also oppose the Bill’s keeping of Obamacare’s pre-existing condition policy – insurers must cover everyone regardless of pre-existing conditions, and prohibits firms from charging higher rates based on an individual’s medical history.
Conservative opposition to the Bill comes as the first major test for the Republican Party under Trump’s leadership.
There are already a handful of GOP senators in vocal opposition to the bill: Rand Paul dubbing it ‘Obamacare Lite.’, Mike Lee calling it ‘a step in the wrong direction,’ and Tom Cotton saying that the ‘bill can’t pass the senate W/O major changes'. Those three legislators alone could prevent the bill from passing the senate.
The Bill will also face a fight from the House Freedom Caucus. So with the Bill under attack from both the Left and the Right it’s path to passing is unclear.
This is where the new establishment of the Republican Party will come into play. It is Trump’s first test at having to convince legislatures to vote with the party, and it is unclear how his administration will respond to these GOP rebels.
What is perfectly clear is that this first fight within the GOP will set the table for how the party will operate over the next two years, and what fights the Tea Party conservatives will choose to engage in when in opposition to the establishment party line. This fight will define Trump’s relationship with congress.
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