Treasury Secretary Steve Mnuchin confirmed many Republican fears when he said recently that President Donald Trump’s first budget proposal would not include cuts to Social Security or Medicare.
Meanwhile, after years of saying that immediate repeal of the 2010 health care law was necessary before it collapsed, GOP leaders are finding their members under pressure to back off unless they have something to replace it with. And in Trump’s address to Congress on Tuesday, he emphasized maintaining aspects of the health care law like protection for people with pre-existing conditions, far from the campaign-trail rhetoric of total repeal.
Republicans are running up against a relatively straightforward fact of politics: Once government starts giving things to Americans, it’s hard to take them away.
“That’s always been the secret of Democratic politics, with Medicare, Social Security, and Obamacare,” said Michael Tanner, a senior fellow at the Cato Institute, a libertarian think tank. “Once they’ve been given out, people don’t want to give them back.”
Dean Baker, co-director of the liberal-leaning Center for Economic and Policy Research, said Republicans are finding that repealing the health care law is much easier said than done.
“Tens of millions of people benefit from Obamacare,” he said. “The Republicans had no trouble attacking an abstraction, but now it’s a question of people actually losing health care coverage and that’s a really big deal.”
Big universal programs survive
Social Security and Medicare provide an example of how Democrats could have better protected their health care overhaul by making it bigger and more universal. If it’s hard to discard the health care law because so many Americans have come to depend on it, that’s far truer of the larger, more-established entitlement programs.
“The [Affordable Care Act] had much complexity which made it difficult for people to recognize the benefits in many cases,” Baker said.
In 1961, actor Ronald Reagan spoke out against Medicare, calling it “socialized medicine,” on a 10-minute recording for the American Medical Association.
“Behind it will come other federal programs that will invade every area of freedom as we have known it in this country,” he said, “until one day … we will wake to find that we have socialism.”
Reagan was one of many Republicans who opposed the creation of the program. Social Security faced similar GOP opposition around the time of its 1935 creation. But by the time he was president in 1981, Reagan found Medicare to be nearly untouchable. (It had become law in 1965.) He managed to cut its budget with a price control system, but ended his presidency essentially supportive of the program.
By 2011, presidential hopeful Mitt Romney and other Republicans found it a useful argument to accuse Obama of cutting Medicare to pay for the health care overhaul, another form of “socialized medicine,” as critics called it — a complete reversal from the 1960s when Republicans would see any Medicare cut as a good thing.
Complex programs are easier to kill
But smaller, less universal programs aren’t always as fortunate. Take the example of Aid to Families with Dependent Children, the onetime main U.S. welfare program for poor families. Created as part of the same law that began Social Security in 1935, AFDC (initially called Aid to Dependent Children) offered small benefits to white single mothers, later expanded to include black women. AFDC gave declining monthly benefits after a peak in 1976, until President Bill Clinton and a Republican Congress cut the program entirely in 1996 and replaced it with the less generous Temporary Assistance for Needy Families.
It was far easier to form a bipartisan consensus to cut AFDC because it only helped a small fraction of the U.S. population — one that carried a stigma and had virtually no political clout.
A program’s complexity can also confuse voters about what it actually does, as seen in the example of Kentucky, where most voters disapprove of “Obamacare,” but more voters approve of “Kynect,” the state health care exchange set up by the health care law. Similarly, in a 2015 poll, seven in 10 Kentuckians wanted to keep the Medicaid expansion that was one of the health care law’s major achievements.
Baker puts the blame for the confusion on the political considerations of the law’s drafters. “They wanted to leave as much of the existing system in place as possible, both to limit disruptions and appease the insurance industry,” he said. “But it did make the system much harder for people to understand and it is hard to defend something you don’t understand.”
Lessons for Democrats
While conservative interests from The Heritage Foundation to the House Freedom Caucus and Texas Sen. Ted Cruz all continue to enthusiastically support immediate repeal of the health care law without immediate replacement, other Republicans are less certain. Whether they are feeling the pressure from town hall protests in favor of the law in their home districts or just wary of being deemed responsible for 18 million people losing their health insurance, as predicted by the Congressional Budget Office if repeal goes through, some congressional Republicans are pushing a more piecemeal approach to repeal or looking for ways to include some replacement provisions in the repeal package.
If Democrats can learn anything from the past decade of politics, it may be that they need to change their legislative style, exemplified by Hillary Clinton’s presidential bid: addressing problems with complicated, targeted tax credits.
But after voters responded to Clinton’s plans with a shrug last year, and with recent events indicating the resilience of large, universal programs, Democrats may decide it’s time to think big.
As Tanner of the Cato Institute pointed out, “If you’re getting your check every month, even if politicians say it’s not going to be your check that’s affected, you’re not going to want to mess with it.”Get breaking news alerts and more from Roll Call on your iPhone or your Android.