The inconsistencies, incoherence and contradictions of Donald Trump's presidency are nowhere illustrated so vividly as in his efforts to repeal and replace Barack Obama's Affordable Care Act. His efforts to reverse Obamacare in the US Senate this week before Congress goes into summer recess reveal an irresponsible failure to prepare political alternatives, deep policy divisions within his Republican party and a remarkable lack of concern for the disastrous effect of any such decision on the wellbeing of the poorest Americans, many of whom voted for him last November.
Trump introduced his push for the measure with a group of "victims of Obamacare" in the White House. He argues, along with most Republicans, that they have suffered from inflated insurance rates and the collapse of markets. Most Americans are insured through their employers and are relatively satisfied with that arrangement. But the poorest 20 per cent of the population on whom more than 80 per cent of public funds are spent lacked access to the insurance system before the mandatory contributory Obamacare scheme was introduced, relying on the Medicaid system for support. Removing cover from them, as provided for in draft bills being considered by the Senate, would leave tens of millions completely uninsured within 10 years. Moderate Republican senators say this is too steep a price to pay while ideological right-wingers believe the state should not be in health care markets at all.
Many of the poor white voters who supported Trump last November would suffer directly from such decisions, so it is little wonder so few of them approve of them in polling. The Republican party is caught in a dilemma of its own making, having so viscerally opposed Obamacare, for openly or subliminally racist reasons, since most of those covered are non-white Americans. Trump badly needs to show a legislative success in his domestic policy and hopes this will achieve it. But without an alternative system in place he and his party will be left vulnerable to losing their congressional majority in next year’s mid-term elections.
Trump’s promise to make America great again involves creating border walls against immigration, personal and corporate tax reform and rebuilding infrastructure as well as dismantling Obama’s legacy. To have put so much energy into repealing and replacing Obamacare instead of getting an infrastructure renewal programme going, which would attract cross-party support, is politically incoherent. Instead Trump is mired in a desperate and reactive effort to ward off accusations of Russian collusion in last year’s election. Those accusations are deeply damaging and could be fatal for Trump. More serious politically is the dissipation and potential betrayal of his support base among millions of ordinary Americans who will suffer if Obamacare is removed.