"We're going to have insurance for everybody," Trump told the Washington Post after the election. Under Trumpcare, according to Trump, people "can expect to have great health care. It will be in much simplified form. Much less expensive and much better."
This was bolder and brasher than what more establishment-minded Republicans had said over the years. But it was, fundamentally, similar to promises and insinuations made by Paul Ryan, Mitch McConnell, and dozens of other Republicans. It's not just that the Affordable Care Act was killing jobs and sentencing people to death panels. It's that Republicans had some much better plan in their back pocket that would give Americans what they want — cheap, comprehensive health insurance that offers them oodles of choice.
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It was a great line, and it helped Republicans win Congress and eventually the White House. But it was a lie, and now Trump and Republicans in Congress are paying for it.
Policy-minded conservatives have serious criticisms of President Obama's health care law. They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put "skin in the game" in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.
And this, more than tensions between the conservative and moderate flanks of the caucus, is why the prospect of actually legislating has brought the GOP to a crisis point. The chasm between what they've been saying they want to do and what their policy ideas actually do is simply much too large to be bridged.