Trump: 'We Learned a Lot' From Health Care Debacle
Donald Trump campaigned to repeal and replace Obamacare in his first 100 days in the White House. He boasted of wielding a businessman’s negotiating skills alongside a determined GOP commitment to upend the old ways of Washington with conservative governance.
But on Friday, his 64th day as president, Trump swallowed his first legislative defeat, after House Republicans balked at passing a health care measure they came to view as flawed and too politically radioactive to embrace before next year’s midterm elections.
“I’m disappointed,” the president told reporters. “I’m a little surprised, to be honest with you. We really had it. It was pretty much there within grasp.”
The Patient Protection and Affordable Care Act -- signed by President Obama and a survivor of two Supreme Court decisions and more than five dozen GOP efforts to repeal it -- remains the law of the land.
The public-private coverage system created in 2010, which benefits a minority of all Americans but touches all of the health care system, will eventually “explode,” Trump predicted. “It’s going to have a very bad year,” he told reporters in the Oval Office after he and House Speaker Paul Ryan opted to yank the doomed GOP replacement bill from the House floor.
Ryan chalked up his conference’s dramatic flameout to “the growing pains of governing.”
Trump, at least initially, blamed congressional Democrats for standing together against the Republicans’ repeal effort, forcing the GOP to pursue complicated legislative procedural steps that navigated around Democratic opposition, which one frustrated lawmaker compared to trying to shove a camel through a keyhole.
“I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare,” the president said.
(Trump never met with any Democratic lawmakers to seek their ideas before launching the repeal and replace endeavor after January.)
Obamacare, on its own, Trump continued, is teetering in some states in which private insurance policy choices in the federally subsidized marketplaces are evaporating. Premium prices have escalated, and deductibles soared, often rendering policy choices unaffordable for those who can’t access insurance through employers, are not seniors on Medicare, and for the working class whose incomes are too high to qualify for state-based Medicaid.
Asked if he sought to remedy some of those Obamacare problems in the interim (as his predecessor recommended he do during private conversations months ago), the former New York businessman said he was eager to put health care behind him and move to tax reform-- another policy-heavy endeavor that in the past has required years, rather than months, of congressional labors.
Failing to enact health care legislation complicates Trump’s tax-cutting ambitions on several levels, White House officials conceded. To underwrite the revenue lost with potential tax cuts, the administration hoped to use savings achieved by repealing the Affordable Care Act.
Trump said he had long predicted that Obamacare would crater, and he boasted he would be proven correct.
“There’s not much you can do to help it,” the president said of the law, which his Department of Health and Human Services is charged with implementing. HHS could make limited alterations under its regulatory authority attached to the Affordable Care Act’s existing provisions, and Trump could work with lawmakers of both parties to craft new piecemeal legislation this year. But he made no specific commitments.
The president sought to save face, arguing he had done everything he could to pass legislation through the House, even if the patched-together product was not entirely to his liking by the end of the week. The demise of the bill presented an opportunity, he argued.
“Both parties can get together and do real health care; that's the best thing,” the president said. “I think having bipartisan [legislation] would be a big, big improvement,” Trump added. “I think that this is going to end up being a very good thing.”
But in an afternoon phone conversation with the New York Times, the president sounded eager to abandon health care, rather than persist. “It’s enough already,” he said of the negotiations, which the White House noted had included meetings, visits, and telephone calls with more than 120 lawmakers just in the run-up to the anticipated vote this week.
Health care’s policy complexities, which the president never described to his audiences during his recent speeches and rallies, and internecine party politics swamped Trump from the moment he said the White House would have its own repeal and replacement plan. In a hurry, he switched gears early this month and celebrated the Ryan-crafted bill as “the plan,” after the speaker posted it online on a Monday night.
Trump’s labors to overhaul the Affordable Care Act lasted just three weeks. Obama’s efforts, which included both parties before every Republican voted against it, took 18 months.
Health care has been a graveyard for political ambitions for decades. The Medicare Catastrophic Coverage Act, later repealed, was a political disaster in 1988 and 1989 that provoked irate elderly constituents to blast President Reagan and chase former House Ways and Means Committee Chairman Dan Rostenkowski through an Illinois parking lot while television cameras captured every frame. The Clintons failed to get their secretly constructed universal coverage plan to a vote in 1994, and Hillary Clinton’s opponents used it as a weapon against her in 2008 and 2016.
Mitt Romney pioneered what became a model for Obamacare in Massachusetts as governor, and later turned his back on his own plan as a presidential candidate in 2012. Obama and Democrats initially exulted in 2010 that they would run and win elections on the ACA benefits. Seven years later, the law expanded coverage to an estimated 20 million Americans, reduced the ranks of the uninsured, and “bent the cost curve” of rising health care costs -- but it also cost Democrats dearly in four straight election cycles because public opinion remains split.
Trump now has his own health care headstone. The failure Friday challenged everything he celebrated over half a century of brand building: the art of the deal, the dynamics of human behavior, and the ability to achieve a desired outcome on the basis of salesmanship and fears.
Trump said the lessons he drew from such a prominent flop were mixed. He had put two former House members in his Cabinet to navigate the shoals: Tom Price as HHS secretary and Mick Mulvaney as director of the Office of Management and Budget. Trump embraced Ryan’s bill. He instructed Congress that they must link repeal of the ACA to replacement, to occur together. And Trump championed a plan with House Republicans that was supposed to have three phases: the legislation that on Friday died in the House; deregulation accomplished through HHS; and separate health care-related measures that would have required 60 votes in the Senate later on (viewed as a fantasy because Democrats would not collaborate under those terms).
The president also understood that the bill he hoped the House would pass would never clear the Senate, complicating the political stakes for House Republicans who chafed at the more moderate instincts presented by their colleagues in the upper chamber.
While the president met privately with scores of lawmakers, interest groups and stakeholders, he promised Americans a “big, beautiful negotiation,” but offered no details of what Washington was cooking up. It became clear that Trump’s campaign vows that Americans would not lose their coverage, and that an Obamacare replacement would offer higher quality care at lower costs, had changed. During March, the White House softened Trump’s boasts: the new spin became consumer “choice” and “access” to health insurance.
Trump’s job approval poll numbers dipped below 40 percent in several surveys conducted in March, and the president began openly telling the public that he was anxious to move on to tax reform, which he viewed as more fruitful and less politically painful.
It was Ryan who arrived at the White House at midday to tell Trump the House GOP conference did not have 216 votes to pass the measure. Trump later praised the speaker and declined to blame him for the party’s explosive failure. Ryan talked with the president, whose instincts are usually to roll the dice, about whether lawmakers should be compelled to go on the record with their votes Friday afternoon, even if the bill went down. Ryan recommended against that drama, and the president agreed the bill should be pulled from the floor.
“It certainly was an interesting period of time,” Trump said a few hours later. “We all learned a lot. We learned a lot about loyalty. We learned a lot about the vote-getting process. We learned a lot about some very arcane rules in obviously both the Senate and in the House. … Certainly, for me, it's been a very interesting experience.”