With the election of Donald Trump to become the 45th president, intense questioning has erupted over his intended legislative agenda when he takes office on January 20th. His campaign was full of slogans and platitudes (e.g., “I’m gonna build a wall with a big, very beautiful door”) but pretty weak on policy substance. The Trump transition team launched a new government-hosted website, GreatAgain.gov, earlier this morning. The site architecture is there, but most of the pages are blank. As the site fills in, it will be another source for policy information. But where else should the nonprofit sector look for clues to where Trump and the incoming Republican Congress take the country and address issues affecting civil society?
After meetings on Capitol Hill yesterday, Trump mentioned three priorities. “We’re going to move very strongly on immigration. We will move very strongly on health care. And we’re looking at jobs. Big-league jobs.” Trump added, “We have a lot of priorities, a lot of really great priorities,” Trump added. “People are gonna be very, very happy.”
There are a plethora of interest groups, think tanks, experts, and potential presidential appointees that have their own ideas that may wander into the mix as policy and platform become legislation. Examples of media speculation include articles on what Trump’s election means for higher education and the future of Social Security. Advocacy groups like Breast Cancer Action are writing about their beliefs—and often fears—about the coming administration and the new Congress.
One documented route for discerning upcoming legislative priorities, however, begins with the Republican platform, moves to the Trump campaign itself, and follows up with consideration of what Speaker Paul Ryan (R-WI) and the House Republicans propose in their “A Better Way” agenda. Each of these three stops addresses several issues and policy proposals.
Rather than address each of these areas in depth, we’re going to focus on healthcare, since it serves as a helpful example that touches the nonprofit sector at several points. It will have a strong impact on the work of the nonprofit sector that extends beyond nonprofit hospitals and community health clinics to substance abuse work, mental health, nursing homes, personal care, and much more. What might be in store includes dismantling structures only just built at great cost and a general refitting that could require enormous amounts of time and money.
An analysis of the draft “Republican Platform 2016” was featured by NPQ shortly before the GOP Convention last summer. The preamble in the 66-page final version includes the following statement: “The President and the Democratic party have dismantled Americans’ system of healthcare. They have replaced it with a costly and complicated scheme that limits choices and takes away our freedom.” The platform briefly mentions technological innovations beneficial to healthcare administration and opposition to funding Planned Parenthood “so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare” as well as more general opposition to abortion.
The platform specifically mentions “preserving Medicare and Medicaid” by allowing people under age 55 to choose either the traditional Medicare program or transition to a “premium-support model.” The GOP platform advocates for block granting Medicaid funds, giving states more flexibility in systems administration as well as service changes.
The Affordable Care Act (ACA) receives at least two pages of dedicated coverage, as well as references in several other areas of the platform. As expected, repeal is job one. For replacement, the GOP advocates a combination of “what worked best in the past with changes needed for the future.” Reduced mandates, state regulation of insurance markets, and to “assist all patients, including those with pre-existing conditions, to obtain coverage in a robust consumer market.” Consumer choice, including insurance portability (even across state lines) is touted as the key to reducing costs and increasing options. This paradox of state-level regulation coupled with interstate portability of insurance isn’t resolved in the platform.
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Trump’s campaign website lists policy positions and key issues, but it’s still a leap from that information to actual legislation and regulations. The position paper lists seven components, each of which requires Congress to pass legislation:
- Completely repeal Obamacare
- Modify existing law that inhibits the sale of health insurance across state lines
- Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system
- Allow individuals to use Health Savings Accounts (HSAs)
- Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals
- Block-grant Medicaid to the states
- Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products
The position paper notes, “Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.” No source is cited for this figure; neither is the alternative cost of providing healthcare services to this population that would be denied insurance under a Trump administration.
The current House Speaker, Paul Ryan, is first and foremost a policy wonk. He was among the most articulate critics of Obamacare before its passage in 2009 and later achieved his dream job as chair of the House Ways and Means Committee before being drafted to be House Speaker in late 2015. In early 2016, Ryan assembled a group of GOP legislators and others to develop a policy agenda independent of the GOP platform or any of the 17 Republican candidates for president.
The “A Better Way” agenda is built around the mantra of “A confident America.” The central principle of healthcare is, “In a confident America, everyone has access to quality, affordable health care.” The three-page “snapshot” talks about distilling hundreds of ideas into a single plan that explicitly will not constitute either “a return to the pre-Obamacare status quo” or “an attempt to replace Obamacare and leave it at that.” The ideas center on four points: “More choices and lower costs; real protections and peace of mind; cutting-edge cures and treatments; and a stronger Medicare.”
There is no legislation written around this plan, according to the two-page FAQ sheet, because President Obama wouldn’t sign such a bill and because it won’t be a single bill, but rather a step-by-step approach including multiple pieces of legislation. In addition to the stated reasons, it’s a well-known fact of legislating that the first ideas reduced to paper are the easiest for one’s opponents to attack and one’s allies to wish to modify.
Healthcare is but one example, albeit a very important one, of many issues that can be traced in a similar way. There is a consistency in the ideology, aims, and even the bullet points outlined in the GOP platform, Trump’s campaign documents, and Paul Ryan’s House-based legislative plan. Analyzing the proposals separately and collectively paint a picture of where legislative priorities are most clearly in focus and where there may be general agreement between Republican factions. It provides opportunity for nonprofit advocates, if they choose and when possible, to fashion arguments that advance their missions using language and principles similar to those expressed in the documents.
One key to persuasive conversation is to secure agreement using the other party’s preferred language and communication style. Even if one chooses against persuasion and decides on opposition, it’s still important to know where the other side is coming from when fashioning one’s own arguments. In uncertain times, research is a valuable tool. Take advantage of new sources to help refine missions, communications, and advocacy.
We know nonprofits and philanthropists all over the country are girding for what’s to come and busy picking up the same clues we are. In healthcare, at least, many organizations, having just been through an enormous change that involved unending complexities and great expense, are very well informed about the threats and opportunities embedded in this moment for various populations and fields. We welcome reader contributions about their strategies and considerations as they face this new policy environment, and we welcome any guidance from readers about what you would like to see NPQ look into during this transition.