Despite the conventional wisdom that it is almost impossible to dismantle domestic programs once they are up and running, the House just took a big step toward doing so.
States would be allowed to obtain waivers to remove requirements on insurance companies to provide "essential health benefits," including protecting people with pre-existing conditions. The last-minute compromise would provide money to help these Americans pay for more costly insurance, but, most experts agree, not nearly enough to address the problem.
Perhaps most damaging of all to lower-income Americans, the Medicaid expansion, which has been essential to expanding insurance coverage, would be phased out. In addition, states would be allowed to receive Medicaid funds as a "block grant" which would result in steep cuts since the change would end the federal guarantee that every person who applied for benefits and was eligible would receive them. Under the block grants, states would have more authority to restrict eligibility and slash benefits.
These changes to Medicaid could also be damaging for the elderly, since Medicaid -- not Medicare -- covers a significant portion of nursing home care.
The vote in the House was a pivotal moment for President Trump. To be sure, the prospects for passing this bill in the Senate remain difficult. Senate Republicans are not excited about moving forward with this extremely conservative measure and fear the electoral consequences of this vote. And Republicans will certainly be hearing from angry voters in the coming week about the benefits that they would be losing.
Nobody is certain how the CBO will score this measure, which means that the implications of the legislation remain unclear. Nor is it certain that Senate Republicans will be able to use the budget reconciliation process, which prohibits a filibuster. If the legislation is not deficit neutral or if the parliamentarian decides that the waivers are not related to the budget, Senate Democrats will be able to filibuster the bill.
Yet Democrats should not be too confident. There will be a lot of partisan pressure on Republicans in the upper chamber to finish the job. Senator Mitch McConnell and his colleagues will realize that a victory would give President Trump and the party an enormous boost in his political standing. The legislation would strike a blow at the heart of President Obama's expansion of the social safety net. A complete victory on health care would also generate substantial political momentum for Republicans to move forward on other much-desired measures like a massive supply-side tax cut and legislative deregulations on energy markets.
Senator McConnell will do everything that he can to find ways to make this work. The same dynamics and dealmaking at play in the final hours of the House deliberation could be at work in the Senate as well.
All of this is to say that those who have been dismissing President Trump at the end of his first 100 days are greatly downplaying the impact that he can still have. The same radical possibilities that were evident in the days that followed the historic election, when Speaker Ryan claimed that President Trump had earned a mandate and most Republicans fell in line, are very much in play. Yes, President Trump's tweets are outlandish and insulting; yes, he failed miserably on the legislative front in the first months of his presidency; and yes, the President and his advisors sometimes seem to have no idea about what they are doing.
But that doesn't mean that the conditions are not still ripe for this President to push through a radically conservative agenda. United government in an era of intense partisan polarization is a powerful force. Republicans are chomping at the bit for this President to send them legislation that will dismantle the welfare state, strip free markets of regulations and cut taxes.
President Trump has been making considerable progress through executive actions and, with this vote, we see that if he gets his act together and focuses on legislation, he will find Republican colleagues who are prepared to take big steps to support him. In the House, enough moderate Republicans were willing to accept this compromise while the Freedom Caucus moved away from its all-or-nothing approach to reach a deal on this bill. In the final days of the debate, the Democratic activists who were so successful in blocking legislation the first time around were caught off guard.
Democrats might be feeling like George Foreman when he fell victim to Muhammad Ali's rope-a-dope strategy in 1974. The Democrats spent the last few months taking many swings at the President and keeping him against the ropes. It looked like President Trump was politically bruised and battered.
But at the very moment that Democrats were feeling confident, President Trump struck back with a vengeance. At least at this moment, the Democrats are the party laying on the ground.
This presidency is far from over. The stakes of what takes place in the next few months are enormous. Democrats should take this vote as a lesson that this White House and Congress can still pack a powerful punch. Conservatives will come out of this decision, as well as the executive order easing up restrictions on the political activities of religious organizations, feeling energized and determined. As a party, Republicans will feel better about what they can accomplish with Trump up top. Senate Republicans will be prepared to do whatever is necessary to finish this job through the reconciliation process.
The obstacles facing this administration remain immense, as do the steps needed to bring this health care vote to completion. The incompetent manner in which President Trump has handled legislation and the congressional process could easily result in disastrous stumbles in the week ahead.
But this is a big moment for President Trump and Republicans who now have a taste of just how much damage they can inflict on the strength of government if they are able to get their act together between now and the midterms of 2018.
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