When the Republicans tried and failed last month to begin the process of repealing and replacing Obamacare, Donald Trump seemed neither crestfallen nor in a hurry to try again.
In an uncharacteristically measured statement, Trump predicted that Obamacare would soon enough fall under its own weight. At that time, Trump predicted, Democrats would come to him “and try to work out a health care bill for the great people of our country.” When that time comes, “whenever they’re ready, we’re ready.” In the meantime, Trump indicated, he was prepared to move on to tax reform.
It was therefore somewhat surprising when we learned last week that Trump was not, in fact, waiting for Democrats to come to him following an implosion of Obamacare. To the contrary, it turns out that the White House was in active discussions with the Republican House Freedom Caucus in an attempt to revive the bill.
This development was surprising not only because it seemed to contradict Trump’s suggestion that he was willing to move on to other legislative priorities. But also because moving even further right to appease the never-satisfied Freedom Caucus was pretty much the opposite of waiting until the Democrats were ready to work with him.
When this second attempt also failed to receive enough support to move forward before the House left for its Spring break, most people wrote it off as just a last-minute effort to ram through a quickie healthcare bill.
On Wednesday, Trump gave an interview on Fox Business that explains a lot about both why Trump is insisting that Congress move forward immediately with a healthcare bill, and why he is indifferent to whether that bill is shaped by the Freedom Caucus on the right, or by Democrats and moderate Republicans in the center.
Trump made it clear that his urgency to get a healthcare bill done right away is not just a matter of striking while the iron is hot, or providing Americans with an urgently needed fix to the healthcare system.
Rather, it is a strategic imperative that the healthcare bill be sequenced before a tax reform bill.
“I have to do healthcare first, I want to do it first to really do it right,” Trump told Maria Bartiromo on Fox Business on Wednesday.
Trump wants to do healthcare first so that he can use the “hundreds and hundreds of millions of dollars” that would be saved by reforming healthcare for tax cuts. “If you don’t do that you can’t put any of the savings into the tax cuts and the tax reform.”
This finally explains Trump’s dogged refusal to table healthcare legislation and move on to his other legislative priorities. It’s not about being unwilling to accept defeat. And it’s not about a passionate determination to fix healthcare.
In fact, it’s not really about healthcare at all. It’s about tax cuts. Trump wants to “reform” healthcare to finance tax cuts.
The hundreds of millions of dollars of healthcare savings that Trump plans to use to finance tax reform are not going to just fall out of the sky. The money is going to have to come from somewhere. Trump didn’t say exactly where, but savings of that magnitude can be achieved only by drastically cutting subsidies to persons who can’t otherwise afford healthcare insurance, payments to insurers who are taking extra risk to by covering the elderly and people with pre-existing conditions, and funding Medicaid.
The strategy of using savings from healthcare reform to finance tax cuts also explains the curious phenomenon of a President who has no healthcare policy, but is nevertheless urgently seeking healthcare reform. If the goal is simply to free up money to use elsewhere, not to fix healthcare, it doesn’t matter what is in the legislation so long as it generates sufficient savings.
That’s why Trump seems so utterly indifferent to whether he shapes a healthcare bill to appease the Freedom Caucus, or to gain the support of enough moderate Democrats and Republicans to render the opposition of the Freedom Caucus irrelevant.
It doesn’t matter that going right would yield a completely different healthcare system than moving to the center. Trump doesn’t care what would be in either bill, and probably wouldn’t even know the difference between the two. None of that matters to Trump so long as he gets a bill that he can claim will generate sufficient savings to finance big tax cuts. That’s what he really cares about.
It’s getting the bill passed that matters. Not what’s in it.
Follow the money.
Philip Rotner is an attorney and an engaged citizen who has spent over 40 years practicing law. His views are his own and do not reflect the views of any organization with which he has been associated. Follow Philip on Twitter at @PhilipRotner