One of the main prerogatives of the presidency compared to Congress is its freedom in foreign policy: to make treaties, negotiate agreements and to deploy troops. But while Congress cannot set foreign policy, writes Jeremi Suri, it can influence it through the power of its purse. He argues that from now until at least 2020, we should expect push back from Congressional Democrats on President Trump’s nationalistic rhetoric as well as on his trade and military agendas

Suri, Jeremi

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LSE Research Online

Despite	Democrats’	takeover	of	the	House,	don’texpect	Republicans	to	give	up	on	undoing	ObamacareIn	the	lead	up	to	last	week’s	midterm	elections,	polls	consistently	showed	that	healthcarewas	on	the	forefront	of	many	Americans’	minds.	With	the	Democratic	Party	now	in	controlof	the	US	House	of	Representatives,	Republican	efforts	to	repeal	President	Obama’ssignature	healthcare	reform,	Obamacare,	are	likely	to	be	significantly	curtailed.	But	thatdoesn’t	mean	they	will	end	completely,	argue	Simon	F.	Haeder	and	Philip	Rocco.Drawing	on	evidence	from	their	research	on	previous	Republican	actions	to	repealObamacare,	they	write	that	the	influence	of	activists	within	their	party	means	that	the	GOP	are	likely	to	continue	theirefforts	to	impede	the	full	operation	of	the	Affordable	Care	Act	at	the	state	level,	through	the	courts,	and	via	executiveactions.The	Affordable	Care	Act	(ACA)	was	a	big	winner	in	last	week’s	elections.	Across	the	country,	Democrats	ran	onprotecting	pre-existing	conditions,	defeating	Republican	governors	like	Wisconsin’s	Scott	Walker,	who	had	used	theiroffice	to	obstruct	the	implementation	of	healthcare	reform,	as	well	as	the	architects	of	congressional	efforts	to	repealthe	law	like	Rep.	Tom	MacArthur	(R-NJ).	Ballot	measures	to	expand	Medicaid	passed	in	the	deep	red	states	ofIdaho,	Nebraska,	and	Utah.Yet	legislative	losses	for	Republicans	do	not	mean	that	the	ACA	is	now	safe	from	interference.	As	our	researchshows,	there	are	good	reasons	to	believe	that	Republicans	will	continue	to	pursue	their	long-held	goal	of	undoingPresident	Obama’s	signature	accomplishment.	While	full-blown	statutory	repeal	(and	replace)	now	seems	off	theagenda	with	a	Democratic	takeover	of	the	House,	Republicans	continue	hold	many	tools	at	their	disposal	to	continuetheir	question	to	impede	the	ACA’s	full	potential.Our	recent	work	shows	that	repeal	efforts	have	been	driven	not	by	voters	but	by	“intense	policy	demanders.”	Theseare	mobilized	activists	within	the	Republican	coalition	that	use	their	control	of	important	electoral	resources	to	shapethe	policy	agenda.		When	it	comes	to	the	ACA,	these	extremists	have	defined	the	politics	of	repeal	and	replace	infundamental	ways.	There	is	little	reason	to	suspect	that	they	will	relinquish	this	goal.What	Republicans	Have	Done	to	Make	the	ACA	FailWhile	our	most	recent	research	is	focused	on	hotbeds	of	Republican	in	Congress,	Republican	opposition	has	ofcourse	not	been	only	come	from	the	US	Congress.	Many	Republican-controlled	state	legislatures	and	governorshave	done	their	fair	share	to	oppose	the	implementation	of	the	Affordable	Care.Dozens	of	lawsuits	have	been	filed	seeking	to	overturn	parts	or	the	entirety	of	the	healthcare	law.	Many	states	haverefused	to	establish	insurance	marketplaces	or	expand	their	Medicaid	program,	leaving	millions	of	Americansuninsured	and	victims	of	a	political	struggle.	Various	states	have	passed	unenforceable	statutes	and	constitutionalamendments	seeking	to	nullify	the	ACA	within	their	borders.	Others	have	prohibited	state	employees	fromcooperating	with	the	federal	government	in	any	implementation	activities.	Some	states	are	seeking	to	establish	a	so-called	health	compact	that	would	allow	them,	with	Congressional	approval,	to	circumvent	ACA	requirements.	Mostrecently,	states	like	Idaho	and	Iowa	are	seeking	to	establish	alternative	insurance	markets	to	sell	low	qualityinsurance	products	prohibited	under	the	ACA.On	top	of	Republican	opposition	in	the	states,	the	Trump	Administration	has	taken	a	slew	of	action	seeking	todamage	and	undo	much	of	the	Affordable	Care	Act	since	taking	office.	Initially,	the	Trump	Administration	sought	toraise	the	uncertainty	in	the	minds	of	Americans,	ACA	beneficiaries,	and	insurance	companies	about	the	viability	ofthe	ACA	by	making	a	slew	of	false	and	misleading	statements	to	destabilizing	insurance	markets	across	the	country.Over	time,	the	Trump	Administration	has	supplemented	these	efforts	through	regulatory	efforts	seeking	to	reduce	theimpact	of	the	ACA.Our	Research	on	Republican	Opposition	in	CongressUSApp – American Politics and Policy Blog: Despite Democrats’ takeover of the House, don’t expect Republicans to give up on undoing Obamacare Page 1 of 3		Date originally posted: 2018-11-14Permalink: http://blogs.lse.ac.uk/usappblog/2018/11/14/despite-democrats-takeover-of-the-house-dont-expect-republicans-to-give-up-on-undoing-obamacare/Blog homepage: http://blogs.lse.ac.uk/usappblog/Our	research	focuses	on	the	actions	taken	by	Republicans	in	the	US	Congress	in	opposition	to	the	Affordable	CareAct,	which	has	seen	little	scholarly	attention	so	far.We	argue	that	much	of	the	persistence	of	Republican	resistance	in	Congress	more	than	eight	years	after	thepassage	of	the	ACA	can	be	attributed	to	intense	policy	demanders.	These	ideological	extremists	like	the	Koch-funded	Americans	for	Prosperity	seek	to	use	resources	at	their	disposal	like	campaign	contributions	to	support	like-minded	individuals	in	their	quest	for	political	office	in	return	for	loyalty	commitments	to	their	favored	causes.	Andindeed,	it	was	these	intense	policy	demanders	that	defined	the	boundaries	of	the	retrenchment	agenda	during	theearly	implementation	of	the	ACA	and	beyond.Credit:	NOBama	NoMas	[CC	BY-SA	2.0],	via	Wikimedia	CommonsThe	first	part	of	our	analysis	looks	at	the	introduction	of	bills	seeking	to	overturn	all	or	part	of	the	ACA.	Our	findingsshow	that	contributions	by	businesses	are	the	most	important	driver	of	bill	introductions	seeking	to	undo	the	ACA.This	particularly	holds	for	the	introduction	of	bills	seeking	the	outright	repeal	of	many	or	all	of	the	ACA	provisions.	Notsurprisingly,	the	most	conservative	Members	of	the	House	were	also	the	ones	seeking	to	undo	the	ACA.The	second	part	of	our	analysis	looked	at	the	votes	of	Members	of	the	House	of	Representatives	on	the	first	majorrepeal	effort	under	the	Trump	Administration,	the	American	Health	Care	Act	(AHCA).In	its	initial	form,	the	AHCA	proved	decidedly	too	liberal	for	groups	like	the	Heritage	Foundation	and	the	Koch-fundedAmericans	for	Prosperity,	terming	it	“Obamacare	Lite.”	Not	surprisingly,	in	a	whip	count	taking	days	before	anexpected	vote,	the	group	closest	to	AFP	and	Heritage,	the	Freedom	Caucus,	refused	to	support	the	bill	pushed	bySpeaker	Paul	Ryan.	Indeed,	membership	in	the	Freedom	Caucus	proved	the	overwhelming	predictor	of	Republicanopposition	to	the	AHCA.Seeking	to	salvage	their	repeal-and-replace	efforts,	Republicans	were	able	to	negotiate	an	agreement	that	sought	tobring	that	vast	majority	of	Congressional	Republicans	on	board,	the	so-called	MacArthur	amendment.	Theamendment	allowed	states	to	opt	out	of	almost	all	the	requirements	of	the	ACA.	As	a	result,	virtually	all	Republicansin	the	House	of	Representatives	eventually	voted	for	the	bill.That	House	conservatives	ran	the	table	on	the	AHCA	should	be	instructive	given	the	results	of	last	week’s	elections.By	and	large,	Democrats’	wins	last	week	wiped	out	moderates	while	the	conservatives	who	pushed	a	more	hardlineversion	of	‘repeal	and	replace’	largely	remain	in	office.	While	they	may	not	be	able	to	push	their	preferred	legislationout	of	the	House,	it	is	doubtful	that	their	positions	on	the	ACA	will	changes	substantially.What	Our	Research	Indicates	for	the	Future	of	the	ACAUSApp – American Politics and Policy Blog: Despite Democrats’ takeover of the House, don’t expect Republicans to give up on undoing Obamacare Page 2 of 3		Date originally posted: 2018-11-14Permalink: http://blogs.lse.ac.uk/usappblog/2018/11/14/despite-democrats-takeover-of-the-house-dont-expect-republicans-to-give-up-on-undoing-obamacare/Blog homepage: http://blogs.lse.ac.uk/usappblog/Outright	repeal	seems	off	the	table	for	the	time	being.	However,	intense	policy	demanders	are	not	likely	to	bedeterred	by	the	election	results.	Instead,	they	will	continue	to	exert	their	sway	in	the	Republican	Party	at	the	federaland	state	levels.We	expect	the	Trump	Administration	to	double	down	on	its	efforts	to	use	regulatory	policymaking	to	little	the	efficacyof	the	Affordable	Care	Act.	With	broad	delegative	powers	inherent	in	the	ACA,	the	Trump	Administration	has	a	largeset	of	opportunities	to	shape	the	ACA.	This	includes	everything	from	further	relaxing	oversight	of	provider	networks	inthe	insurance	marketplaces	to	weakening	the	ACA’s	contraception	coverage	requirements.	Based	on	recent	action,	italso	seems	likely	that	the	Trump	Administration	will	continue	its	efforts	to	expand	coverage	options	outside	thepurview	of	the	ACA.Perhaps	equally	important,	with	an	extended	majority	in	the	Senate,	Republicans	will	move	swiftly	ahead	withconfirming	solidly	conservative	judges.	With	many	parts	of	the	ACA	still	in	litigation,	and	with	a	significant	need	forcontinuously	issuing	regulations,	the	courts	continue	to	remain	pivotal	when	it	comes	to	the	implementation	of	thehealth	law.	Moreover,	moderates	Lisa	Murkowski	and	Susan	Collins	have	now	lost	their	pivotal	status	when	it	comesto	judicial	nominees,	who	can	be	confirmed	with	simple	majorities.Even	with	large	Democratic	gains	in	the	states,	a	large	number	of	states	remain	solidly	in	Republican	hands.	Thisbodes	ill	for	the	further	expansion	of	Medicaid	or	the	strengthening	of	insurance	markets	for	example	via	state-basedindividual	mandates	or	reinsurance	programs.Finally,	the	ongoing	Texas	v.	Azar	lawsuit	remains	a	potential	wild-card.	Seeking	to	achieve	what	Republicans	inWashington,	DC	have	been	unable	to	do,	Republican	attorneys-general,	led	by	Texas,	are	aiming	to	wipe	out	theACA	through	the	judicial	pathway.	While	this	case	is	likely	headed	to	the	Supreme	Court,	its	outcome	appearscompletely	open.	Of	course,	should	Republicans	be	successful,	all	the	cards	will	be	reshuffled.	This	blog	post	is	based	on	the	article	“How	Intense	Policy	Demanders	Shape	Post-Reform	Politics:	Evidencefrom	the	Affordable	Care	Act.”	in	the	Journal	of	Health	Politics,	Policy	and	Law.Please	read	our	comments	policy	before	commenting.											Note:		This	article	gives	the	views	of	the	author,	and	not	the	position	of	USAPP	–	American	Politics	and	Policy,	northe	London	School	of	Economics.Shortened	URL	for	this	post:	http://bit.ly/2zSqJXnAbout	the	authorsSimon	F.	Haeder	–	West	Virginia	UniversitySimon	F.	Haeder	(@simonfhaeder)	is	an	assistant	professor	in	the	department	of	political	science	in	theJohn	D.	Rockefeller	IV	School	of	Policy	&	Politics	at	West	Virginia	University.	Simon	is	also	a	Fellow	inthe	Interdisciplinary	Research	Leaders	Program,	a	national	leadership	development	program	supportedby	the	Robert	Wood	Johnson	Foundation	to	equip	teams	of	researchers	and	community	partners	inapplying	research	to	solve	real	community	problems.	Philip	Rocco	–	Marquette	UniversityPhilip	Rocco	(@philiprocco)	is	an	assistant	professor	in	the	Department	of	Political	Science	atMarquette	University.	He	is	the	co-author	of	Obamacare	Wars:	Federalism,	State	Politics,	and	theAffordable	Care	Act	(University	Press	of	Kansas,	2018).	His	work	has	been	featured	in,	among	othervenues,	Journal	of	Health	Politics,	Policy,	and	Law,	Political	Science	Quarterly,	Publius:	The	Journal	ofFederalism,	Journal	of	Aging	and	Social	Policy,	and	Policy	Studies	Journal.	USApp – American Politics and Policy Blog: Despite Democrats’ takeover of the House, don’t expect Republicans to give up on undoing Obamacare Page 3 of 3		Date originally posted: 2018-11-14Permalink: http://blogs.lse.ac.uk/usappblog/2018/11/14/despite-democrats-takeover-of-the-house-dont-expect-republicans-to-give-up-on-undoing-obamacare/Blog homepage: http://blogs.lse.ac.uk/usappblog/

The Democrats are about to remind us that while Donald Trump has great freedom in foreign policy, it’s Congress which holds the purse strings

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The Democrats are about to remind us that while Donald Trump has great freedom in foreign policy, it’s Congress which holds the purse strings

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