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Horowitz: Trump Has Opportunity to Reset on Health Care

Tuesday, March 28, 2017


Rob Horowitz

The only thing worse for President Trump than his failure last week to garner sufficient House votes to ‘”repeal and replace” Obamacare would have been to succeed.  While the short-term political costs of this resounding defeat in his first major legislative effort are considerable, the long-term political costs of adopting legislation bearing close resemblance to the defeated House version, which combined a giant tax cut for the rich with 24 million people losing their health insurance, along with a hollowing out of essential care requirements for some of those who remain insured, would have been disastrous.

President Trump now has an opportunity for a reset on health care—one that can serve him well politically and serve the nation well substantively-if he is willing to fundamentally change course and fulfill his campaign promise that everyone would be insured and have access to great health care.  This requires abandoning repeal and making the goal the reform and repair of Obamacare. It means building a completely different legislative coalition that includes Democrats, along with moderate Republicans and pragmatic conservatives.

As one of the sharper and more pragmatic Republican members of Congress, Tom Cole of Oklahoma told the New York Times, “the president is a deal maker and Ronald Reagan cut some of his most important deals with Democrats.”

This is good advice, especially on health care where a majority of Americans now approve of Obamacare, while less than 1-in-5 approve of  so-called “Trumpcare or Ryancare.” Underlying these results, as I argued in a recent column, is the fact than 6-in-10 Americans say the government should be responsible for ensuring health care coverage for all Americans, as opposed to less than 4-in -10  who say this should not be the government’s responsibility, according to recent Pew Poll.  This reflects a marked increase in the percentage of Americans who now believe that providing health insurance is an affirmative duty of the government.

Research demonstrates that the defeated House health care legislation would have hit older working class whites, Trump’s strongest demographic, particularly hard, leaving many without health insurance. If Trump is going to succeed politically, he needs to back-up his professed populism and concern for the ‘forgotten man’ with policies that help-not hurt—especially on an issue that directly impacts people’s lives.  

Reforming and repairing Obamacare and restoring more competition can be accomplished by minimizing risks for health insurance companies and increasing—not lowering-- government subsidies. This can help put the brakes on big premium increases. These common sense fixes can be combined with experimenting with allowing health insurance to be bought across state lines and permitting small businesses to join large health care purchasing pools to give them more leverage in the market.

Since most experts believe, contrary to the doomsday arguments of Trump and the Republicans, that Obamacare is sustainable and polling shows that people who get their health insurance through it are mainly satisfied, by putting in place these more incremental reforms, Trump could ultimately emerge as a hero.  His efforts would be directly responsible for more people being insured and more market competition to hold down premiums.  And he could build a winning Congressional coalition for these kind of approach and truly demonstrate he is a different kind of Republican—one that looks out for average people.

That is the winning way forward, Mr President.


Rob Horowitz is a strategic and communications consultant who provides general consulting, public relations, direct mail services and polling for national and state issue organizations, various non-profits and elected officials and candidates. He is an Adjunct Professor of Political Science at the University of Rhode Island


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