Somewhat counterintuitively, campaign promises made by presidential candidates are a fairly reliable guide to how they’ll govern. But Donald Trump is the exception to a lot of political science rules, and:
Donald Trump’s embrace of the American Health Care Act, authored by Paul Ryan and other House Republicans seemingly in collaboration with establishment-minded members of his administration, represents a massive betrayal of his own clear and repeated promises to the American people.
To an extent, sophisticated political journalists always knew Trump was likely to break those promises. And his embrace of conventional, conservative House Republicans such as Mick Mulvaney to run the Office of Management and Budget and Tom Price to run the Department of Health and Human Services was a clear indication that he intended to break them. But it would be a mistake to simply gloss over this breach of faith.
Trump’s embrace of more centrist positions on health care and retirement security was a crucial aspect of his campaign, and there was enough campaign-season tension between Trump and the GOP leadership that a voter could be forgiven for assuming Trump meant what he was saying.
He did not. Trump ran and won promising to cover everyone, avoid Medicaid cuts, and boost funding for opioid abuse treatment. He is now lobbying Congress to pass a bill that does none of those things. Instead, millions will lose insurance and Medicaid spending will be sacrificed on the altar of tax cuts for the rich.
While cutting financial assistance overall to ensure that most people are worse off, the American Health Care Act also specifically advantages and disadvantages certain groups of people relative to the ACA. In particular, residents of rural areas where the cost of health insurance is inherently higher due to reduced competition will get less help under the AHCA. Older Americans will also face drastically higher premiums due to laxer regulation of insurance companies.
This means that not only will Trump be betraying his promises in general, but, as Nate Cohn writes for the New York Times, he’ll be specifically harming people who voted for him the most.
One might expect the media to have pushed back on these lies, but something like the opposite happened. To the extremely limited extent the media covered policy at all, it tended to focus on Trump’s alleged breaks from Republican orthodoxy.
It’s tempting to blame marginal Trump voters for voting for policies that will brutalize them in particular. And, well, they have agency. But Trump was saying he would protect their most cherished benefits, the media amplified this message rather than countering it, and expecting the typical marginal voter to understand that Paul Ryan would be setting the agenda and his agenda is “funnel as much money to the rich as possible” is probably unrealistic. Like a lot of Republican norm violations, Trump’s completely shameless lying was very shrewd politics, although it will be harder for him to pull it off as an incumbent.