One of Trump’s main campaign promises was to repeal and replace the Affordable Care Act. You may know it better as Obamacare, a sobriquet devised by those opposing the scheme that has now passed into near universal usage. Republicans have been promising this for years, but now that Obama will no longer be in office to veto a proposed bill they might actually attempt to do it.

Let’s start with  the repeal part of this promise. Republicans really, really hate Obamacare. So the will is certainly there. But as I have mentioned so many times before it is much easier to stop things happening in the American system than to push them forward. Witness the soul-crushing, years-long slog Obama, Pelosi and Reid had to go through to pass the dashed thing in the first place. Repealing it would be a long and hard campaign for the GOP, not least because they can count on stiff Democratic opposition.

Many Democrats, particularly the now ascendant Liberal wing of the party, didn’t like the Affordable Care Act because it was a messy compromise. Many wanted a system analogous to the rest of the developed world where the government simply paid for medical treatment for those who need it. They were brought along kicking and screaming, eventually acceding to the reality that there were not the required 60 votes for such a proposal in the Senate. The Republicans can probably repeal it. But if the Democrats choose, and I think they will, they can make the process time costly in both time and political capital. The increasingly desperate and angry progressives who wanted more to start with will not go gently into the night.

That brings us to the replace part of the plan. This, friends, is where the wheels really start to come off. Trump has at this stage promised to keep the parts of the law that make it illegal to refuse coverage to those with pre-existing medical conditions. That is good. He has also said he want’s to have ‘universal health care’. That is also good. But Trump says he will do it without mandating individuals purchase health insurance on the one hand or providing government insurance on the other.

This is total nonsense. You can’t have universal healthcare without either mandating private healthcare or providing public healthcare. That isn’t what those words mean. Moreover, one of the problems with Obamacare is that not enough young and healthy people signed up, meaning the risk pool wasn’t sufficiently diverse and premiums kept rising to try and make up the difference. Remove the mandate and the numbers get much worse. It just doesn’t  work.

The Republican plan a la Paul Ryan would basically make healthcare cheaper to those who don’t need it and more expensive for those who do. The bottom line is that if you want everyone to have healthcare, and insurance companies to cover people on whom they will never make a dime because of chronic and pre-existing conditions, someone has to pay. Either other consumers or the taxpayer.

Trump is essentially trying to have his cake and eat it as well. Nobody really likes the individual mandate, but it’s the part that makes the whole thing function. So his promise and stated policy are obviously bunk. What then should we expect?

Well, it’s pretty clear what his pick for Secretary of Health and Human Services (HHS) wants, and it isn’t anything good. Tom Price has been one of the harshest critics of health care reform, advocating repeatedly and vociferously for measures that would totally the progress that has been made over Obama’s two terms in the oval office. If Trump wanted a conciliatory plan that protected the most vulnerable he certainly picked the wrong guy to execute it.

Of course, this isn’t really news. It shouldn’t surprise any of us that Trump obviously has no understanding of the American healthcare system. I myself doubt if he understands any system at all with the possible exception of bankruptcy courts. But it demonstrates very neatly the problems he will run into as he tries to make headway with what we may charitably call his policy program.

Because Trump wasn’t elected as the leader of a party of pragmatic center-right conservatives. Doing what he seems to genuinely be his inclination, keeping exemptions for pre-existing conditions and ensuring everyone has health care, will require measures utterly unacceptable and antithetical to both his base and the cavalcade of sycophants and mediocrities with which he now surrounds himself.

A time is rapidly approaching when Trump can’t simply exist in the world of tweets and word-salad, easily forgotten by the next news cycle and impervious to decryption. He cannot be all things to all people as President. He will have to take a stance and codify his position in black and white. And once he does that there are going to be a lot of very, very angry people on one side of politics or the other.

And in case you thought he might have some master plan up his sleeve, if he waits too long he will lose the initiative. Paul Ryan knows exactly what he wants to do about health care. He has been thinking, writing, filling ring-binders with detailed tables and spreadsheets for years. The same goes for many of the hardline, anti-government conservatives within his party. If Trump fails to take the lead on the issue he is likely to be led by the nose as the congressional wing of his party, scared witless by the rabidity of the base they must face in only two years, starts writing the next chapter without him.

 

While gubernatorial elections in the United States get a lot less media attention both domestically and internationally than contests for federal office they are extremely important. There are two main reasons for this.

Firstly there are the governmental reasons. Governors are quite powerful. Like the President they sit atop large bureaucracies of state organisations, administer large budgets and wield great political influence. Governors really can change states, setting priorities and shepherding legislation through state legislatures. Gun control, healthcare, law enforcement, infrastructure and a host of other issues have all been pushed by various governors across the country during their time. Franklin Roosevelt used to conceive of the state governments as fifty laboratories for testing policy, and history has shown a great deal of truth to this.

The Affordable Care Act, or Obamacare if you would rather, gained considerable inspiration from Mitt Romney’s experience reforming healthcare in Massachusetts. They can also set precedents and give the lead to other states as California did with its emission standards and carbon reduction schemes. So from a policy and governance standpoint winning gubernatorial elections is important.

Secondly there are political reasons to care about performance in these contests. It is usually governors who run for Senate and President, so the more you have the deeper your bench of talent is. This is how one avoids the sad state of affairs in the Democratic party in the recent cycle, where the pool of high-profile and top-tier candidates was depressingly small, mostly due to Republicans thrashing them in gubernatorial contests across the country during the Obama years.

Having a large contingent of proven politicians with executive experience to run for higher office is of inestimable value to a political party. It also provides you with partners in state government to help with the implementation of federal laws and initiatives. By contrast it is often quite difficult to force a recalcitrant governor into compliance, draining political capital and slowing down the process of reform even further.

There are also other political dividends that can accrue form good performance in gubernatorial contests. For instance, influence or control of state redistricting boards to try and redress the gerrymander currently benefiting the Republican party or just make sure that election law is fairly and properly implemented.

The governorship will be up for grabs in 36 states in 2018, and while some of these are states like Texas or Arkansas where the Democrats have little chance of unseating incumbents in conservative states many others are up for grabs. This is either because the incumbent is term-limited, retiring or a Democrat, as well as a few others where Republican incumbents will be running in what are largely Democratic or swing states.

Connecticut, Oregon, New York, Pennsylvania, Rhode Island and Hawaii should all be pretty easy to keep in the blue column. These states have Democratic incumbent governors in pretty safe states.

Of the rest the most promising looking targets to me are states with term-limited or retiring Republican governors. Florida, Maine, Michigan, Nevada, New Mexico and Ohio will all have open seats as well as having given their electoral votes either to Clinton or to Trump by a small to moderate margin. If the Democrats can nominate good candidates in these races and resource them properly there is no reason why any should be unbelievable. That is important, because some of these states are large with powerful and influential state governments. For political purposes its also pretty useful to have a guy hanging around in the wings who can deliver Ohio, Florida or Michigan. That is a pretty good feather  in the cap for a Presidential aspirant, as well as making it easier to challenge sitting Republican senators in any of those states.

The other category worth mentioning are states where a Republican incumbent is running for re-election but might be vulnerable, or where the incumbent isn’t running. Places like Illinois, Maryland, Massachusets, New Hampshire, Vermont, Wisconsin and Iowa spring most obviously to mind.

Previously Democrats have allowed their performance in Gubernatorial contests to slide. Partly I think this is because Liberals in particular tend to think in a to-down fashion, without the emphasis on local solutions and offices that Conservatives often evince. The increasingly liberal ideology of the democratic party is much more focused on national solutions and programs, as are their donors and activists.

But there has also been a part for hubris. Excellent performance at the federal level during the Bush years, where they could run against an increasingly unpopular Republican program and incumbent was seen as a protection against more conservative State administrations. And then the election and re-election of President Obama provided something of a false sense of security. It didn’t matter so much that they kept getting creamed in races for governor, because they had the Presidency.

Now no such reasoning can be employed. Democrats have a reasonably favorable map, a soon-to-be President with historically low approval ratings to run against and a base that is virtually being galvanized for them by the daily toxic emissions from the Trump camp.

Being at the nadir of your political powers is disheartening and sad for any party. But from here the only way is up, and it seems like a lot of people have realized that the best route back to serious national power for the Democratic party runs through governors offices all around the country, and not from a myopic focus on the House and Senate.