C.B.O. Report Leaves Trump in a Political Jam on Health Care

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Referring to House Republicans’ proposed replacement for Obamacare, Senator Chuck Schumer said, “If there was ever a war on seniors, this bill is it.”Referring to House Republicans’ proposed replacement for Obamacare, Senator Chuck Schumer said, “If there was ever a war on seniors, this bill is it.”CreditPHOTOGRAPH BY ERIC THAYER / THE NEW YORK TIMES / REDUX

When it comes to spotting an opportune moment to hold a press conference, Chuck Schumer, the Senate Minority Leader, has few equals. There he was on Tuesday morning, surrounded by nurses, patients, and health-care advocates. The subject at hand was the Congressional Budget Office’s new estimate that House Republicans’ proposed replacement for the Affordable Care Act, which President Trump has endorsed, would swell the number of uninsured Americans by twenty-four million over ten years, while also raising insurance premiums for older people, gutting Medicaid, and providing a hefty tax cut to many of the richest people in the country.

“If there was ever a war on seniors, this bill is it,” Schumer said. “It spends more on tax cuts for health-insurance companies and the wealthy than on tax credits to help the middle class. It’s vintage Donald Trump. He talks like a populist, but when he acts it’s hard right, favoring the special interests, hurting the middle class and those striving to get there.”

Schumer also obliquely addressed some members of the Administration—such as Mick Mulvaney, the head of the Office of Management and Budget—who have tried to dismiss the C.B.O.’s numbers. Schumer pointed out that when Tom Price, Trump’s Secretary of Health and Human Services, was in Congress, he helped to appoint the current head of the C.B.O., Keith Hall, who previously worked at the Mercatur Institute, a right-wing research organization funded, in part, by the Koch brothers. “And now they are saying what he is saying isn’t real,” Schumer said, employing a shocked tone. “Do facts matter anymore to our colleagues, to the President? Does truth matter? Sad, as somebody once said.”

That jibe at Trump earned Schumer some smiles from the people standing behind him. Whether Trump was watching the press conference on TV is unknown, but about half an hour after Schumer spoke the President tweeted out a message that said, “JOBS, JOBS, JOBS!” and showed a screenshot of some figures from the latest employment report from the Labor Department, which came out last Friday. A bit later, Trump linked to a Bloomberg News story about rising optimism among the country’s C.E.O.s and wrote, “Great optimism in America—and the results will be even better!”

On a day when the front pages of newspapers all across the country were blaring out the C.B.O.’s twenty-four-million figure, surely even Trump wasn’t delusional enough to think he could change the subject that easily. He might, instead, have been trying to cheer himself up, or perhaps to distance himself from the Republican plan. In his daily briefing, Sean Spicer, the White House spokesman, insisted that Trump was “proud” of the bill and dismissed the C.B.O.’s figures as “consistently wrong.” But Spicer also said that the President didn’t want the health-care proposal to be named after him.

Later on Tuesday, Trump met with Paul Ryan, the bill’s primary backer, and other Republican leaders. At this stage, the President has three possible options in front of him for how to deal with health care, none of which he may find particularly palatable or easy to follow through on.

The first option is to tough it out, sticking with the House Republican legislation and seeking to shrug off or belittle the C.B.O.’s analysis. This was the strategy that Spicer tried on Tuesday, when he claimed that the C.B.O. analysis failed to take into account follow-on legislation that the White House and the Republicans intend to propose which would get rid of many of the A.C.A.’s coverage guidelines, enabling insurers to offer cheaper, lower-quality plans that, the White House claims, will prove popular.

There are several problems with this strategy, however. To begin with, the reason the additional measures that Spicer mentioned aren’t included in Ryan’s current proposal is that they would require sixty votes in the Senate to pass. The Republicans have only fifty-four votes, and there is virtually no prospect of getting six Democrats to switch sides.

Moreover, in order to get this bill through the House, the Republican leadership might have to make it even more draconian in order to satisfy ultra-conservatives, who continue to insist that it doesn’t go far enough in dismantling the A.C.A. On Tuesday morning, Jim Jordan, the Ohio representative who heads the Freedom Caucus, said on Fox News, “Remember, this bill doesn’t repeal Obamacare. This bill doesn’t unite Republicans. This bill doesn’t bring down the cost of premiums.” Jordan added that he and his colleagues would offer a series of amendments to the legislation when it comes to the House floor, next week. These are likely to include things like moving up the dismantling of the A.C.A.’s Medicaid expansion from 2020 to 2018, which would only further increase the number of uninsured.

That points to the larger problem. If he sticks with the current bill, Trump would be tied to a proposal that would do great harm to many of his supporters and make a mockery of his claims to be a populist. As I have pointed out, the twenty-four-million estimate for the rise in the number of uninsured is far from the only damaging figure in the C.B.O. report. It also says, for example, that a sixty-four-year-old earning an income of twenty-six thousand dollars a year could see his or her insurance premiums rise by twelve thousand nine hundred dollars annually.

A second option would be for Trump to gently distance himself from the Ryans and the Jordans of the world, and ally himself with Republican senators such as Louisiana’s Bill Cassidy and Maine’s Susan Collins, who have accepted the C.B.O.’s figures and are calling for big changes to the House proposal. “It’s an awful score for the authors of the bill,” Cassidy said on Tuesday. “You can’t sugarcoat it.”

The White House does have a bit of room to work with. Largely because of the huge cuts to Medicaid that the House proposal would entail, the C.B.O. estimated that it would reduce the budget deficit by three hundred and thirty-seven billion dollars over ten years. The Trump Administration could, for example, push to take some of this money and make the tax credits in the bill more generous, especially for lower-income people, or preserve at least part of the Medicaid expansion. (That is what Cassidy and Collins advocated in a bill they put forward in January.) If the White House preserved some of the taxes imposed by the A.C.A., which fell on people earning more than a quarter of a million dollars a year, it would have even more leeway to come up with a less damaging proposal.

The challenge would be getting the movement conservatives in the House and Senate to go along with such an approach. But at least one of Trump’s friends thinks he should take the risk of alienating the ultras and strive to put together a health-care bill that fulfills his campaign promise to cover everybody. Chris Ruddy, the founder of the conservative news site Newsmax, wrote in a piece published Tuesday that it’s time for Trump to “ditch the Freedom Caucus and the handful of Senate Republicans who want a complete repeal of Obamacare. They don’t agree with universal coverage and will never be placated.”

Once Trump has veered away from the right, Ruddy went on, he could find a few parts of the Ryan plan that might win majority support. But he should also “reject the phony private health insurance market as the panacea. Look to an upgraded Medicaid system to become the country’s blanket insurer for the uninsured. Tie Medicaid funding to states with the requirement each pass legislation to allow for a truly nationwide healthcare market.”

Following Ruddy’s advice, or doing something similar, represents the third option for Trump. It would be a big reversal, of course, and it would put him on a collision course with the Republican leadership on Capitol Hill, whose support he needs in many other areas, including his efforts to resist calls for a proper public investigation of his campaign’s reported ties to Russia. As of now, there is no sign of such a shift. Trump seems to be stuck.