Of all the people that Donald Trump has to contend with in his administration, members of his own party may end up being among his most vocal opponents. A burgeoning fight on Medicare reform between the ends of the GOP's ideological spectrum is a timely reminder that the Trump-shaped rift in the Republican Party will make his presidency an uphill battle, even among those theoretically on his side. With only Trump's vague policy proposals to lead the way for now, Republicans may find themselves in the midst of a fight for the soul of the party.
Trump's choice of Representative Tom Price, a long-time critic of public insurance programs, to lead the department of health and human services made the GOP's long-lived dream of privatizing Medicare seem more achievable than ever. However, recent and unexpected pushback from Senate Republicans may put a wrench in those plans.
“We’re going to have a whole new look at a lot of things. … It depends on what it is. It depends on how it is written. It depends on what it would do,” Senator Orrin Hatch, head of the Senate committee that oversees Medicare, told Politico regarding potential changes to the embattled entitlement program. Hatch's comments, particularly as head of the committee that runs Medicare, indicate that reforms will be slow and cautious, if they happen at all in the near future.
“[Medicare reform] falls under the rule of not biting off more than you can chew,” Senator Lamar Alexander of Tennessee, the Health, Education, Labor and Pensions Committee chair, said in an interview along the same lines. “The problems about the solvency of Medicare should be left for another debate, another discussion, and not be part of the replace and repeal” push by Republicans regarding Obamacare.
Price, on the other hand, has advocated for diving head first into Medicare and Medicaid reform. Right now, states cover a certain percentage of each enrollee's cost, typically less than 50 percent, and the federal government covers the rest. Under a block grant plan, which Republicans have generally been advocating for for long time, the federal government only give a certain amount of money to each state, and the states have to figure it out if the costs rise one year due to a measles outbreak or particularly hot summer. Price has shown significantly less hesitancy than Hatch when it comes to reform, even suggesting that a complete overhaul of the program could be accomplished by next summer.
One problem in this specific instance is that Trump has seemingly flip-flopped on the issue of entitlements. Trump even contradicts himself with his selection of Price as HHS secretary, because he promised back in 2015 that he wouldn't mess with public health insurance. “I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid,” Trump said in an interview last year. With Price in charge at HHS, there's no telling if Trump is going to now follow Price's lead or make Price acquiesce to his initial promise.
This is the whole, overarching problem with Trump as president — it's difficult, if not impossible, to know what he actually stands for. He's the Aaron Burr of the era, and just given how inconsistent he's been on some of the most basic tenants of his platform, he seems to be potentially persuadable on almost anything. In the Republican legislature, that means fights over which side is right, and thereby the future of the party. From immigration to education to military action to criminal justice, Trump's victory represents the opportunity for the GOP to redefine and reprioritize, but failure to unify could also ruin these chances.
Once thought to be one of the areas that united all Republicans, the infighting on public health care shows just how split the party is now. These ideological differences likely existed before Trump, but have been further exposed to reveal the full extent in light of the campaign and new administration. Realistically, this is a good time for the Republicans to figure this out — if they can come together and choose a singular direction for the party, they have a chance to hold on to Congress for a long time. If not, it could really spell the end of the party of Lincoln.