Paul Ryan admits health care bill is designed to open way for tax cuts for wealthy

Beleaguered moderates in Trump White House have been left out of domestic policy decisions

Matthew Sheffield
March 21, 2017 12:26AM (UTC)

It’s been nearly a decade since Republicans last held all three elected branches of government and now, according to House Speaker Paul Ryan, it’s about time for the GOP to finally get serious.

“What good is it to just howl at the moon?” he asked Friday at a conference sponsored by the nonprofit foundation of the conservative magazine National Review.


Ryan made his remarks in an interview with National Review editor Rich Lowry, who is among a handful of self-described “reformicons” attempting to steer American conservatism away from its angry, Cold War-inspired present into a movement that is more comfortable with the welfare state.

"What's happening out there right now in conservative movement is the growing pains of going from a 10-year opposition movement to a governing one,” Ryan added.

To some extent, the Donald Trump phenomenon has made the efforts to dial back the GOP’s libertarian fantasies a more urgent matter for the party.


Despite being a political novice, Trump on the campaign trail was one of the first major Republican politicians to promise he would not make changes to Medicare and Social Security spending. It was one of the few positions he was firm about and it almost certainly helped him persuade Upper Midwesterners to vote for him.

Throughout his candidacy and in his inaugural address, Trump has also repeatedly spoken about how “the forgotten men and women of our country will be forgotten no longer.”

Since he assumed office, however, the president has largely farmed out much of his policymaking to Ryan and his fellow Ayn Rand admirers.


It’s made for a weird sort of mix.

Thus far, Social Security and Medicare have not become part of the discussion. The “budget blueprint” released by the White House Office of Management and Budget has nothing to say about the two large programs. The agency’s director, former GOP congressman Mick Mulvaney, says the administration is not trying to avoid difficult subjects.


"The president is absolutely going to keep the promises he made on the campaign trail," he said Thursday at a news conference. "Just because it's not here, doesn't mean we're dodging the issue."

While the administration may not be trying to avoid the subject, the net effect thus far has been that Trump’s right-leaning advisers and congressional allies have had much more influence on his policies than the moderates who rarely get much press attention nowadays — even though they may reflect the policy views that Trump once held and advocated for before he began running as a serious Republican presidential candidate.

Over the weekend The Washington Post provided a look at the battles going behind the scenes in the Trump White House, such as the influence of the more moderate faction led by the president’s daughter Ivanka, her husband Jared Kushner and two former Goldman Sachs executives Gary Cohn and Dina Powell.


They are essentially teaming up against outsider, nationalist Republicans led by top adviser Steve Bannon and his newfound ally, chief of staff Reince Priebus:

An unexpected political marriage has formed between Bannon, with his network of anti-establishment conservative populists, and Priebus, who represents a wing of more traditional Republican operatives.

They are often at odds with the New Yorkers, led by Cohn and Powell, who are close to Ivanka Trump and her husband, Jared Kushner, arguably the most powerful White House aide.

The lines can be blurred. Kushner and Cohn are particularly close with the Cabinet’s industry barons — Commerce Secretary Wilbur Ross, Treasury Secretary Steven Mnuchin and Secretary of State Rex Tillerson — as well as Chris Liddell and Reed Cordish, two businessmen recruited by Kushner to work on long-term projects. Bannon and Priebus have their own relationships with those figures.

Still, many people inside and outside the White House frequently note the growing visibility of Cohn and Powell and wonder if they might eventually gain influence over Trump’s message and moderate it from Bannon-style populism, especially if the president’s popularity wanes further.

“They’re more involved than ever,” Larry Kudlow, a Trump ally and longtime CNBC economic analyst, said of the group. “Trump is instinctively drawn to them, but that doesn’t mean he’s losing his populist message. It means that in terms of day-to-day business and grinding out policy changes, he’s drawn to the business people that are around him.”

Tensions between Bannon and Priebus ran hot in the early days of the presidency, suggesting that their outsider-vs.-establishment feud would be the central division. But Priebus forged an alliance with Bannon, which they see as mutually beneficial because either or both could be sidelined if others, such as Cohn or Powell, ascend further, according to three White House officials.

The Post's Philip Rucker and Robert Costa painted a picture of the moderates gradually accruing more power but even if that's the case, the fact that the administration two months in is severely understaffed means that domestic policy is being driven by the congressional GOP, Republicans who are decidedly uninterested in compromise with centrists.

With few experts making policy and the ones who are often ignored, Ryan and his cohort are running the show.


The House speaker hinted as much on Friday when he described to attendees how he and Senate Majority Leader Mitch McConnell "spent much of the post-election with the president to map out a 200-day agenda."

The congressional GOP leadership is also responsible for the health care proposal currently being referred to as "Trumpcare." It has also spearheaded a bill that was just passed which requires welfare recipients to be subjected to drug testing, even though such screenings have largely been proved to be ineffective and wasteful.

By the same token, while the leadership's health care bill is currently reviled by conservative legislators as "ObamaCare Lite," its ultimate purpose is to cut enough Medicaid spending from federal budget to enable the passage of a large tax cut package skewed toward Americans with high incomes.

"It makes tax reform a trillion dollars easier," Ryan said at the National Review conference.


“We’ve been dreaming of this since you and I were drinking out of a keg,” he added to audience laughter.

The prospects for the health care bill remain in doubt, given far-right opposition, but it's not exactly a surprise that for Republicans, all roads are still leading to tax cuts for the wealthy.

Matthew Sheffield

A writer, web developer, and former tv producer, Matthew Sheffield covers politics, media, and technology for Salon. You can email him via m.sheffield@salon.com or follow him on Twitter.

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American Health Care Act Donald Trump Health Care Paul Ryan

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