To celebrate the release of our new issue, all subscriptions are discounted this week.

After Trumpcare

Republicans wanted to repeal Obamacare and gut Medicaid. Instead they galvanized the push for Medicare for All.

President Trump shaking hands with House speaker Paul Ryan prior to his address to a joint session of Congress on February 28, 2017. Office of the Speaker / Twitter

The life of Trumpcare was, to repurpose Thomas Hobbes’s words, “nasty, brutish, and short.”

Born in March in the Republican-controlled House, Trumpcare succumbed in the Senate this past week thanks to its fundamentally defective design and pitiable unpopularity, along with the relentless pummeling it received from enraged constituents across the country. After a dramatic vote Thursday night on the final “skinny” version of repeal, it seems safe to say that Trumpcare is now finally where it belongs: six feet under.

The ramifications of this saga will be many and long lasting. One possible effect is a rather paradoxical one: Trumpcare’s architects were intent on undermining the progressive elements of the health care system (for instance, by gradually squeezing Medicaid and degrading protections for the chronically ill), yet they may have wound up bolstering them — most notably, by sparking widespread indignation and resistance.

For though a host of factors helped bring down Trumpcare, we shouldn’t neglect the role of activists — whether it was disability-rights organizations like ADAPT or left groups like Democratic Socialists of America — who never let the bill’s human cost fade from public view.

Vox’s Jeff Stein chronicled many of their actions in recent months: the eighty activists from twenty-one states who were arrested after bursting into the offices of some eighteen Republican lawmakers earlier this month; the disabled Coloradans — several in wheelchairs — who camped out for days in Sen. Cory Gardner’s office in late June; the roughly fifty brave disabled individuals who were hauled away by police for opposing Trumpcare in Sen. Mitch McConnell’s office about a month ago.

The pressure simply did not let up, especially during the final stretch. As Senate Republicans moved into the eleventh hour of their repeal effort this week, protestors hounded them from the chamber’s gallery, chanting: “Don’t kill us, kill the bill!”

Trumpcare ultimately fractured the Right. But it powerfully united grassroots progressives and leftists.

A related factor in Trumpcare’s death was progressives’ swift victory in framing the debate in the moral language of life and death. Scoring from the Congressional Budget Office — which estimated that Trumpcare would leave 20 million more people uninsured — was widely cast as damning, and various observers proceeded to quantify the bloodshed that could be expected to flow from such a reckless withdrawal of health care access.

Republicans couldn’t own any of this. Instead they were forced to respond with a hopelessly ineffective combination of obfuscation and deceit. Earlier this month on Fox, for instance, Secretary of Health and Human Services Tom Price made the comical claim that “we’re going to be able to cover more individuals on this bill than are currently covered.”

Yet Price’s lie can also be seen as almost encouraging: it was essentially a concession that universal coverage should be our common moral ambition.

Similarly, consider the emotional debate over “pre-existing conditions.” The idea that people should be punished for their illnesses received widespread condemnation throughout the Trumpcare debacle (witness Jimmy Kimmel’s viral monologue about his sick newborn son), but for the most part, the House and Senate bills included provisions that would have effectively worsened protections for the sick. Again, Republicans had to respond to criticism with duplicity, as when President Trump tweeted that Republicans would surely be “taking care of pre-existing conditions!”

Even before they lost the repeal battle, in other words, Republicans had already lost the moral war. As a result, the Obamacare repeal effort — or more precisely, the response it provoked — may have inadvertently strengthened the conceptualization of health care as a basic social right.

Conservative commentator Charles Krauthammer conceded as much back in March, noting that Medicare for All could be the next logical demand in the coming years.

After all, the case has now been made that uninsurance is a species of violence. So if it is morally abhorrent to leave nearly 50 million uninsured (as Trumpcare would have done), why is it acceptable to leave 28 million uncovered (as the status quo law will do)?

And if it is beyond the pale to punish people with pre-existing conditions by charging them higher premiums, how is it appropriate to force them to pay handsomely at the point of health care use (through deductibles) simply because they have more medical needs?

It’s worth restating again: there is now a broad consensus that being sick should not mean paying more for health care through premiums. This exact same logic, however, would seem to preclude forcing the sick to pay more for health care through cost sharing. There simply is not much daylight between risk-adjusted premiums and deductibles: both function as types of taxes on the sick.

The activists resisting Trumpcare decried uninsurance and underinsurance as gravely immoral, framing that helped slay the venomous bill. But these ideas — and these passions — will not now suddenly melt away in the summer heat.

Trumpcare’s authors were hoping to deliver the coup de grâce to health care universalism. Instead they seem to have galvanized it.

The health care journey, then, is far from over. This time, however, it will be progressives and leftists at the helm, with Medicare for All the increasingly discernible destination on the horizon.