Ryan steers by very different stars. Throughout his career, he’s rejected economic nationalism and championed trade and immigration. As a disciple of the late Jack Kemp, Ryan has pushed the party to welcome more minorities—while Trump, for example, more commonly portrays undocumented immigrants or inner-city gangs as threats to his preponderantly white supporters. Conversely, Ryan has been much more ideologically doctrinaire than Trump about cutting taxes and spending. That includes entitlement programs, like Medicare, that benefit the older and blue-collar whites who are central not only to Trump’s coalition, but also to the GOP House majority.

The Trump administration’s early weeks have been a delicate minuet between these contrasting perspectives, which can be simplified as nationalism and libertarianism. Trump has emphasized nationalism in his own actions, including executive orders withdrawing from the Trans-Pacific Partnership trade agreement, escalating efforts to deport undocumented immigrants, and restricting immigration from initially seven—now six—Muslim-majority nations. During the campaign, Ryan criticized all of those ideas. But since Trump’s victory, the speaker has defended them.

Trump and Ryan have also found common cause in rolling back federal regulations, particularly those concerning energy production and climate change. That cause unites conservative nationalists and libertarians.

But as the health-care debate shows, the seams are more visible on questions related to federal spending. Trump struck the first blow in late February when he previewed his three-pronged guidance for the federal budget. Trump aligned with Ryan and other congressional Republicans by promising to increase defense spending and severely cut domestic discretionary programs. Those programs, in fields like education and scientific research, provide the federal government’s principal investments in the future productivity of younger people, a racially diverse and mostly Democratic constituency.

But Trump decisively departed from libertarian Republicans by reaffirming his campaign pledge to block cuts to Medicare and Social Security. Those programs benefit an older population that is predominantly white (about three-fourths of all Americans over age 45 are white) and heavily Republican (whites over 45 provided over half of all Trump’s votes). With his pledge to protect Medicare, Trump elevated his nationalist agenda over Ryan’s libertarian-flavored drive to restructure the program into a “premium support” system that shifts financial risk from government to seniors.

The health-care struggle flips this order. Trump has embraced Ryan’s blueprint to radically retrench the ACA while cutting taxes for the wealthy. But in its devastating analysis of the Ryan plan, the Congressional Budget Office reaffirmed what I’ve called the Trumpcare conundrum. The plan would lower costs for younger and healthier people, many of whom now lean Democratic. At the same time, it would raise premiums—by as much as 25 percent—and swell the uninsurance rate for older adults ages 50 to 64, who now mostly vote Republican.