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Affordable Care Act

Trump Gets His Second Trifecta

The Atlantic

www.theatlantic.com › politics › archive › 2024 › 11 › republicans-win-senate-house-presidency › 680636

Donald Trump will begin his second term as president the same way he began his first—with Republicans controlling both the House and Senate.

The GOP scored its 218th House-race victory—enough to clinch a majority of the chamber’s 435 seats—today when CNN and NBC News declared Republicans the winner of two close elections in Arizona. How many more seats the Republicans will win depends on the outcome of a few contests, in California and elsewhere, where ballots are still being counted. But the GOP’s final margin is likely to be similar to the four-seat advantage it held for most of the past two years, when internal division and leadership battles prevented the party from accomplishing much of anything.

Such a slim majority means that the legislation most prized on the right and feared by the left—a national abortion ban, dramatic cuts to federal spending, the repeal of Barack Obama’s Affordable Care Act and Joe Biden’s largest domestic-policy achievements—is unlikely to pass Congress. “I don’t think they’re even going to try on any of those things,” Brendan Buck, who served as a top aide to former Speaker Paul Ryan during Trump’s first term, told me.

[Daniel Block: The Democrats’ Senate nightmare is only beginning]

Trump’s biggest opportunity for a legacy-defining law may be extending his 2017 tax cuts, which are due to expire next year and won’t need to overcome a Senate filibuster to pass. He could also find bipartisan support for new immigration restrictions, including funding for his promised southern wall, after an election in which voters rewarded candidates with a more hawkish stance on the border.

In 2017, Trump took office with a 51–49 Republican majority in the Senate and a slightly wider advantage in the House—both ultimately too narrow for him to fulfill his core campaign promise of axing the ACA. Next year, the dynamic will be reversed, and he’ll have a bit more of a cushion in the Senate. Republicans gained four seats to recapture the majority from Democrats; they now hold a 53–47 advantage, which should be enough to confirm Trump’s Cabinet picks and judicial nominees. The impact on the Supreme Court could be profound: Trump named three of its nine members during his first term, and should Justices Clarence Thomas and Samuel Alito, who are both in their 70s, retire in the next two years, he would be responsible for nominating a majority of the Court.

Yet on legislation, Republicans will be constrained by both the Senate’s rules and the party’s thin margin in the House. Republicans have said they won’t try to curtail the Senate’s 60-vote threshold for circumventing a filibuster. “The filibuster will stand,” the outgoing Senate minority leader, Mitch McConnell, declared on the day after the election. But he’ll be only a rank-and-file member in the next Congress. McConnell’s newly elected successor as party leader, Senator John Thune of South Dakota, reiterated his commitment to the legislative filibuster after winning a secret-ballot election for the role.

How many votes are needed to pass bills in the Senate won’t mean much if Trump can’t get legislation through the House, and that could be a far more difficult proposition. The two speakers during the current Congress, Kevin McCarthy and Mike Johnson, each had to rely on Democrats to get major bills passed, because the GOP’s majority proved too thin to govern. With Trump’s backing, Johnson should have the votes to stay on as speaker when the new Congress convenes in January. (When Trump addressed House Republicans today in Washington, the speaker hailed him as “the comeback king” and, NBC News reported, the president-elect assured Johnson he would back him “all the way.”)

But the Republican edge could be even narrower next year if Democrats win a few more of the final uncalled races. Trump’s selection of Representative Elise Stefanik of New York to serve as United Nations ambassador and Representative Mike Waltz of Florida to serve as national security adviser could deprive Republicans of two additional seats for several months until voters elect their replacements. (Senator Marco Rubio’s expected nomination as secretary of state won’t cost the GOP his Florida seat, because Governor Ron DeSantis can appoint an immediate replacement.)

[Read: Elise Stefanik’s Trump audition]

Still, the GOP has reason to hope for a fruitful session. During Biden’s first two years in office, House Democrats demonstrated that even a small majority could produce major legislation. They passed most of Biden’s agenda—though the Senate blocked or watered down some of it—despite having few votes to spare. And Trump exerts a much tighter grip on his party than Biden did on congressional Democrats. Unlike during Trump’s first term, few if any Republicans hostile to his agenda remain in the House. His decisive victory last week, which includes a likely popular-vote win, should also help ensure greater Republican unity.

“I think we will have a much easier time in terms of getting major things passed,” predicts Representative Mike Lawler of New York, whose victory in one of the nation’s most closely watched races helped Republicans keep their majority. “The country was very clear in the direction it wants Congress and the presidency to go.”

Trump might even hold sway over a few Democrats on some issues. Because Trump improved his standing almost everywhere last week, the House in January will include many Democrats who represent districts that he carried. Two House Democrats who outran their party by wide margins, Representatives Jared Golden of Maine and Marie Gluesenkamp Perez of Washington State, refused to endorse Kamala Harris, while several candidates who more fully embraced the party’s national message underperformed. Nearly all Democratic candidates in close races echoed Trump’s calls for more aggressive action to limit border crossings, which could yield the new president additional support in Congress for restrictive immigration legislation.

[Mike Pesca: The HR-ification of the Democratic Party]

Like most House Republicans, Lawler endorsed Trump, but he ran on a record of bipartisanship and told me he’d be unafraid to defy the president when he disagreed. As a potential swing vote in a narrow majority, he could have more influence over the next two years. Lawler told me Monday that the GOP should heed the voters’ call to focus on issues such as the economy, border security, tax cuts, and energy production. Pursuing a national abortion ban, he said, would be “a mistake.” And Lawler serves as a reminder that enacting legislation even in an area where Republicans are relatively unified, like tax cuts, could be difficult: He reiterated his vow to oppose any proposal that does not restore a costly deduction for residents of high-tax states such as New York and California—a change that Trump supports but many other Republicans do not.

Trump showed little patience for the hard work of wrangling votes during his first term. Now he’s testing his might on Capitol Hill—and displaying his disdain for Congress’s authority—even before he takes office. Though he didn’t endorse a candidate to succeed McConnell, he urged all of the contenders to allow him to circumvent the Senate by making key appointments when Congress is in recess. After he won, Thune wouldn’t say whether he’d agree. Trump apparently wants the ability to install nominees—Robert F. Kennedy Jr. as secretary of health and human services?—who can’t win confirmation by the Senate.

“The Trump world does not give a damn about normal processes and procedures and traditions and principles of the prerogatives of certain chambers,” Buck, the former GOP aide, said. “They just want to do stuff.” The fight could be instructive, an early indication that no matter how much deference the new Republican majority is prepared to give Trump, he’ll surely still want more.

Genetic Discrimination Is Coming for Us All

The Atlantic

www.theatlantic.com › health › archive › 2024 › 11 › dna-genetic-discrimination-insurance-privacy › 680626

The news came four years ago, at the end of a casual phone call. Bill’s family had always thought it was a freak coincidence that his father and grandfather both had ALS. But at the end of a catch-up, Bill’s brother revealed that he had a diagnosis too. The familial trend, it turned out, was linked to a genetic mutation. That meant Bill might also be at risk for the disease.

An ALS specialist ordered Bill a DNA test. While he waited for results, he applied for long-term-care insurance. If he ever developed ALS, Bill told me, he wanted to ensure that the care he would need as his nerve cells died and muscles atrophied wouldn’t strain the family finances. When Bill found out he had the mutation, he shared the news with his insurance agent, who dealt him another blow: “I don’t expect you to be approved,” he remembers her saying.

Bill doesn’t have ALS. He’s a healthy 60-year-old man who spends his weekends building his dream home by hand. A recent study of mutations like his suggests that his genetics increase his chances of developing ALS by about 25 percent, on average. Most ALS cases aren’t genetic at all. And yet, Bill felt like he was being treated as if he was already sick. (Bill asked to be identified by his first name only, because he hasn’t disclosed his situation to his employer and worried about facing blowback at work too.)

What happened to Bill, and to dozens of other people whose experiences have been documented by disease advocates and on social media, is perfectly legal. Gaps in the United States’ genetic-nondiscrimination law mean that life, long-term-care, and disability insurers can obligate their customers to disclose genetic risk factors for disease and deny them coverage (or hike prices) based on the resulting information. It doesn’t matter whether those customers found out about their mutations from a doctor-ordered test or a 23andMe kit.  

For decades, researchers have feared that people might be targeted over their DNA, but they weren’t sure how often it was happening. Now at least a handful of Americans are experiencing what they argue is a form of discrimination. And as more people get their genomes sequenced—and researchers learn to glean even more information from the results—a growing number of people may find themselves similarly targeted.

When scientists were mapping the immense complexity of the human genome around the turn of the 21st century, many thought that most diseases would eventually be traced to individual genes. Consequently, researchers worried that people might, for example, get fired because of their genetics; around the same time, a federal research lab was sued by its employees for conducting genetic tests for sickle-cell disease on prospective hires without their explicit consent. In 2008, the Genetic Information Nondiscrimination Act (GINA) was signed into law, ensuring that employers couldn’t decide to hire or fire you, and health insurers couldn’t decide whether to issue a policy, based on DNA. But lawmakers carved out a host of exceptions. Insurers offering life, long-term-care, or disability insurance could take DNA into account. Too many high-risk people in an insurance pool, they argued, could raise prices for everyone. Those exceptions are why an insurer was able to deny Bill a long-term-care policy.

[Read: The loopholes in the law prohibiting genetic discrimination]

Cases like Bill’s are exactly what critics of the consumer-genetic-testing industry feared when millions of people began spitting into test tubes. These cases have never been tallied up or well documented. But I found plenty of examples by canvassing disease-advocacy organizations and social-media communities for ALS, breast cancer, and Huntington’s disease. Lisa Schlager, the vice president of public policy at the hereditary-cancer advocacy group FORCE, told me she is collecting accounts of discrimination in life, long-term-care, and disability insurance to assess the extent of the problem; so far, she has about 40. A man Schlager connected me with, whose genetic condition, Lynch syndrome, increases the risk for several cancers, had his life-insurance premium increased and coverage decreased; several other providers denied him a policy altogether. Kelly Kashmer, a 42-year-old South Carolina resident, told me she was denied life insurance in 2013 after learning that she had a harmful version of the BRCA2 gene. One woman I found via Reddit told me she had never tested her own DNA, but showed me documents that demonstrate she was still denied policies—because, she said, her mom had a concerning gene. (Some of the people I spoke with, like Bill, requested not to be identified in order to protect their medical privacy.)

Studies have shown that people seek out additional insurance when they have increased genetic odds of becoming ill or dying. “Life insurers carefully evaluate each applicant’s health, determining premiums and coverage based on life expectancy,” Jan Graeber, a senior health actuary for the American Council of Life Insurers, said in a statement. “This process ensures fairness for both current and future policyholders while supporting the company’s long-term financial stability.” But it also means people might avoid seeking out potentially lifesaving health information. Research has consistently found that concerns about discrimination are one of the most cited reasons that people avoid taking DNA tests.

For some genetically linked diseases, such as ALS and Huntington’s disease, knowing you have a harmful mutation does not enable you to prevent the potential onset of disease. Sometimes, though, knowing about a mutation can decrease odds of severe illness or death. BRCA mutations, for example, give someone as much as an 85 percent chance of developing breast cancer, but evidence shows that testing women for the mutations has helped reduce the rate of cancer deaths by encouraging screenings and prophylactic surgeries that could catch or prevent disease. Kashmer told me that her first screening after she discovered her BRCA2 mutation revealed that she already had breast cancer; had she not sought a genetic test, she may have gotten a policy, but would have been a much worse bet for the insurer. She’s now been cancer-free for 11 years, but she said she hasn’t bothered to apply for a policy again.

[Read: Remember that DNA you gave 23andMe?]

Even employers, which must adhere to GINA, might soon be able to hire or fire based on certain genetic risk factors. Laura Hercher, a genetic counselor and director of research at the Sarah Lawrence College Human Genetics Program, told me that some researchers are now arguing that having two copies of the APOE4 mutation, which gives people about a 60 percent chance of developing Alzheimer’s, is equivalent to a Stage Zero of the disease. If having a gene is considered equivalent to a diagnosis, do GINA’s protections still apply? The Affordable Care Act prevents health insurers from discriminating based on preexisting conditions, but not employers and other types of insurers. (The ACA may change dramatically under the coming Trump presidency anyway.) And the Americans With Disabilities Act might not apply to the gray area between what might be viewed as an early manifestation of a disease and the stage when it’s considered a disability. FORCE and other advocacy groups—including the ALS Association and the Michael J. Fox Foundation—as well as members of the National Society of Genetic Counselors, are working in a few states to pass laws that close gaps left by GINA, as Florida did in 2020, but so far they have been mostly unsuccessful.

Genetic testing has only just become common enough in the U.S. that insurers might bother asking about it, Hercher said. Recently, groups like Schlager’s have been hearing more and more anecdotes. “People are so worried about genetic discrimination that they are failing to sign up for research studies or declining medically recommended care because of the concerns of what could happen to their insurance,” Anya Prince, a professor at the University of Iowa College of Law, told me. Carolyn Applegate, a genetic counselor in Maryland, told me that when patients come to her worried about a hereditary disease, she typically advises them to line up all the extra coverage they might need first—then hand over their DNA to a lab.

So far, these unintended consequences of genetic testing seem to be manifesting for people with risk for rare diseases linked to single genes, which, combined, affect about 6 percent of the global population, according to one estimate. But the leading killers—heart disease, diabetes, and the like—are influenced by a yet unknown number of genes, along with lifestyle and environmental factors, such as diet, stress, and air quality. Researchers have tried to make sense of this complex interplay of genes through polygenic risk scores, which use statistical modeling to predict that someone has, say, a slightly elevated chance of developing Alzeheimer’s. Many experts think these scores have limited predictive power, but “in the future, genetic tests will be even more predictive and even more helpful and even more out there,” Prince said. Already, if you look deep enough, almost everyone’s genome registers some risk.

[Read: What happens when you’re convinced you have bad genes]

In aggregate, such information can be valuable to companies, Nicholas Papageorge, a professor of economics at Johns Hopkins University, told me. Insurers want to sell policies at as high a price as possible while also reducing their exposure; knowing even a little bit more about someone’s odds of one day developing a debilitating or deadly disease might help one company win out over the competition. As long as the predictions embedded in polygenic risk scores come true at least a small percentage of the time, they could help insurers make more targeted decisions about who to cover and what to charge them. As we learn more about what genes mean for everyone’s health, insurance companies could use that information to dictate coverage for ever more people.

Bill still doesn’t know whether he will ever develop ALS. The average age of onset is 40 to 60, but many people don’t show symptoms until well into their 70s. Without long-term-care insurance, Bill might not be able to afford full-time nursing care if he someday needs it. People who do develop ALS become unable to walk or talk or chew as the disease progresses. “Moving people to the bathroom, changing the sheets, changing the bedpans,” Bill said—“I dread the thought of burdening my wife with all of those things.”

Cases like Bill’s could soon become more common. Because scientists’ understanding of the human genome is still evolving, no one can predict all of the potential consequences of decoding it. As more information is mined from the genome, interest in its secrets is sure to grow beyond risk-averse insurers. If consumer-facing DNA-testing companies such as 23andMe change their long-standing privacy policies, go bankrupt, or are sold to unscrupulous buyers, more companies could have access to individuals’ genetic risk profiles too. (23andMe told me that it does not share customer data with insurance companies and its CEO has said she is not currently open to third-party acquisition offers.) Papageorge told me he could imagine, say, scammers targeting people at risk for Alzheimer’s, just as they often target older people who may fall for a ploy out of confusion. All of us have glitches somewhere in our genome—the question is who will take advantage of that information.

Democrats Deserved to Lose

The Atlantic

www.theatlantic.com › ideas › archive › 2024 › 11 › election-2024-liberal-loss › 680591

By electing Donald Trump again, the American electorate has made a bad decision, one that will expose our country to unreasonable risks in areas from foreign policy to public health. Fiscal policy will get worse—budget deficits will become even larger, keeping interest rates high, and programs that provide health care to the poor and elderly are likely to be trimmed back to finance tax cuts for rich people. Abortion rights are likely to be further restricted by a hostile administration that uses the powers of the FDA and the Department of Justice to make abortion harder to provide. And we’ll have another four years under Trump’s exhausting, mercurial, and divisive leadership, making our politics nastier and stupider.

I wish the election had gone the other way. I am annoyed. That said, when Trump won eight years ago, I was much more than annoyed. I was really upset and shocked. This time is different, because Americans have been through this before, and I expect we’ll get through it again. But it’s also different because there’s a big part of me that feels Democrats deserved to lose this election, even if Trump did not deserve to win it.

I write this from New York City, where we are governed by Democrats and we pay the highest taxes in the country, which doesn’t mean we receive the best government services. Our transportation agencies are black holes for money, unable to deliver on their capital plans despite repeated increases in the dedicated taxes that fund them, because building a subway line here costs four times as much per mile as it does in France, and because union rules force the agency to overstaff itself, inflating operating costs. Half of bus riders don’t pay the fare, and MTA employees don’t try to make them. Emotionally disturbed homeless people camp out on the transit system—the other day, I was on a bus where one shouted repeatedly at another passenger that he was a “faggot.” And even though police are all over the place (at great taxpayer expense), they don’t do much about these disturbances, and I can’t entirely blame them since our government lacks the legal authority to keep troubled people either in jail or in treatment. The city cannot stop people from shoplifting, so most of the merchandise at pharmacies is in locked cabinets. A judge recently said the city can’t even padlock the illegal cannabis stores that have popped up all over the place—that’s apparently unconstitutional, and so years into what was supposed to be the “wokest” legal cannabis regime in the country, our government still can’t figure out how to make sure that people who sell weed have a license to do so, even though they’ve done that with regard to alcohol forever.

[Read: The ‘stop the steal’ movement isn’t letting up]

Ever since the COVID shutdowns, Democrats here have stopped talking very much about the importance of investing in public education, but the schools remain really expensive for taxpayers even as families move away, enrollment declines, and chronic absenteeism remains elevated. Currently, we are under a state-court order to spend billions of our dollars to house migrants in Midtown hotels that once housed tourists and business travelers. Housing costs are insane because the city makes building anything very hard—and visiting here is really expensive, too, partly because so many hotels are now full of migrants, and partly because the city council made building new hotels functionally illegal. And as a result of all of this, New York is shedding population—the state will probably lose three more congressional districts in the next reapportionment. And where are people moving to? To Sun Belt states, mostly run by Republicans, where building housing and growing the economy is still possible.

Meanwhile, the voters of New York have just adopted an equal-rights amendment to the state constitution, which was put on the ballot by the Democrat-controlled state legislature. One effect of this amendment is to create a state constitutional right to abortion. Of course, abortion was already legal in New York, and a state constitutional provision will not override any new federal laws or regulations that Republicans might impose with their new control in Washington. This is exactly the sort of brain-dead symbolism that exemplifies the Democrats who rule our state: They pat themselves on the back for a formalistic, legal declaration of the rights of the people who live here, and meanwhile, people of all races and identities flee New York for other, officially less “inclusive” places where they can actually afford a decent quality of life.

I am unfortunately a Democrat, but as someone who lives in a place that is governed very badly by Democrats, I can easily understand why “Can you imagine what incompetent, lunatic shit those people will do if they get control of the government?” would fall flat as an argument against Republicans. It doesn’t surprise me that the very largest swings away from Democrats in this post-COVID, post–George Floyd, post-inflation election occurred in blue states. The gap between Democrats’ promise of better living through better government and their failure to actually deliver better government has been a national political problem. So when Republicans made a pitch to change all this (or even burn it all down), it didn’t fall flat.

Right before Election Day, Ross Douthat wrote a column for The New York Times that left me quite uneasy. It was about the campaign signs he was seeing all over New Haven that read Harris-Walz 2024: Obviously. Douthat started with a point that’s almost tautological: Because the election appeared close, by definition neither candidate was the obvious choice. And he looked at why the decision would not be obvious to so many voters, writing:

Let’s take one last survey of why some waverers might not yet be sold on Kamala Harris and Tim Walz, by returning to where this all began: The world of 2016, when Americans normally disinclined to vote for liberals were first informed that there was no other reasonable choice … the promise was that even if you disagreed with liberalism’s elites on policy, you could trust them in three crucial ways: They would avoid insanity, they would maintain stability, and they would display far greater intelligence and competence than Trump and his hangers-on.

Many voters believe these promises were broken. Of course, the most politically significant aspect of the instability has been post-COVID inflation—a global problem that has taken out incumbent governments of the right and left all over the world. Inflation is mostly not Democrats’ fault, though they did exacerbate it by overstimulating the economy with the American Rescue Plan, and then they failed to focus early enough on inflation as the key economic problem of this administration.

To be precise, the ARP, passed in early 2021, constituted an unnecessary $2 trillion stimulus that mostly produced inflation rather than real GDP growth. Then, throughout 2022, even as inflation started to bite, Democrats were still looking for every way they could find to spend as much money as possible to satisfy interest-group constituencies. Even the so-called Inflation Reduction Act, which was supposed to reduce inflation by reducing the deficit, is currently increasing the deficit by tens of billions of dollars a year and, if left unchanged, will continue to do so through 2027. The deficit reduction does not begin until 2028, far too late to be politically relevant for Joe Biden’s Democrats.

The other big destabilizer is the migrant crisis, which was born out of this administration’s fecklessness—Biden rapidly reversing Trump’s immigration executive orders upon entering office without any plan for controlling the border and apparently without realizing that migrants are smart, and will be more likely to come if you make clear that coming very likely means they will get to stay. (A failure to consider incentives is a running theme when Democrats fail.) Democrats did not pivot to enforcement until far too late—and not until after Texas Governor Greg Abbott made the crisis a blue-state issue by bussing migrants here en masse to fill Democrats’ hotels and consume Democratic budgets.

On the “insanity” front, Douthat cites the political movement in the aftermath of George Floyd’s murder, responses to COVID, and trans-youth medicine—all areas where liberals’ moral fervor has caused them to lose sight of whether the ideologically driven courses they had taken were actually producing the intended positive effects. Democrats know they paid a price for “Defund the police” and they have mostly learned their lesson, or at least they will now, because several high-profile “progressive” prosecutors lost their blue-city posts this week. On the COVID restrictions, Democrats have not really reckoned with how off-putting a lot of the busybody moralizing was, but this issue will likely simply fade with time.

As for trans issues, I have been skeptical about their political salience—although I don’t believe that Lia Thomas belonged on the Penn women’s swim team, I also can’t imagine casting a vote based on my views about that story. But Kamala Harris’s 2019 declaration to the ACLU that she would have the government pay for gender-affirming surgeries for prisoners and people held in immigration detention became a major attack line against her in this campaign. That’s because it highlights several problems with the party’s image all at once: Here was the Democratic nominee, bowing to pressure from interest groups to look for ways to spend your tax dollars on the most bespoke concern of a criminal, or of a noncitizen who isn’t even supposed to be here, before thinking about you and your interests. But the truly grim irony about the political cost of this promise is that, of course, the federal government that only got seven electric-vehicle-charging stations built in two years has performed zero transgender surgeries on detained migrants. That’s the Democrats in a nutshell: the party that promises trans surgeries for undocumented immigrants but doesn’t deliver them.

[Thomas Chatterton Williams: What the left keeps getting wrong]

And all of this is why I think Democrats’ approach to the cost-of-living issues that have dominated this campaign has fallen so flat. The Democratic argument is, more or less, “look at all my programs”—all of the things I’m going to have the government do to make life easier for you. In some cases, they have a clear track record to run on: The Affordable Care Act has gotten more popular over time, and the expanded subsidies that reduce the premiums most Americans pay to buy individual plans on the exchanges have increased enrollment. But mostly, I think Americans look around at how it goes when the government actually tries to help, and they have a healthy skepticism about how helpful the government is really going to be, and about whether the benefits are really going to flow to them. Democrats are making too many promises; they have tried to do a zillion different things and done them badly at great expense, as was the approach with the moribund Build Back Better Act. They instead need to pick a few things for the government to do really well, with a focus on benefits to the broad public rather than to the people being paid to provide the services.

Although I think Harris should have picked Pennsylvania Governor Josh Shapiro as her running mate, I don’t think choosing him would have changed the outcome. But Shapiro is a popular swing-state governor who will be a front-runner for the 2028 nomination. And Shapiro’s signature policy achievement is rebuilding a highway underpass. There is a lesson here: When government focuses on its core responsibilities and delivers on them quickly, efficiently, and with a laser focus on making sure people can go about their lives as normal, the voters reward that. You don’t need a grand vision; you need to execute.

Winning the next federal election is important. For that reason, it is important that Democrats get the voters to believe they deserve to win that election. They have two years to work on it before the midterms.

This article was adapted from a post on Josh Barro’s Substack, Very Serious.

How America Made Peace With Cruelty

The Atlantic

www.theatlantic.com › politics › archive › 2024 › 11 › trump-campaign-cruelty › 680498

This story seems to be about:

At a rally just outside Atlanta in late October, thousands of Donald Trump supporters lined up in the punishing southern sun to see their hero; some had driven hours from out of state. Vendors hawked T-shirts with slogans such as Say no to the ho, and Roses are red, Hunter smokes crack, Joe Biden has dementia and Kamala isn’t Black, sometimes chanting the phrases out loud to amused onlookers.

Hundreds of people still standing in the winding queue shuffled off into a disappointed crowd when told that the venue was now full. Many hung around outside, browsing the vendors’ wares or grabbing a bite at one of the nearby food trucks. They were there to see Trump, but also to enjoy the sense of belonging that comes from being surrounded by the like-minded. They were there to see and be seen, dressed in MAGA hats, MAGA shirts, MAGA tights. Service dogs decked out in stars and stripes, men in silk shirts printed with an image of a bloodied Trump raising his fist. As “Y.M.C.A.” blared from inside the venue, Trump supporters stopped their conversations to sing along and shape their arms with the chorus.

The first time Trump ran for president as a Republican, when I spoke with his followers I encountered a superficial denial of Trump’s prejudice that suggested a quiet approval of it. They would deny that Trump made bigoted remarks or proposed discriminatory policies while also defending those remarks and policies as necessary. What I found this time around were people who were far more deeply embedded in an unreality carefully molded by the Trump campaign and right-wing media to foment a sense of crisis—and a belief that they were being exploited by a shadowy conspiracy that Trump alone could vanquish. Whereas many supporters I spoke with at rallies in 2016 rationalized or dismissed Trump’s yarns as exaggerations or bombast, in 2024 they would repeat them solemnly and earnestly, as gospel.

The conspiracy theories, particularly surrounding immigration, are significant because they justify extreme measures—Trump’s promises to stripcritical news outlets of their broadcast licenses, prosecute political rivals, and purge the federal government of “the enemy within.” Yet some supporters I spoke with also seemed either unaware or disbelieving of the plans that Trump and his allies have for a second administration. There is a disconnect between what Trump and his allies intend to do in power and what many of the people who would vote him in believe he would do.

This disconnect was apparent earlier in the 2024 campaign, when Democrats began attacking Project 2025, the Heritage Foundation “blueprint” for a second Trump administration. The agenda contemplates not only a political purge of the federal government, and a president who can order the Justice Department to prosecute his enemies, but drastic limits on abortion; drastic cuts to education, the social safety net, and efforts to fight climate change; and using federal powers to discriminate against LGBTQ people. Although Project 2025 was not affiliated with the campaign, it was largely a Trumpworld project, conceived by former Trump aides. Trump surmised that his own followers would not support what was in Project 2025 and distanced himself from it, posting late one night in July that he knew “nothing about Project 2025. I have not seen it, have no idea who is in charge of it, and unlike our very well received Republican Platform, had nothing to do with it.” (CNN reported that at least 140 people who worked for Trump were involved in the project, including six of his former Cabinet members.) Its architects were left to quietly reassure their fellow travelers that he was saying this for political reasons. “He’s running against the brand,” Russell Vought, a Project 2025 contributor and potential future Trump chief of staff, told an undercover reporter. “He’s very supportive of what we do.”

I noticed a particular disconnect on immigration; people I spoke with emphasized their support for legal immigration and, unlike Trump, did not single out particular ethnicities or nationalities for scorn. They said they would welcome anyone as long as they came legally. It’s possible that this was merely something they were telling themselves they believed so as not to interrogate their own motives further. They were ultimately also in thrall to Trump’s narrative about how Joe Biden and Kamala Harris were conspiring to repopulate the country with undocumented immigrants living on the dole at their expense. That fiction was not just a source of rage but a predicate for whatever radical action might be needed to rectify it.

One Trump voter I met among the cheerful crowd of supporters milling around outside a packed rally outside Atlanta, who identified himself only as Steve and said he worked in telecommunications, managed to touch on virtually every immigration conspiracy theory put forth by the Trump campaign in about 30 seconds. Yet even Steve told me the issue was people coming in illegally, not that they were coming in at all. “You’re not coming in legally; you’re not pledging to the country; you’re not saying you’re going to support that country,” Steve said.

[Adam Serwer: The cruelty is the point]

Another Trump supporter named Rebecca Cruz told me, “We need immigration in this country, but we need safe, safe immigration.” Referring to the Biden administration, she explained that “they take them from other countries, bringing them. They’re going into certain countries, and they fly them in here … because they want to destroy America. They hate what America stands for.”

A few days earlier, at another Trump rally, in Greenville, North Carolina, the crowd cheered when Trump demanded that news outlets be taken off the air for criticizing him or for giving positive coverage to Harris. They laughed when Trump played a bizarre video mocking trans people in the military. They cheered for the death penalty. They booed when Senator Ted Budd warned that Harris would let “the illegals who are here … use your taxpayer dollars for transgender surgeries.” Trump insisted that “Kamala Harris has imported an army of illegal-alien gang members and migrant criminals from prisons and jails, from insane asylums and mental institutions all around the world, from Venezuela to the Congo, not just South America.” Trump repeated “the Congo” three times, in case the audience didn’t understand that the immigrants he was attacking were Black. He would occasionally pay lip service to legal immigration, or vow to defend Americans of “any color and creed,” but this was only after invoking a litany of stereotypes designed to justify state violence against whichever marginalized group he had just finished demonizing.

When I spoke with people one-on-one, they reflected back to me Trump’s rhetoric, occasionally with a somewhat more human touch. A retired English teacher who did not want to give her name emphasized that “I believe in immigration, but do it legally. Don’t make your first act of coming to America be coming illegally … We’re taking away from servicing children who don’t even get to eat because you’re giving housing to the people coming in.” Another retiree in North Carolina, named Theresa Paul, gave me a hard look and said she was supporting Trump because “when you take illegals over our citizens, that’s treason … We’re being worked to death, taxed to death, and for what? So we can put up people that’s coming in illegally, and putting them up way superior to us.” I asked her why she thought the Biden administration would want to do that. She grasped my arm lightly and said, “To replace us, right?”

I began to realize that these Trump fans—diehards though they may be—represent a distinct space in the MAGA landscape. They enjoy his cruelty, seeing it as righteous vengeance for the constellation of wrongs they have been told they are the victims of, but they aren’t the architects of these conspiracy theories, and neither do they stand to profit from them. Their conspiracism serves to distract them from Trump’s actual policy agenda and his authoritarian ambitions.

There are, I’ve come to see, three circles of MAGA that make up the Trump coalition. The innermost circle comprises the most loyal Trump allies, who wish to combine a traditional conservative agenda of gutting the welfare state and redistributing income upward while executing by force a radical social reengineering of America to resemble right-wing nostalgia of the 1950s. Trump’s advisers and other conservative-movement figures understand Trump’s populism as a smoke screen designed to conceal their agenda of cutting taxes for the wealthy, banning abortion, eviscerating the social safety net, and slashing funding for education, health care, and other support for low-income people. All of this is consistent with how Trump governed when he was in the White House, although many people seem to have forgotten what he was actually like. This faction wants a government that works to preserve traditional hierarchies of race, gender, and religion, or at least one that does not seek to interfere with what it sees as the natural order of things.

This innermost circle includes legislative allies such as House Speaker Mike Johnson, who has vowed to repeal the Affordable Care Act; policy aides such as Vought, who has spoken of mass deportation as a means to “end multiculturalism”; and elite backers such as Elon Musk, who hopes to use his influence to inflict hardship on Americans by dramatically cutting the welfare state so that he can reduce his own tax burden. It is no coincidence that Musk has transformed the social network formerly known as Twitter into a haven for racist pseudoscience that he himself consciously amplifies.

This faction also includes those far-right figures who are not official members of Trumpworld but who see the reality-show star as a champion of a resurgent white-nationalist identity. These people understand what Trumpism’s goals are, and most of them also understand that, absent the particular devotion Trump inspires, their plans would not be politically viable.

There is a second, slightly larger circle around this first one, comprising devoted Trump fans. These fans are the primary target for a sanitized version of the “Great Replacement” theory, which holds that American elites have conspired to dispossess them of what they have in order to give it to unauthorized immigrants who do not belong. They are not ideologically hostile to the welfare state—indeed, many of them value it—but they believe it is being wasted on those who have no claim to it. People in this circle are acting rationally in response to conspiracy theories they have chosen to believe, and are bewildered by those who refuse to acknowledge what they are certain is true. This bewilderment serves only to further cement their feeling that they are the victims of an elite plot to take from them that which they deserve. This is the group you might refer to as true believers.

In a different political and informational environment, many of these true believers would be unlikely to support the Project 2025 agenda—or at least not much of it—but here they are so isolated from mainstream news sources that they believe Trump’s claims that he has no ties to it, and that he has their best interests in mind because “he cannot be bought” by the same elites they believe are responsible for their hardships.

Then there is the outer circle: Americans with conservative beliefs who may be uneasy about Trump but whose identification with conservative principles and the Republican Party mean they wish to persuade themselves to vote for the Republican candidate. They may be ardently anti-abortion, or small-business owners, or deeply religious. They do not believe everything Trump says; in fact, their approach to the man is dismissiveness. These are voters who fall into what my colleague David Graham calls the “believability gap.” They don’t like Trump’s authoritarian rhetoric but also don’t think he will follow through with it. This is the “What’s the downside for humoring him?” faction.

This group of Trump voters treat his authoritarianism as mere bombast or as exaggerations from the media, seeing this election as an ordinary one in which a party with a bad economic record should be replaced by a party with a better one, not an election in which a man who tried to destroy American democracy is running for a chance to finish the job.

Denial is the mortar that holds the three MAGA circles together. The innermost circle denies the radicalism of its agenda to the middle ring of fervent Trump supporters, presenting any criticism as the lies of the same liberal elites responsible for dispossessing real Americans of what is owed them. The outer circle treats Trump’s authoritarianism and racism as regrettable and perhaps too colorful, but equivalent or similar to other common character defects possessed by all politicians. To acknowledge the liberal critique of Trump as correct would amount to a painful step away from a settled political identity that these outer-circle members are not willing to take—they would have to join the Never Trumpers in exile.

As different as some of the people I spoke with at these Trump rallies could be, when they went into the crowd, they experienced the ecstasy of the cruelties they would perhaps not allow themselves to indulge in alone. The rationalizations and explanations and denial melted away. They understood that they were there to mock and condemn those they hate and fear, and to listen to all of Trump’s vows to punish them.

A person, alone in conversation, can be rational. People, in a crowd, become something else.

Conspiracism is not an inherently right-wing indulgence. After September 11, many in liberal circles fell for nonsense alleging that the Bush administration was secretly behind the attacks. After George W. Bush’s reelection in 2004, some liberals indulged absurd theories about voting machines in Ohio switching votes and thus delivering the state to Bush. More recently, conspiracy theories about the assassination attempt on Trump being staged spread in certain liberal circles online.

Political leaders, intellectuals, and public figures can play a crucial role in containing such conspiracism. Democratic leaders shamed 9/11 truthers out of the party. John Kerry conceded the election rather than champion baseless allegations about voter fraud. Unlike Trump, who gleefully promoted conspiracy theories around the violent assault on Nancy Pelosi’s husband, no prominent Democrats embraced any of the conspiracy theories that emerged about the attempt on Trump’s life. But when elites cultivate and indulge conspiracism—when they exploit it—they can create the conditions for authoritarianism and political violence.

“In social movements … conspiracy theories that may be absurd and specious on their face nevertheless contain valid information about the motivations, grievances, insecurities, and even panics among their promoters, so they cannot be simply dismissed,” the historian Linda Gordon wrote in The Second Coming of the KKK. “Among Klan leaders, conspiracy theories also did a great deal of organizing work: they provided identifiable and unifying targets, supplying a bonding function that explanations based on historical analyses do not deliver.” Political and national identities of any ideology can be forged by the sense that some part of your identity is under assault. When that assault does not truly exist, conspiracism can provide it.

Trumpist conspiracy theories perform a similar function. In his stump speeches, the former president calls the United States an “occupied country” that will be “liberated” from criminal migrants when he retakes power. He tells his audience that crime by undocumented immigrants is not simply a social problem that might be solved with more restrictive immigration policy but a deliberate plan by those in office. “Kamala is importing millions of illegals across our borders and giving them taxpayer benefits at your expense,” Trump declared in Greenville.

Humiliation is an essential part of the Trumpist style. Trump appeals to his audiences’ pride by telling them they have been hoodwinked by their adversaries, but that he has the power to avenge this injustice. Invoking that sense of humiliation is part of how he primes his audiences to be manipulated, knowing that their sense of shame will make them both angry and eager to reassert that pride. It is one of the most obvious con-man tricks in history—you got scammed, you paid too much, but if you give me your money, I’ll get you a better deal—and it has worked on tens of millions of Americans for a decade.

[Read: The malignant cruelty of Donald Trump]

These conspiracy theories create communities that are hostile to dissenters, and they legitimize radical, even violent actions. This is how thousands of Trump supporters ended up ransacking the Capital on January 6, 2021, hoping to overturn an election on the basis of a conspiracy theory about voting machines, spread by elite figures who knew it to be false. The Dominion lawsuit against Fox News and the congressional inquiry into January 6 revealed that although much of the right-wing leadership class understand they have created a monster they cannot control, they lack the courage to confront it. Trump and his closest aides, by contrast, are well aware of the hold they have on their audience and see it as useful for their own purposes.

“Before they seize power and establish a world according to their doctrines,” Hannah Arendt wrote, “totalitarian movements conjure up a lying world of consistency which is more adequate to the needs of the human mind than reality itself; in which, through sheer imagination, uprooted masses can feel at home and are spared the never-ending shocks which real life and real experiences deal to human beings and their expectations.” Trumpism is neither Nazism nor Stalinism, but Arendt’s observation about people living in a universe of complete unreality still applies.

All of us navigate the world on the basis of information sources we trust, and millions of people trust Donald Trump. Understanding his longevity is perhaps impossible absent an information environment in which people come to passionately believe things that are not true. This is not a false-consciousness argument. If banning abortion matters more to you than raising the minimum wage, and you make your choice with that in mind, that is your right as a voter. But that decision should be based on values, not on a universe of unreality.

The former president and his surrogates have woven a totalizing conspiracy theory in which virtually every problem facing the nation can be laid at the feet of immigration. Violent crime is rising because of immigrants (it isn’t). Democrats are chartering planes from other countries to bring in illegal immigrants (they aren’t), whom they are paying to come (it’s not happening) and who are smuggling in fentanyl (it’s overwhelmingly citizens who are doing the smuggling, actually), in the hopes that these illegal immigrants will vote for them (they can’t vote, and they wouldn’t necessarily vote for Democrats if they could). Immigrants are the main reason for the housing crisis (they aren’t—it’s a lack of supply); they’re getting FEMA money meant for citizens affected by the hurricanes in the South (wrong); and none of this would have happened if Biden and Harris hadn’t opened the border (the Biden administration is on pace to match Trump’s border deportations) to undocumented immigrants who don’t pay taxes (false). There really was a rise in illegal border crossings after the pandemic, but the response of the Democratic Party was to move closer to Trump’s positions on immigration.

Nor will mass deportation, framed as a means to fight crime, resolve any of these issues. Mass deportation will not raise wages. It will not make housing less expensive. It will not create jobs. It will not make the welfare state more generous to those who need its assistance. And indeed, during Trump’s term as president, his administration shirked prosecuting undocumented criminals in favor of destroying families and removing as many people as possible, regardless of what roots they might have established. Trump aides are planning an attack on the kind of legal immigration that supporters at his rallies repeatedly told me they wanted—an attack that, if prior experience holds, will take precedence over enforcing the law against criminals.

But for some today, just as in the past, the presence of immigrants threatens a “dominance” that, as Gordon wrote of the 1920s, “many white native-born Protestants considered a form of social property.” It is an odd but insufficient sign of progress that such status anxiety is no longer confined to white, Protestant, or native-born people—the irony is that America is such a powerful machine of assimilation that the ascendant reactionary coalition includes millions of people descended from those once deemed unassimilable aliens by their predecessors movements. Unfortunately, lies and conspiracy theories directed at those we see as unlike us are far more likely to be believed.

Like Trump’s lies about voter fraud in 2020, the conspiracy theories about immigration are important not because there is truth to them but because they forge a political identity that is not amenable to fact-checking or correction. It does not matter if the “voter fraud” in 2020 did not happen; believing that it did expresses the symbolic view that the opposing coalition should not be considered truly American. To point out that very little of what Trump and his allies say about immigration is factual cannot dispel the worldview that causes one to embrace it: that the America you know has been stolen by people who have no claim to it.

The workings of American immigration policy are complicated, though, and any sufficiently complicated process can appear to someone who doesn’t understand it as a conspiracy—if you don’t understand the weather, for example, you might think the U.S. government has a hurricane gun it can aim with pinpoint accuracy at Republican-majority districts. If you don’t understand something—and if understanding it might leave your conception of your own identity teetering, Jenga-like—it is much easier to believe what the people you love and trust are telling you, even if that thing is untrue.

Perhaps most important, the breadth of the conspiracy and the power of the conspirators place any solutions beyond the reach of ordinary politics. At the rally prior to the storming of the Capitol, Trump warned the audience that “if you don’t fight like hell, you’re not going to have a country anymore.” Then he retreated to the safety of the White House and watched the mob attack Congress, hoping that by some miracle his supporters would succeed in keeping him in power by force. In such dire circumstances, only a messianic figure will rescue the virtuous from the corrupt. The logic of grand conspiracy thus elevates the strongman.

In the conspiracist mind, Trump is not simply the only logical solution but the only hope, the only man not compromised by the grand cabal that opposes him and its puppet politicians. Trump’s followers are convinced that Trump’s wealth means he cannot be bought. Few politicians have ever been more clearly for sale.  

Doubtlessly, many liberals would deny a distinction between the devotion of Trump supporters who flock to his rallies and the ideological vanguard that aims to use him as a vehicle to remake the country. While I was out reporting this story, The Atlantic published an account of how, according to Trump’s former chief of staff General John Kelly, Trump spoke admiringly of Adolf Hitler and his generals. Typically, when I go out to rallies, I do not argue with voters or offer my own views, because I am there to find out what they believe and why. But because of my affiliation with The Atlantic, several people I spoke with asked me to explain my views—occasionally referring to the story as “fake news” or “Democrats calling Trump Hitler,” having heard the story wrongly characterized this way.

In one exchange, I mentioned that as a man married to a woman born to a West African immigrant father, I did not appreciate Trump’s remarks about Black immigrants, and recounted the story of Trump complaining about not wanting immigrants from “shithole countries.” The Trump supporter had not heard of the 2018 incident and refused to believe that it had occurred as I relayed it.

In two other conversations, when asked about my views, I explained that, as a Texan, if I choose to have another child, I have to worry that if something goes wrong, doctors may refuse to treat my wife because of the state’s abortion ban. Doctors in Texas are afraid to provide lifesaving medical care to mothers with pregnancy complications because the Republican-controlled state government has passed laws that punish abortion providers with steep fines, loss of their medical license, and jail time. The Texas courts have repeatedly refused to clarify or expand the exceptions to the ban—these exceptions are simply meant to ensure sufficient political support for those bans. Because of this, Texas parents have to roll the dice with a pregnancy, knowing that their existing children may end up without a mother.

Not only did the people I spoke with react in disbelief that an abortion ban would be so strict; they did not believe that a doctor would refuse to treat a woman until she was at death’s door. Last week, ProPublica reported that a Texas mother, Josseli Barnica, died after doctors thought it would be a “crime” to treat her while she was having a miscarriage. ProPublica also reported that in 2023, a pregnant teenager from Vidor, Nevaeh Crain, died after three emergency rooms refused to treat her. Texas has fought the Biden administration’s attempt to set federal rules allowing emergency abortions. Last month, the Supreme Court let a ruling siding with Texas remain in place.

[Read: Gullible Mr. Trump]

There is a distance between the views of many of the most ardent Trump fans and the policy goals of the people they would put in power. The innermost MAGA circle understands this, even if many of the people whose votes they rely on don’t. This is why the role played by Fox News and other conservative media outlets is so crucial—not only in maintaining a sense of conspiracism and emotional siege but in ensuring that stories about women like Barnica and Crain never reach the eyes and ears of their audience.

This is an observation, not an excuse. In a democracy, citizens are responsible for knowing the consequences of their votes. They are responsible for not being enthralled by a jumped-up con man who tells them flattering lies. They are responsible for knowing the difference between fact and fiction. And yet few of us would find it easy to extract ourselves from a social universe in which belief in those fictions is a requirement for good standing.

Trump rallies are where the mask usually comes off. At the rallies, the different circles of MAGA lose their distinctiveness; in the anonymity and unity of the crowd, they can indulge the feelings of anger and hatred without the oversensitive, judgmental liberals of the outside world making them feel ashamed. Here, they can be themselves.

This is why the insult comedian Tony Hinchcliffe thought he was in the right place to call Puerto Rico a “floating island of garbage” at Trump’s rally at Madison Square Garden in late October. “These are the kind of jokes that normal people tell,” the conservative media figure Matt Walsh declared. Hinchcliffe was hardly an outlier. Other speakers that night called Harris a prostitute, “the anti-Christ,” “the devil.” The disgraced former Fox News host Tucker Carlson mocked Harris as “the first Samoan Malaysian, low-IQ former California prosecutor ever to be elected president.”

The big mistake made by Hinchcliffe was that, in wrestling parlance, he broke kayfabe. The Trump campaign has fine-tuned its line-stepping over the years, invoking racist stereotypes with just the thinnest veneer of deniability, the better to cast liberal criticism as hypersensitive hysteria. In 2016, Trump campaigned on banning Muslims writ large, not just jihadist terrorists. In 2020, he publicly vowed to meet the nationwide Black-rights protests with violence. In 2024, Trumpism remains a politics of bullying marginalized groups and framing those unwilling to do so as possessing a lack of virtue. Do you want to coddle murderous illegal aliens? Do you want men in women’s sports? Why are you okay with gangs taking over our cities?

Trump’s agenda of using state power to maintain traditional American hierarchies of race, religion, and gender has not changed. But for much of his 2024 run, the sweeping generalizations of previous outings resembled more traditional dog whistling with superficially plausible connections to actual policy concerns. The shift can be imperceptible to people who have paid close attention to politics—Trump’s personality and ideology have not really changed—but to those who have not, his racial animus and misogyny are less obvious. About two-thirds of Hispanic voters in one recent poll said that Trump’s attacks on immigration were not directed at them.

The rightward shift of some Hispanic and Black voters seems to have persuaded the Trump campaign to tone down the explicit racial stereotyping of his previous campaigns, though not the promises to use state power to crush his political enemies. But when you put a guy in front of a Trump campaign sign to warm up the crowd with hacky jokes about Black people liking watermelon, it gets harder to suspend disbelief.

Amid the comedian’s insult to Puerto Rico and the barrage of racist stereotypes—not only about Black people and Puerto Ricans, but about Jews being cheap and Palestinians being terrorists—the word routine takes on another meaning: dull, tedious, boring. Yet the line about Puerto Rico broke through, and a growing list of Puerto Rican celebrities are now endorsing Harris, and perhaps moving crucial Hispanic votes in key swing states to her column.

The crisis caused by Hinchcliffe’s routine and remarks by other speakers that night is that they troubled voters in that outer MAGA circle by briefly revealing what Trump’s entourage actually believes—that when Stephen Miller says “America is for Americans and Americans only,” he is referring to a very limited number of people. The event pierced the veil of denial for those who are otherwise inclined to dismiss such criticisms as the tedious whining of an oversensitive age.

The Puerto Rican Reggaeton singer Nicky Jam renounced his support for Trump after the rally, saying, “Never in my life did I think that a month [after I appeared at a rally to support Trump] a comedian was going to come to criticize my country and speak badly of my country and therefore, I renounce any support for Donald Trump, and I sidestep any political situation.” Those people who renounced their support for Trump after realizing that the contempt he has expressed for others also applies to people like them must understand: He was always talking about people like you, even when you didn’t want to believe it.

At Trump rallies, the denial and the dismissal cease, and the nature of Trumpism is revealed. This is why, despite the fact that the Puerto Rico “joke” bombed at a comedy club the night before, Hinchcliffe thought everyone at the rally would love it. His set was not a divergence from Trumpism. It was … Well, it was routine.