Expanded Medicaid for millions. Penalties for poorly performing hospitals. Even the Trump administration’s own plans to lower drug prices.

Those and many other initiatives would all be illegal under a federal judge’s sweeping decision that the entire Affordable Care Act must be struck down — the latest shock to the nation’s health system after a decade of upheavals, including two fights over the ACA that reached the Supreme Court.

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Friday night’s surprise decision — the Trump administration had asked U.S. District Court Judge Reed O’Connor to wait until after the ACA’s open enrollment period ended early Sunday morning — doesn’t require all ACA-created projects and health coverage to immediately cease. California Attorney General Xavier Becerra already has vowed to appeal, and administration officials say the law will remain in place while the legal challenges play out.

But the case, seemingly bound for the Supreme Court’s new conservative majority, now threatens to complicate a wide array of policies, from state decisions on Medicaid expansion to HHS Secretary Alex Azar’s national health agenda.

The decision’s timing also throws another wrench into ACA enrollment, a campaign that was showing signs of new strength after former President Barack Obama and others tried to boost flagging sign-up numbers this week. And it raises new uncertainty for the entire U.S. health care system, as hospitals, doctors and patient groups have increasingly reoriented around the numerous provisions buried within the 2010 health law.

“The judge got it wrong,” said Chip Kahn, the head of the Federation of American Hospitals. “This ruling would have a devastating impact on the patients we serve and the nation’s health care system as a whole.”

Among the pressing questions ahead:

Who appeals and how fast?

Friday night’s ruling raises a number of decisions for the White House: Will the government appeal, how quickly and will its agencies continue to enforce the law in the meantime?

It’s not clear what the Trump administration will choose to do, given its legal strategy to date. Career Justice Department lawyers this summer were told to drop their defense of the law — a near-unprecedented decision that led three lawyers to remove their names from the government’s brief and prompted the senior attorney, Joel McElvain, to resign.

While some senior officials inside the administration have lobbied to preserve elements of the ACA, President Donald Trump’s public jubilation over Friday night’s ruling may complicate that outcome.

“As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster!” the president tweeted. “Great news for America!” he added.

The Trump administration bears some responsibility for Friday night’s decision because it failed to protect the law in court, said Tim Jost, an emeritus professor at Washington and Lee University School of Law. But, he noted, “the judgment goes far beyond what they asked for” by invalidating all of the ACA — including parts that the Trump administration has used to achieve its own goals.

Democratic-led states immediately said they will challenge the decision, ensuring that the court fight stays alive — although it’s not clear how quickly they will move.

How will higher courts, including the Supreme Court, view the case?

The lawsuit was brought by the attorneys general of Texas and other conservative-led states, who are expected to continue the legal fight for years.

But if the case is appealed all the way to the Supreme Court, legal scholars — including Jonathan Adler, a law professor who was the architect of a previous challenge to strike down the ACA — say they’re deeply skeptical that the arguments will sway Chief Justice John Roberts or Justice Brett Kavanaugh, the court’s newest addition.

“The states would be lucky to get two votes at SCOTUS, and there’s no way Roberts or Kavanaugh goes along,” Adler told POLITICO.

Notably, O’Connor ruled on Friday night that the entire ACA should be struck down because the health law’s mandate was repealed. That verdict takes direct aim at the majority ruling Roberts wrote in 2012 that the law could stand even though Roberts believed that part was unconstitutional — a decision that is unlikely to endear O’Connor’s decision to the chief justice.

What happens to in-progress reforms?

The Trump administration has increasingly oriented its strategy around using the ACA to test new pilot projects.

“The biggest things we’re going to be launching, coming soon, are going to be these demonstrations that Adam Boehler — our head of the Center for Medicare And Medicaid Innovation — has been working on,” Azar said on Wednesday. Those projects would involve “testing new models of how we pay in Medicare for services… and then getting out of the way.”

Those projects — and Boehler’s entire center — would be illegal if Friday night’s ruling stands.

The Trump administration also has repeatedly pledged to lower the nation’s high drug prices, with the president vowing to “bring soaring drug prices back down to earth.” Azar has steadily rolled out a multi-part strategy this year, pushing ideas like changing how Medicare pays for some drugs.

But “Secretary Azar’s most ambitious plans to lower the price of prescription drugs are only possible because of authority conferred on the department by the ACA,” said Rachel Sachs, a Washington University in St. Louis law professor. “Without that power, his ability to deliver what he has promised is severely limited.”

When does the Trump administration hash out its strategy?

The White House and its key health agencies issued short, vague statements in the wake of Friday night’s ruling — largely because health officials were caught flat-footed by the timing, multiple HHS officials told POLITICO, speaking on condition of anonymity.

“There are a few dusty plans in a drawer, but we didn’t think a ruling was coming down this week,” said one official.

“There’s been no messaging, no nothing,” said another official.

Administration officials late Friday indicated it would be business as usual, pending legal appeals.

How will this affect Democrats’ 2019 health strategy?

House Democratic leaders already had planned to immediately file to intervene in the case upon taking control of the chamber in January — a largely symbolic move intended as a signal to voters after health care helped carry the party to victory.

But the latest legal threat to the ACA could be a pressure point to do far more on Obamacare, even as fissures emerge over whether Democrats should focus their energies on preserving the law or fight for universal government health care, which many new House members campaigned on this fall.

Mick Mulvaney, President Donald Trump’s budget director, walked into the Oval Office in early May on a longshot mission. The slash-government conservative wanted to persuade the president to break one of his most popular campaign promises.

During his populist run for the White House, Trump had vowed to leave Social Security and Medicare alone. But Trump had also vowed to rein in America’s national debt, which Mulvaney didn’t think was possible without reining in the two biggest chunks of the federal budget. So Mick the Knife brought a cut list to his meeting in the Oval.

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“Look, this is my idea on how to reform Social Security,” the former South Carolina congressman began.

“No!” the president replied. “I told people we wouldn’t do that. What’s next?”

“Well, here are some Medicare reforms,” Mulvaney said.

“No!” Trump repeated. “I’m not doing that.”

“OK, disability insurance.”

This was a clever twist. Mulvaney was talking about the Social Security Disability Insurance program, which, as its full name indicates, is part of Social Security. But Americans don’t tend to think of it as Social Security, and its 11 million beneficiaries are not the senior citizens who tend to support Trump.

“Tell me about that,” Trump replied.

“It’s welfare,” Mulvaney said.

“OK, we can fix welfare,” Trump declared.

Sure enough, the Trump budget plan that Mulvaney unveiled a few weeks later would cut about $70 billion in disability benefits over a decade, mostly through unspecified efforts to get recipients back to work. That may sound like welfare reform, but the program isn’t welfare for the poor; it’s insurance for workers who pay into Social Security through payroll taxes. The episode suggests Trump was either ignorant enough to get word-gamed into attacking a half-century-old guarantee for the disabled, or cynical enough to ditch his promise to protect spending when it didn’t benefit his base.

The story is also revealing about the source who told it on the record: Mulvaney himself, an ideological bomb-thrower from the congressional fringe who has become an influential player in the Trump administration. Republicans have said for years that government should only take people’s money to provide absolutely vital services, but Mulvaney truly believes it—and as the head of the powerful Office of Management and Budget, he’s got the perfect job to try to act on it. For all the focus on race, the Russia scandal and the president’s latest tweets, this administration’s lasting impact on American lives will likely depend much more on how often Mulvaney can push his conservative ideas into national policy.

In a White House where the president and most of his inner circle are new to government, Mulvaney is one of Trump’s few top domestic policy aides with any prior experience in how Washington works, and the disability story is just one example of how he uses that advantage to target Big Government generosity. At OMB, he gets to weigh in on almost everything the government does, and he’s driving the administration’s ambitious efforts to slash spending, kill regulations and reorganize the federal bureaucracy. He also has juice with the president, which is one reason Trump’s agenda has been much more rigidly conservative and partisan than many expected from an ideologically gelatinous former Democrat who ran as a flexible deal-maker. Mulvaney isn’t the only top White House aide pushing for less spending, less taxation and less regulation, but as he cheerfully points out: “I don’t think anyone in this administration is more of a right-wing conservative than I am.”

Yet it’s also notable that Mulvaney’s story featured Trump rejecting as well as embracing his spending-hawk advice—an unusual revelation in a city where pretending you always agreed with every decision is an indigenous art form. Mulvaney is candid about his role as a movement conservative advising a boss who isn’t one, what he calls “presenting the right-wing perspective” in a White House full of conflicting views. He readily acknowledges that Trump has shot down his limited-government proposals on issues ranging from war funding to the opioid crisis to the Export-Import Bank. It’s a risky message for any presidential aide; the last OMB director to air his differences this publicly, David Stockman, was famously “taken to the woodshed” for questioning President Ronald Reagan’s commitment to fiscal conservatism in a 1981 magazine article. But not only has Mulvaney avoided Trump’s crowded woodshed, he says he plans to keep pressing for Medicare and Social Security retirement reforms, even if Trump keeps shooting him down.

Mulvaney has gotten away with his heresy partly because Trump likes him and thinks he’s good on the Sunday shows, but partly because he always supports Trump’s final decisions—even decisions he would have trashed as a back-bencher in Congress. It’s quite a change for an intransigent provocateur who spent the past decade calling out his own party’s departures from conservative orthodoxy. Mulvaney launched his political career because he thought Republicans were spending too much in the George W. Bush era. He helped launch the hard-right House Freedom Caucus that tormented Republican leaders for compromising too much in the Barack Obama era. Now that he has moved inside the tent in the Trump era, some of his Freedom Caucus pals tease him about selling out his radical dreams.

But Mulvaney still harbors the same dreams of taming the federal leviathan. He just has a different job, conveniently located in the belly of the beast. In the past, he has questioned whether government should fund medical research or student loans, called Social Security a Ponzi scheme, proposed abolishing the Environmental Protection Agency and pushed repeatedly for government shutdowns. In his new gig, he has questioned whether government should fund Meals on Wheels or diabetes treatment for patients who “eat poorly,” called climate action “a waste of your money,” hinted that the Energy and Education departments might be unconstitutional, and suggested he would welcome another shutdown. He is still the same unapologetic ideologue who proposed naming the Freedom Caucus the Reasonable Nutjob Caucus, which gives a sense of his out-there politics, as well as his humor about his out-there politics.

Now he’s in there, and his transition from renegade to insider has not always been smooth. (“Renegade? How about visionary?” he quipped to me.) He was initially Trump’s point man on repealing Obamacare, but his role dwindled after he struggled to convince the Freedom Caucus that the House bill was conservative enough. “What have you done to our friend Mick Mulvaney?” one former colleague needled him. He was sidelined again after urging Republicans to demand spending reforms before raising the debt ceiling, his longstanding position in the House but an incendiary one in his new job; the White House hastily announced that it backed a conventional “clean bill.” Congressional leaders also froze out Mulvaney during its private negotiations over a 2017 budget bill, and ignored most of his public demands.

Still, Trump’s 2018 budget proposal is a very Mulvaney document, proposing radical rollbacks of popular programs, including more than $1 trillion in cuts to Medicaid, another entitlement Trump pledged to protect. So this fall’s budget negotiations could end up producing some very Mulvaney surgery to federal spending. Or they could produce a very Mulvaney stalemate that forces the government to shut down or even default on its obligations.

They could also end up extending the status quo. Mulvaney has learned from experience that change won’t come easily to Washington, and government won’t automatically shrink just because Republicans control it. In recent years, Tea Party ideals have achieved impressive electoral victories, but Mulvaney’s tenure will be a revealing test of whether they can achieve similar policy victories in the city they aim to conquer. But no matter what happens, as long as Mulvaney holds Washington’s most pivotal wonk job, he’ll get his say on every dollar, every regulation and every executive order—even if he doesn’t always get his way.

“My friends tell me, Mulvaney, you’re the hard-core right-winger, you’re dealing with a president who’s not on the same page all the time, you must be losing all the time,” he says. “I’m like, well, at least I’m losing at the very highest levels!”

***

Mulvaney has an amusing way of announcing his extremism. His first words to Trump’s top economic adviser, Gary Cohn, were: “Hi, I’m a right-wing nutjob!” (Cohn’s deadpan reply: “Hi, I’m Gary.”) At a meeting with OMB analysts, Mulvaney wryly described himself as a crazy reactionary. But he bristles a bit at stereotypes of Southern conservatives as knuckle-dragging backwoods Neanderthals, because he’s not that kind of reactionary. He comes off more like a 50-year-old Rotary Club suburbanite with triplets, a standing desk and an eight handicap, which he is. He studied abroad in Madrid. He drives a Miata. In the House, he represented the same homespun district Frank Underwood did in “House of Cards,” but his own house is in a Charlotte exurb, just barely over the South Carolina line.

“I like to accuse Mick of being from North Carolina,” jokes Congressman Trey Gowdy of South Carolina, his best friend in the House. Mulvaney is more in-your-face than most South Carolina pols; at one home-state prayer breakfast, he joked to the evangelical crowd that he didn’t know what the hell a Roman Catholic like him was doing there. “I call him Robitussin,” Gowdy says. “Doesn’t taste good at first, but good for you.”

His background is not backwoods. John Michael (Mick) Mulvaney was born inside the Beltway, in Alexandria, Virginia, then grew up around Charlotte, where his father became a prominent homebuilder. He attended a Catholic high school and Georgetown University, where he became president of the student body and, after a tip from his dad, an avid fan of a new talk-radio host named Rush Limbaugh. “I was one of the original Rush Babies!” he gushed recently on Limbaugh’s show.

I call him Robitussin,” South Carolina Congressman Trey Gowdy says of his friend Mick Mulvaney. “Doesn’t taste good at first, but good for you.”

Mulvaney was a star economics student in college—he earned an academic scholarship to law school—and during an interview he mentioned he still keeps Ayn Rand’s Atlas Shrugged in his office. But he suggests his worldview came less from books than from his parents, who were middle-class Roman Catholics, children of children of the Depression. He describes his Polish-American mother as a natural fiscal conservative who saved ketchup packets from McDonald’s and soy sauce from the family’s monthly Chinese dinners. “She probably still has them,” Mulvaney says. His Irish-American father, a former teacher, started a construction company and built it into a multimillion-dollar business.

Mulvaney was working for his dad’s firm in 2006 when he decided to run for the South Carolina state legislature, because he was tired of Republicans betraying conservative values. He had expected the Bush era to produce a small-government revolution, not a new entitlement for seniors to buy prescription drugs, a No Child Left Behind law increasing federal power over schools or an explosion of the deficit. He says when Jeb Bush called him in 2015 to seek his endorsement for president, he replied: “Governor, I got into politics because I didn’t like what your family was doing.” Instead, Mulvaney endorsed Rand Paul, another libertarian-leaning ideologue. At the time, he said he had a “very difficult time taking [Trump] seriously,” a stance he would reconsider.

While Mulvaney is a conviction politician, he’s also an ambitious politician. He spent only one term in the state assembly before moving up to the state senate in 2009, then promptly started running for the congressional seat he won in the Tea Party wave of 2010. He soon launched an unsuccessful bid to lead the conservative Republican Study Committee in the House in 2014. And he was considering a race for governor in 2018 before Trump’s victory, when he asked House Speaker Paul Ryan to recommend him for OMB.

Mulvaney never compiled much of a legislative record in the House. But he was an effective agitator. In 2011, he helped lead a group of Tea Party insurgents who threatened to block any increase in the debt limit unless Obama agreed to deep spending cuts, even though experts warned that failing to raise the limit would force the Treasury into default and trigger a global economic meltdown. The crisis Mulvaney helped create eventually did produce significant cuts through the so-called sequester. But it also produced a damaging downgrade of the U.S. credit rating, as well as a lasting rift between Republican firebrands and party leaders who didn’t want to pick apocalyptic fights they couldn’t win.

That rift drove fiscal battles for the rest of the Obama era, including the 2013 government shutdown. Mulvaney and other GOP rebels would refuse to back any budget bill that didn’t include draconian spending cuts along with conservative dreams like the repeal of Obamacare or the defunding of Planned Parenthood. House leaders, unable to pass partisan bills without the so-called Shutdown Caucus, would cut status-quo deals with Democrats that the rebels hated. Then the cycle would begin anew. “They wanted to throw a Hail Mary on every play,” grumbles Congressman Tom Cole, an Oklahoma Republican aligned with leadership. “They didn’t believe in forward progress.”

But Mulvaney didn’t see progress. He saw Republican leaders breaking promises to Tea Party voters. His campaign to take over the RSC in the House was his boldest protest, dedicated to the proposition that the group was too cozy with squishy House leaders. When he lost, he and several allies responded by starting the smaller, purer and more confrontational Freedom Caucus. Their rabble-rousing soon helped hassle House Speaker John Boehner into retirement.

Even though Mulvaney was in the thick of the rebellion, he was always considered among the more reasonable of the Reasonable Nutjobs. “Mick said a lot of ‘no,’ but he was always willing to explain how he could get to ‘yes,’” says Congressman Jim Jordan, the original leader of the Freedom Caucus. He was close with the new House leaders, Speaker Ryan and Majority Leader Kevin McCarthy. He also worked with liberal Democrats like Barney Frank to push for accountability in military spending. He even hosted a town hall in Spanish where he supported a path to legal status for undocumented immigrants, which got him slammed by Breitbart News as Ryan’s “Amnesty Ally.” He could come off as brash and mouthy—the Robitussin thing—but he was mostly regarded as a rock-thrower with goals, not just a rock-thrower who enjoyed throwing rocks.

“Mick sometimes brought those Freedom Caucus guys back to reality,” says Al Simpson, his former chief of staff. “He’d say: ‘If we’re always telling leadership to fuck off, we’ll never get anything.’”

Frustrated with never getting anything, Mulvaney saw a potential escape route when Ryan agreed to call Vice President Mike Pence to recommend him for the OMB job. Sources say Trump first offered it to House Financial Services Chairman Jeb Hensarling, who suggested Mulvaney instead.

“He’s a principled conservative who actually knows what’s in the budget,” Hensarling said. “There are a finite number of those around here.”

Mulvaney’s confirmation hearings became a fierce partisan battle, partly because of his failure to pay $15,000 in Social Security taxes for a nanny, mostly because of his refusal to walk back his indelicate views—like his support for raising the retirement age to 70, or his belief that failing to raise the debt ceiling wouldn’t trigger a catastrophic default. He also faced blistering attacks from Republican Senator John McCain, who denounced his skepticism about Pentagon spending. In the end, every Senate Democrat voted against Mulvaney, but McCain was the only Republican to break ranks, so he was confirmed by a 51-49 margin.

Mulvaney made it clear at his hearings that his core convictions would not change, that he would give Trump “completely and brutally honest” advice. He says that after his job interview at Trump Tower, he asked strategist Steve Bannon whether Trump wanted a yes man, and Bannon assured him Trump wanted to hear dissenting opinions. In fact, Trump was hiring a bunch of conservatives with similar views, starting with Pence, who had led the RSC when it was almost as hard-edged as today’s Freedom Caucus. And several of Trump’s conservative Cabinet picks—including Scott Pruitt at EPA, Rick Perry at Energy and Betsy DeVos at Education—had expressed deep skepticism about their new departments, a promising sign for a budget director hoping to downsize them.

But in his testimony, Mulvaney also noted that representing the president would be different from representing 700,000 voters, and “that change could result in dramatically different action on my part.” His friend Gowdy, a longtime trial lawyer, says it’s like having a new client. Cole puts it more archly: When you take the king’s shilling, you become the king’s man.

It’s gotta be tough to carry water for a president who doesn’t believe what Mick believes,” says South Carolina Congressman Jeff Duncan.

Mulvaney’s friends wondered how he would adjust to being Trump’s man. The new president had promised no cuts for Medicare, Medicaid or Social Security, plus a huge boost for defense. That put three-fourths of federal spending off limits, which didn’t leave much room for Mulvaney to wield his ax. Congressman Mark Meadows of North Carolina, the current Freedom Caucus chair, says he asked Mulvaney how long he thought he would last before Trump fired him or killed him.

“It’s gotta be tough to carry water for a president who doesn’t believe what Mick believes,” says Congressman Jeff Duncan, another South Carolina Republican.

So far, though, Mulvaney is all in. He says Trump isn’t ideological, but is definitely skeptical, which gets him to similar policies. “His view that government can screw things up as much as fix things is real,” he says. Mulvaney also seems to get along with Trump’s other aides, who haven’t knifed him in the press the way they seem to delight in knifing one another.

He’s less popular inside his own agency. And he’s still having a hard time on Capitol Hill, where he’s fighting the same uphill battles he used to lose in the House.

***

The Eisenhower Executive Office Building, the exuberant Second Empire architectural marvel where OMB’s leaders work, sits next door to the White House, which makes it easy for a budget director to pop into meetings and stay in the loop. But successful directors also take advantage of OMB’s in-house staff of nearly 500 civil servants, some of Washington’s most knowledgeable bureaucrats. They have a powerful ethic of nonpartisan analysis—and since most other presidential aides lack staff, they can give their boss a leg up in West Wing debates.

That’s why the opening of Mulvaney’s first speech to his career staff seemed so shocking: “For starters, you should know that I’m not interested in anything you have to say. I know way more than any of you.”

Then he grinned: “Oh, crap, I was reading from Peter Orszag’s notes.”

It was a savvy starter joke. When Orszag was Obama’s first budget director, many staffers saw him as a dismissive know-it-all, and Mulvaney was signaling that he intended to show more respect for their analytical chops. OMB’s mission, he said, would be speaking truth to power, even when the numbers spoke inconvenient truths. He made a solid first impression, though some brows did furrow when he urged everyone to read The Art of the Deal.

Most OMB analysts are number-crunchers with advanced degrees, not exactly a Trump-friendly demographic, but they share Mulvaney’s goal of rooting out waste. He won some points internally when he persuaded Trump to propose killing several questionable programs that help Trump voters, like Essential Air Service subsidies for rural airports and the Appalachian Regional Commission for coal country. Agency sources said he also earned some credibility by winning a West Wing battle to limit the defense increases in Trump’s budget to $54 billion, still huge but smaller than the $100 billion bonanza that Bannon and some Pentagon officials had sought.

Still, several OMB analysts who didn’t want their names used say Mulvaney consults them without really listening to them, assigning them to war-game drastic cuts he has already decided on and then ignoring their analyses of the impacts. They feel like he is conscripting them into a partisan crusade to dismantle government, while trashing the technocratic norms he pledged to uphold.

“He’s a personable guy. He’s respectful when we see him,” says one OMB budget analyst. “But a lot of us feel nauseous about what he’s doing.”

What Mulvaney is doing is trying to revolutionize the way Washington spends money, judging programs from the perspective of the taxpayers who finance them instead of the recipients who benefit from them. More concretely, he is pushing to roll back funding for foreign aid, research, health care, transportation and almost everything else that doesn’t involve Trump’s priorities of defense and the border. His “America First” budget blueprint included $54 billion in cuts to offset the hike for the military, squeezing “non-defense discretionary spending” to its lowest level as a share of GDP since the Hoover administration. The budget would kill the National Endowment for the Arts, the Corporation for Public Broadcasting, the Legal Services Corporation that provides attorneys for the poor, and dozens of other line items Mulvaney believes ordinary citizens shouldn’t have to pay for. He says he wrote the budget to reflect Trump’s promises, but even though Trump overruled him sometimes—preserving the National Office of Drug Control Policy, boosting a Pentagon war account Mulvaney sees as a slush fund—he did write the budget.

He’s a personable guy. He’s respectful when we see him,” says one Office of Management and Budget analyst. “But a lot of us feel nauseous about what he’s doing.”

The analysts say it was always clear that Mulvaney wanted to mimic The Heritage Foundation’s conservative wish-list budget; his deputy, Russ Vought, is a Heritage veteran. What annoyed them were Mulvaney’s public suggestions that he was just targeting waste and duplication, as if shredding the EPA budget by a third and stripping $7.7 billion out of the National Institutes of Health would have no effect on the environment or medical research. They cringed when he argued without evidence that after-school programs were ineffective, and especially when he lashed out at the nonpartisan Congressional Budget Office, attacking the agency’s integrity and competence, sniping that “the day of the CBO” has probably “come and gone.” He even accused a midlevel CBO analyst of bias because she had served during the Clinton administration, even though she wasn’t a political appointee.

“That really rubbed people the wrong way,” another OMB staffer told me. “The CBO has the same kind of good-government analytic ethos that we do, and Mulvaney undercut it. It was like saying there’s no such thing as an honest broker.”

That’s been a consistent theme for Trump, who often blasts the “fake news” media, “so-called” judges and other independent challengers of his authority. Mulvaney’s staff frets that he is obliterating norms in a less bombastic way. For example, White House budgets have always relied on economic forecasts from the CBO, but Mulvaney tweaked his 10-year budget into balance by simply assuming steady 3 percent annual growth, a gimmick that generated trillions of dollars on paper. He also assumed a flood of new revenues through unspecified tax reforms, which many budget wonks flagged as a $2 trillion double-counting error. He defends those heroic assumptions as the essence of Trump’s pledge to Make America Great Again—Mulvaney coined the phrase MAGAnomics in a column about the necessity of 3 percent growth—but every administration wants higher growth, and every previous administration followed CBO’s assumptions.

“There’s been a lot of sighing and rolling of eyes,” says a third OMB analyst. “Presidents always play games with budgets, but never to this extent.”

Democratic critics have been predictably scathing, attacking Mulvaney as a cartoon villain cooking the books to shaft the hungry and the sick. Think tanks are churning out white papers about his unprecedented cuts to clean energy and other innovation funding, while trying to point out the abnormality of a budget director who believes blowing through the debt ceiling wouldn’t be a catastrophe.

Mulvaney hasn’t tried to push back through intense bipartisan outreach. “I’d be the Democrat to get outreach from Mick, and it hasn’t happened,” says Congressman John Yarmuth of Kentucky, who is the top Democrat on the House Budget Committee and also a Mulvaney golfing buddy. “He’s not the best guy to try to compromise with anyway. He’s as vicious a budget hawk as there is.”

A much bigger concern for Mulvaney is that congressional Republicans, especially appropriators, have been almost as scathing about his priorities, declaring the Trump budget dead on arrival even more emphatically than they usually declare presidential budgets dead on arrival. House Appropriations Committee Chairman Rodney Frelinghuysen publicly called the NIH cuts “ridiculous.” Senator Susan Collins was overheard slamming the budget on a hot microphone while chairing a hearing: “No measurement, no thinking about it, no metrics, no nothing. It’s just incredibly irresponsible.” Senator Lindsey Graham of South Carolina, another Mulvaney golf buddy, warned that his 29 percent cut for the State Department would lead to “a lot of Benghazi situations.”

When Mulvaney met with top House appropriators, Cole confronted him over his plan to abolish low-income heating aid: “Do you want some poor 80-year-old widow to freeze to death?” Appropriators often defend appropriations, but Cole says it’s terrible politics as well as terrible policy to nickel-and-dime bipartisan priorities like pandemic defense and cancer research. “I respect Mick’s principles, but I don’t think these are things he understands deeply,” Cole told me.

Mulvaney says he’s just trying to disrupt budget culture to promote compassion for taxpayers as well as benefit-receivers. And he argues that adopting Democratic framing about the cruelty of cuts is futile politics for Republicans, since they’ll get tarred as mean and stingy no matter what. But he knows from experience that Congress is not an institution that welcomes disruption, and that politicians rarely get tossed out of office for putting extra spending on the national credit card. The danger from the blowback is not that Trump’s budget will get picked apart on Capitol Hill—all budgets do—but that it will be completely discarded.

That’s what happened this spring with the “omnibus” budget funding the last few months of fiscal year 2017. After Mulvaney sent Congress a hastily prepared list of spending cuts for agencies like NIH, Congress accepted none of them, and actually increased funding for NIH. He also publicly demanded money for Trump’s border wall, and when Democrats balked, he floated a compromise to fund Obamacare payments the Democrats wanted if they agreed to fund the wall. The final deal included the Obamacare payments but not the wall, and the media coverage portrayed it as a humiliating smackdown of the president.

The next morning, Trump called Mulvaney at home in a rage, asking why it sounded on his TV like the Democrats won. “It was a candid discussion at 6:30 a.m.,” Mulvaney gingerly recalls. He told Trump he would explain to the press that the White House did fine, securing some funding Trump wanted for the military and border security. In reality, OMB officials believed they had entered the talks too late to have much impact, but Mulvaney was worried that if he didn’t call out Democrats for spiking the football, Trump would veto the deal and create a crisis. Within hours, Trump unleashed his rage on Twitter, implicitly admitting the Democrats had preserved the Obama-era status quo and explicitly threatening to provoke a crisis in the fall: “Our country needs a good ‘shutdown’ in September to fix mess!”

Mulvaney tried to do cleanup with a media call, but it quickly degenerated into a viral-audio technical fiasco that Rachel Maddow replayed in its chaotic entirety on her show, featuring classical music and then smooth jazz drowning out confused questioners, as well as Mulvaney muttering: “This is gonna be a disaster.” He then held a news conference aimed at an audience of one, attacking Democrats for “trying to make it look like they pulled a fast one on the president,” declaring that “I just won’t stand for it, because it’s not true.” But he basically confirmed it was true, criticizing the deal as “business as usual,” warning that he would have “no problem” with a September shutdown if things didn’t change. Mulvaney also made the kind of nothing-to-see-here statement that can define an embattled White House: “We are competent, we know what we’re doing, and the country is safe in our hands.”

This was exactly the kind of kick-the-can-down-the-road deal Mulvaney had hated in the House. In fact, several of his former colleagues say he lobbied them to back it with exactly the kind of pragmatic arguments he scoffed at from House leaders: If this fails, the revised deal will be worse; you need to support the team; we’ll fight harder next time. When I asked Mulvaney if he would have voted for the deal in Congress, he didn’t answer, except to say he has a “different boss now,” and he “went into this eyes wide open,” essentially confirming how he would’ve voted.

Mulvaney has tried to be the kind of team player he never was in the House, staying on message without abandoning his principles. It’s tricky. Gowdy still remembers Congressman Mulvaney explaining to him why the Export-Import Bank was a boondoggle, so he was amused when Director Mulvaney urged him to reauthorize it. Similarly, on the debt ceiling, Mulvaney made the case against a clean bill, but he very publicly lost, so he says he’s “more than happy to defend the administration’s position.” Speaker Ryan called him on the golf course to razz him about his discovery that the perfect shouldn’t be the enemy of the good.

It’s jarring to hear an aide admit he disagreed with a president, especially a president as touchy about authority as Trump. But it can be seen as a validation of that authority, an unusually self-abasing proclamation that Trump calls the shots. “Mick makes it clear: This isn’t how I’d do it, but it’s how we’re doing it,” Gowdy says. “I never thought I’d use the words humility and Mulvaney in the same sentence, but it takes a certain humility.”

Mulvaney’s former Freedom Caucus colleagues don’t expect him to throw rocks anymore, but they considered the omnibus deal an ominous moment. For years, their leaders had told them they couldn’t expect radical budget changes when Republicans didn’t control Washington. Now Republicans controlled Washington, with their own guy on the inside, but the outcome seemed awfully familiar. “We thought the cavalry was coming. How can we still be funding Planned Parenthood and sanctuary cities?” Jim Jordan says.

Several Freedom Caucus members told me they’re worried that “New York”—their shorthand for Ivanka Trump, Jared Kushner and Cohn, the advisers they associate with cosmopolitan liberalism—will end up marginalizing Mulvaney on fiscal issues. But he has assured them the White House will not let Congress dictate another status-quo result this fall, even it takes a government shutdown to get Trump’s priorities.

“This isn’t a unilateral disarmament team,” one official warned.

***

Shortly before the president left on his first overseas trip, Ivanka Trump walked next door to get a briefing from Mulvaney and his team. The 2018 budget was going to be released while her family was in Europe, and she had questions. “I’m sure she was worried that an extreme right-winger from South Carolina was about to make her dad look bad,” one administration official says.

Ivanka’s spokesman said her visit was purely informational. But while the “New York” formulation is exaggerated—and perhaps vaguely anti-Semitic—she is considered an internal voice for moderation, and her questions at the meeting did suggest concern that Mulvaney’s proposed cuts to refugee aid, civil rights enforcement and similar accounts would expose her father to charges of heartlessness. There was a long discussion of his cuts in famine aid, especially the elimination of the Food for Peace program that sends U.S. farm products abroad. Mulvaney says he argued that sending food is less efficient than sending cash, which is true; he also said the budget held emergency famine aid steady, though it sharply reduced global food aid. In any case, Ivanka’s office says she was satisfied, and Mulvaney didn’t revise anything.

“She had a natural reaction that a lot of people have, when you reduce spending on programs with wonderful names, people think you’re against that wonderful thing,” Mulvaney says. “What I did, not only with Ivanka but with everyone in the White House who had never been through a budget process, was walk her through it, and show her it’s not just that we hate kittens and puppies.”

White Houses worry about appearing anti-puppy. But even though Mulvaney’s inflammatory budget was released while Trump was away, the president hasn’t distanced himself from it. And there hasn’t been a torrent of leaks accusing Mulvaney of boxing in the president with doomed proposals for cuts to infrastructure, a top Trump priority, or the State Department, a top congressional priority. Mulvaney’s colleagues don’t even seem to mind his meanderings off the party line, even as they backstab one another in the press for alleged disloyalty.

“Mick has adapted to the president’s point of view, while trying to stay consistent to who he is,” Cohn says.

Mulvaney says the Trump White House is incorrectly perceived as chaotic because the president encourages debate. “Groupthink wouldn’t look chaotic, would it?” he asks. Mulvaney also argues that Trump’s helter-skelter approach to meetings has fostered a misleading impression that he’s clueless about policy. “He’ll bounce around to a bunch of different topics, so people will say, ‘Oh, he’s got a short attention span,’ or ‘Oh, he can’t follow the details,’” Mulvaney says. “I can assure you, the people who discount his ability to grasp the issues do so at their own peril.”

It’s not going nearly as quickly as we had hoped, and the president is learning that it’s all going to be harder than he thought,” Mulvaney says.

Perhaps, but Trump is still a first-time public servant, and so are aides like Ivanka, Kushner and Cohn. Mulvaney’s governing experience, while limited for a budget director, is immense compared with Trump’s top domestic advisers other than Pence. The president routinely calls him to the Oval Office to ask about numbers, as well as nonfiscal matters ranging from wetlands rules to House politics. “He realizes there’s a value to understanding the rhythm of Washington,” Mulvaney says.

So far, Trump has struggled to get things done in Washington. There’s been no health reform, no tax reform, no infrastructure bill. Hensarling mused to me that Thomas Jefferson said the ground of liberty is to be gained in inches, but these days it feels like millimeters. “It’s not going nearly as quickly as we had hoped, and the president is learning that it’s all going to be harder than he thought,” Mulvaney says. “That’s one of the great learning processes he’s gone through, how slow things move in D.C.”

The gridlock in Congress is only amplifying Mulvaney’s influence, because he can get things done at OMB without legislation. He’s overseeing a governmentwide effort to roll back the regulatory state that has already blocked 860 proposed Obama rules. He has also collected restructuring plans from every federal agency, the first step in a bold effort to scramble Washington’s org chart.

But Mulvaney’s next big test will be the budget. It isn’t clear how Congress can pass a spending plan that Trump would be willing to sign. Inertia is a powerful force, and so is the Senate filibuster; a major defense increase would require 60 votes, which would require a deal with Democrats, which would inspire the kind of Freedom Caucus resistance Mulvaney knows well. It’s not even clear whether Trump wants to get to yes, or if he’d prefer that “good shutdown” he tweeted about.

No matter how the budget is resolved, the national debt that Mulvaney loves to denounce is almost certain to keep growing. Most legislators enjoy spending more than cutting spending—and judging from the early maneuvering over tax reform, Republicans seem more eager to cut taxes than they are to end the loopholes and deductions necessary to avoid a new flood of red ink. Fiscal dessert remains more enticing than fiscal vegetables. But Mulvaney has been warning his White House colleagues that in the future, if they want to get serious about debt, they’ll have to get serious about Medicare and Social Security reforms.

Of course, that would require another chat with the president. Mulvaney says Trump listens to him a lot more closely than House leaders used to listen to the Freedom Caucus. But the federal government today is as vast as it was under Obama, and while he may derive some satisfaction from losing at the highest levels, Mulvaney would rather win. One belief he still shares with his fellow Big Government-bashers in the Freedom Caucus is that if Republicans don’t transform Washington now that they control it, voters will never trust them with power again.

“Look, Mick’s frustrated, we’re all frustrated, but at some point, we’ve got to get some stuff done,” Meadows says. “Otherwise, there will be a day of reckoning.”