Tamara Keith and Amy Walter talk about the GOP’s struggle with rising health care costs

Jeff Bennett:

A former key Trump ally plans her departure from Congress, the DOGE is quietly disbanded, and Washington faces rising health care costs once again.

To discuss that and more, we now turn to Monday’s policy duo. This is The Cook Policy Report’s Amy Walter with NPR’s Amy Walter and Tamara Keith.

Always great to see you both.

Tamara Keith, NPR:

It’s good to see you.

Jeff Bennett:

So President Trump was expected today to unveil his plan to deal with rising health insurance premiums for Obamacare, but that announcement, White House and Congressional teams were told, was delayed after Republicans in Congress opposed the president’s apparent sudden embrace of these expiring subsidies.

Amy, what does this delay tell us about the internal dynamics of the Republican Party, especially between the White House and Republican congressional leadership?

Amy Walter, Cook Political Report:

right.

So the health care issue is something that Republicans in Congress have long wrestled with and haven’t really found an answer for. I came back because I remembered, after John Boehner, the former Speaker of the House, had been out of office for a short time, in 2017, when the first version of the Repeal and Replace the ACA came out, he was quoted at a conference as saying: I’ve been in Congress for 25 years. I’ve never seen a single time where Congress agreed on what a health care proposal should look like.

In other words, even before the replacement and repeal failed in 2018, he was predicting it wouldn’t work because Republicans were having a tough time on the issue. This is number one.

The second is that when the divide is real between the president, who believes this is a political liability coming into the midterms, he sees where the polls are at, he sees how much support there is for expanding these ACA subsidies, and Republicans in Congress, who are ideologically very opposed to everything the ACA stands for, many of whom voted to repeal it not long ago when the president was in his first term.

Jeff Bennett:

More than 60 times.

Amy Walter:

Oh, yeah, 60 times, and then they finally got the vote to actually repeal it in 2017 or 2018.

Jeff Bennett:

right. right. Yes.

Tamara Keith:

Yes.

Jeff Bennett:

So, Tam, I mean, how does this episode highlight the tension, to Amy’s point, between ideological purity, the lack of Obama health care subsidies, and the pragmatism of, you gotta do something about these rising premiums?

Amy Walter:

right.

Tamara Keith:

So what happened is that President Trump changed the Republican Party, or at least changed Republican voters.

I was just talking to a political scientist about this today. He expanded the party. He expanded the tent. It brings in a lot of voters who are more working-class, who will be more sensitive to these increases in health care costs.

He has his finger on the pulse of his electoral base, which does not resemble the traditional Republican Party, or the Tea Party, which wants to reduce the size of government. And so, when you have a big tent — and President Trump’s presidency has kind of helped overcome that, when you have a big tent, there are divisions.

And what you’re seeing now is, with these narrow Republican majorities in the House and the Senate, those tensions between the liberal wing and the populist wing or whatever you want to call it, those tensions make it really difficult to get something done. And now Marjorie Taylor Greene is leaving, one less House Republican vote.

Jeff Bennett:

Well, what does it say, Amy, that Republicans have had a decade to come up with some sort of free market solution to health care coverage…

Amy Walter:

Yes. This is it …

Jeff Bennett:

…And yet they haven’t been able to settle on one?

Amy Walter:

Well, the only one who was more successful – a Republican who passed real health care reform was Mitt Romney as governor of Massachusetts…

Jeff Bennett:

right.

Amy Walter:

…which was the platform on which…

Jeff Bennett:

For Obamacare.

Amy Walter:

exactly.

And because of that, I think there’s a sense that we’re using that platform because it was something that Democrats used. But just kind of building on Tam’s point also about the tension within the party, there are 13 Republicans who have publicly stated, we would like to see these ACA extensions go forward.

They’re all in at-risk districts, districts that come out in 2026 that Trump narrowly won or Kamala Harris won. But most people in Congress don’t sit in that kind of district. But these are the people who will determine who will have a majority in the House of Representatives.

Jeff Bennett:

You mentioned Marjorie Taylor Greene. On Friday, she announced her resignation from Congress, effective January 5. This announcement came just one week after she criticized President Trump – or rather, President Trump withdrew his support for her after she criticized him.

But what does her surprising decision to resign tell us about the fault lines within the MAGA-era GOP?

Tamara Keith:

Well, first of all, it tells us that being a congressman isn’t glamorous. And I’ve seen a lot of members of Congress complaining about certain things, complaining about any number of things, having threats to their families, and just a general feeling of discomfort.

There are some ways to see this as a victory for President Trump. I criticized him. It wasn’t, and it wasn’t just the Epstein files. It was on the economy. It was on Venezuela. It was on other foreign entanglements. I became a critic from within the party. That was a problem for him.

Instead of sticking it out and fighting, she said, OK, peace, I’m out. And so, in some ways, this is a win for President Trump. In other ways, it’s a sign that these cracks exist and that people are actually thinking about what the party will look like when it’s no longer the leader who blocks out the sun and prevents others in the party from really deciding where the Republican Party is going.

Jeff Bennett:

Could her resignation create a ripple effect where you have other far-right members, people aligned with MAGA breaking with President Trump?

Amy Walter:

So I think she was a unique person, in that she came to Congress and immediately went for the shiny object of being in the spotlight.

The other case you can make is that she got too close to those lights and it impressed her and now it’s over. But you could also say that, going back to Tam’s point about what the Trump coalition looks like now, if you look at the polls and the election results that have happened, and the elections that have been held since 2025, and what you see is the MAGA base, Trump’s core base, they still like him very much.

They will stick to it. It’s that fringe coalition, young voters, Latino voters, and independents. When you see his numbers among those voters, these were people who never called themselves MAGA. They voted for Donald Trump because they thought he would do certain things, especially on the economy, and now they don’t see those things happening.

Thus, he loses his popularity with them. This is the biggest threat to Trump’s agenda going forward, meaning, what will Trump’s coalition look like in 2028? These are the voters who decide that.

Jeff Bennett:

Well, I mentioned the DOGE solution in the introduction. Fortunately for us, we still have time to talk about it.

So, Tam, then DOGE, the Department of Government Efficiency, will be disbanded ahead of schedule. This organization, the agency, however you want to call it, claims to have cut tens of billions of dollars in spending. They provided no verifiable accounting. How wide is the accountability gap here?

Tamara Keith:

Yes, they never provided receipts for all these cuts they claimed to have made. Many of the cuts they claimed to have made were not real. Others were so inefficient that they actually led to more spending, not less.

The reality is that DOGE has basically been dead since the summer, since President Trump’s falling out with Elon Musk. They have repaired that relationship now. But DOGE was more of an idea than a practical reality.

Jeff Bennett:

What does it say about the feasibility of rapid bureaucratic reform in a federal government built on bureaucracy?

Amy Walter:

Yeah, I think the one thing that it’s been successful in achieving, Jeff, is that it’s fundamentally changed the way that agencies operate and probably operate far, far beyond the four years of Trump’s term.

Jeff Bennett:

Well, we covered a lot of ground on Monday.

Amy Walter, Tamara Keith, thank you, as always.

Amy Walter:

You’re welcome.

Tamara Keith:

You’re welcome.