WASHINGTON — As they take their victory lap for passing a bill that would repeal and replace much of the Affordable Care Act, President Trump and congressional Republicans have been largely silent about one of the most remarkable aspects of what their legislation would do: take a step toward dismantling a vast government entitlement program, something that has never been accomplished in the modern era.
Fighting the expansion of the so-called welfare state is a fundamental premise of the American conservative movement. But as tens of millions of Americans have come to rely on coverage under the 2010 health law, Republicans have learned the political risks of being seen as taking a hatchet to the program, however imperfect it may be.
So conservatives have now cast aside their high-minded arguments of political principle, replacing them with dense discussions of policy. Pre-existing conditions, risk pools and premium costs — not the more conventional Republican disquisitions in favor of the free market, personal responsibility and smaller government — dominate the debate today.
This dramatic shift in focus has confirmed what conservatives said they always feared when Democrats granted the government expansive new powers over health care. The government can giveth, they said, but it can almost never taketh away.
