Trump, McConnell, Sanders Star In New ACA Theatrics

Part tragedy and part comedy, the ongoing debate over the Affordable Care Act (ACA) seems more like a Shakespearean play than a matter of policy. This week, as the house lights dim once more on the political theater of American healthcare, a bipartisan committee in the senate will go about determining the fate of the ACA and the health of millions. This production features three acts, several twists, and an ending that will likely prove predictable only in retrospect.



Character Introductions: I Do Bite My Thumb, Sir

The main curtain draws on the warring houses of Trump and McConnell. The president and senate majority leader have been feuding for months. Trump has taken to Twitter, branding McConnell a failure for the senate's "no" vote back in July. Behind the scenes, McConnell quietly stews, questioning the president's ability to lead. These two protagonists are diametric opposites within the same party – classic archetypes with wholly incompatible styles. Right away, we sense their backstories foretell an ominous ending.

Social scientists and scriptwriters alike would label Trump an "expressive," a vocal leader who has curated a larger-than-life persona, believing himself capable of achieving "huge" things in relative short order. He demands attention for his successes and derides scapegoats for his failures. It was therefore hardly out of character when candidate Trump said in October it would "be so easy" to "immediately" pass a "great" new healthcare law. And then, when senate republicans failed to deliver, Trump stayed true to his expressive style, laying the blame squarely and publicly on the shoulders of McConnell.


In sharp contrast, McConnell would best be labeled an "analytic," rising to power as senate majority leader with his pragmatic intelligence and behind-the-scenes tenacity. Owing to his determination and consensus-building skills, McConnell persuaded his party to resist Barack Obama's every legislative ambition while in office, effectively blocking his Supreme Court nominee for nearly a year. And in response to Trump's bombastic health policy demands, McConnell's analytical style came through loud and clear: "I think he had excessive expectations about how quickly things happen in the democratic process."

Act 1: Prophesies Of Doom

Cue the bipartisan senate meetings. An urgent deadline approaches. Insurance companies have until month's end to sign their 2018 contracts with the government, thus determining their prices and standing within the health insurance marketplace. Senators insist the government must kick in so-called cost sharing reduction (CSR) payments to help patients offset high out-of-pocket expenses, lest insurers hike premiums or, worse, exit the market altogether.