Tom Price, the former extremist House Republican and quite possibly the most corrupt of all popular vote loser Donald Trump's nominees, hates the Affordable Care Act. He's been railing against Obamacare since before it became law and vowed to play a part in its destruction. Now Price is in the Trump administration and here's his chance. But it's not going to be easy now, just like Trumpcare wasn't easy. There are powerful stakeholders—like the insurance companies—that he's going to have to fight, as well as the political life of the man he's serving. Trump owns whatever happens to Obamacare going forward. He's made sure of that. So Price's natural instincts toward destruction might have to be quelled.
"Tom Price is the kind of guy that you hire if you want to uproot the Affordable Care Act. He’s not the guy you want if you want to make it work," Nicholas Bagley, a University of Michigan law professor who specializes in regulatory law, told TPM. "It will be interesting to see if he can shift roles and become an administrator, a competent, careful thoughtful administrator that he may not like but has to live with. Or whether, instead he remains steadfast in his ideological commitment to undoing the Affordable Care Act by any means possible."
As Trump often does, he made that subtext text by promising over the weekend to try overhauling Obamacare again once the law "explodes."
The political wisdom of going such a route is questionable, but then again, political wisdom hasn't gotten in Trump's way in the past.
"There's a statute of limitations for how long you can blame the other guy for things that could go bad on your watch," Bagley said. "They're really going to face a tension between the desire to allow the ACA to crater and to blame it on the Democrats, [or to] follow the recognition that politically it makes a whole lot of sense to try to make the Affordable Care Act work as well as possible."
Price's initial actions have also been seen as a reassurance to insurers that they won't have the rug pulled out from under them. "Those are basically checking the boxes on an insurer company wish list," said Timothy Jost, a health law expert. "If those move ahead, insurers will see those as a sign of good faith." Price isn't going to give two good goddamns over the people who will be screwed over if he destroys Obamacare, but he's going to want to make sure that the insurance companies have time to adjust to whatever might come.
Whatever might come is his, Trump's, and Paul Ryan's big problem. While much of the finger-pointing has been at the purists in the Freedom Caucus who just want repeal and nothing else, Friday's non-vote on Trumpcare showed that they've got just as serious a problem with the moderates. That's because the people have spoken and they are afraid of us. That hasn't trickled all the way up to Ryan and Trump yet, but it will, as all of them learn the lesson articulated so pathetically by Ryan: "Doing big things is hard."