Politics. The George Washington as Cincinnatus narrative emerged almost immediately after the first president left office, so unusual was the peaceful transfer of power in the 18th century.
If you summon your recollection of Livy’s History of Rome, Cincinnatus was remembered for his decision, after using dictatorial powers to dispatch the plebians, to return to farming in the Italian countryside.
The people in charge of the narrative in 1797 conveniently forgot all the dictator stuff as they celebrated Washington’s return to farming, mostly through monumental sculpture, like Horatio Greenough’s work in the National Museum of American History in Washington, D.C.
Since then, U.S. presidents have mostly quit the U.S. Capitol voluntarily or through electoral defeat. They distinguished themselves as statemen through a quiet retirement of library building, book writing, and, yes, farming.
The exceptions to this tradition have been those cases when the former president becomes the future candidate such as Presidents Theordore Roosevelt, Richard Nixon and Donald Trump.
(Not a candidate but still doing his best Theodore Roosevelt to William Taft, is former President Barack Obama who resides part time in northwest Washington, D.C.)
These men cannot be dispensed with as “former” anything, so they persist in their influence on federal power dynamics.
The result? A dark horse Speaker of the House.
Policy. Forgotten in the maelstrom that has been a nearly policy-free political environment for the last 20 years, is the nearly bi-partisan support for certain segments of the Affordable Care Act.
Specifically, developing a system of health insurance that was not tied to employment was embraced by members on both sides of the aisle in 2008-ish. The cost of health insurance gives a competitive edge to large, established employers. It also makes hiring younger workers more attractive than older ones – not that anyone would do that.
The political misjudgments that made the Affordable Care Act big enough to double as a door stop, doomed most of the law to mediocre success, except perhaps the Medicaid expansion, depending on how you define success.
However, the recent elimination of the upper bound qualifying threshold for tax subsidies and credits until after the 2024 election is yielding the expected result. ELV and CNC have reported growth in this part of their book.
It is also creating a middle class benefit which provides a durability known only to things like mortgage interest deduction.
It is curious that several Republican-controlled states have moved to open their own state-based exchanges, as originally envisioned. Once vehemently opposed, they now see merit in offering a tool to access federally subsidized insurance policies.
A lot can change between now and January 2025 but the individual commercial insurance business has better prospects than ever before, the political baggage of the ACA notwithstanding. Perhaps former President Barack Obama's persistent presence in Kalorama is having a salutary effect.
Power. One would think that after all the Speaker drama of the last year and the thin majority Republicans hold in the House, the final choice would be a moderate. Turns out, no, Speaker Mike Johnson is more conservative than Rep. Kevin McCarthy and possibly even a little right of Rep. Jim Jordan.
For our purposes, Speaker Johnson’s central issue is religious liberty and ensuring the federal government is as uninvolved as possible in issues of conscience. As a result, you should not expect any legislative fixes to the war being waged over FDA’s use of accelerated approvals to permit widespread use of mifepristone.
In fact, you should probably expect funding hang-ups over Hyde-amendment language and related topics.
And you should be wondering what has changed that the Republican conference would unanimously elect the most socially conservative Speaker in decades, maybe ever.
It probably has something to do with the power and influence of a once and future president.
Have a great rest of your weekend.
Emily Evans
Managing Director – Health Policy
Twitter
(Politics, Policy & Power is published in the quiet of Sunday afternoon or holiday Monday and attempts to weave together the disparate forces shaping health care. It makes no attempt to defend or prosecute the views of any established political party or cause. Any conclusions to the contrary rest with the reader alone.) in the U.S.
