President Donald Trump got elected in no small part because of a signature pledge during the final months of the presidential campaign: to repeal and replace the Affordable Care Act.
In campaign rallies, he attacked on President Barack Obama’s signature healthcare law mercilessly. He whipped crowds into a frenzy with his vow to halt the increase in premiums and insurer exits from the marketplace.
“Job-killing Obamacare is just one more way the system is rigged!” he said during an October campaign rally.
Trump promised to repeal the law on “day one.” Fives months into his presidency, healthcare overhaul is proving more complicated for Trump than the rhetoric.
And a big part of the blame for the sluggish effort appears to lay squarely on Trump’s shoulders. He has contradicted his own party’s leadership, over-promised, and distracted from his own agenda. Analysts and frustrated members of his own party say he has helped increase the possibility that the law he railed against for so long stays in place.
Promises he can’t keep
On the campaign trail and after his election victory, Trump made grandiose promises about the end result of the Republican healthcare bill.
In interviews before and after the election, Trump promised to cover “everyone” under his Obamacare replacement. He promised that costs for people would come down, that the government would pay less, that no one with a preexisting condition would be denied coverage. He also vowed robust competition in the insurance marketplace.
That defined the debate in Obamacare’s terms. Instead of talking about free-market principles, as Republicans had for years whe advocating for the ACA’s repeal, the debate was framed around how many people would maintain coverage. Instead of talking about streamlining the market, Trump suggested it needed to become even bigger.
“It’s going to be — what my plan is is that I want to take care of everybody,” Trump said in an ABC interview right after he took office. “I’m not going to leave the lower 20% that can’t afford insurance.”
The president even promised not to touch entitlements, including Medicaid. Any repeal of Obamacare, however, inevitably would have to deal with the ACA’s expansion of the Medicaid program.
The results haven’t been pretty. Based on projections from the Congressional Budget Office, the Senate’s bill would slash Medicaid funding, increase the number of uninsured to 49 million in 2026, raise costs for older and sicker Americans, and increase deductibles.
Soon after the election, an idea from Republican leadership emerged: Pass a law that would set a deadline for the repeal, possibly after the 2020 election, and give members a few years to work out a replacement bill.
Trump, however, insisted that the repeal and replace should happen “simultaneously.” And he said he wanted it done as soon “a few weeks” after he took office.
In doing so, he prompted a course correction that forced repeal and replace into one bill and getting it passed as soon as possible.
Sen. Susan Collins of Maine, a more moderate member of the GOP conference, expressed frustration about Trump’s decision after leadership delayed a vote on the chamber’s legislation.
“This president is the first president in our history who has had neither political nor military experience,” Collins said. “Thus, it has been a challenge to him to learn how to interact with Congress and how to push his agenda forward. I also believe it would have been better had the president started with infrastructure, which has bipartisan support, rather than tackling a political divisive and technically complicated issue like healthcare.”
Now, after insisting on speed and a concurrent replacement, Trump is floating the idea of delaying the process.
“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump tweeted Friday, reversing his previous roadmap.
But there no longer appears to be any appetite for that process. According to Axios’ Caitlin Owens, a senior GOP aide said there was “zero” chance a full repeal and then replace process could happen in the Senate.
There may be no broad support, but it could embolden conservative holdouts like Sen. Rand Paul to hold their ground. Paul tweeted his support for Trump’s idea on Friday. Another GOP aide told Axios that the rapidly changing statements from Trump could slow everything down.
“Not really seeing anything happening in July if this keeps up,” the aide said.
Two serious political missteps from Trump and his team have damaged the Obamacare repeal process and allowed Democrats to take advantage.
The first came during a White House meeting about the healthcare push with Republican senators.
Trump called the House’s version of the healthcare overhaul “mean.” Weeks later, during a Fox News interview, he confirmed he used the term.
That has become a rallying cry for Democrats, who are already preparing to use the comment in ads against Republicans running in the 2018 midterms elections.
And during the Senate’s negotiating process, the decision by a pro-Trump nonprofit group to run ads attacking GOP Sen. Dean Heller for his initial opposition mystified party leaders including Senate Majority Leader Mitch McConnell. Heller, up for reelection next year in Nevada, a state which Hillary Clinton won in 2016, is supportive of Obamacare’s Medicaid expansion.
McConnell was reportedly annoyed at the ads and called White House Chief of Staff Reince Priebus to tell him they were “beyond stupid.” Heller even reportedly made a joke about the ads during a White House meeting of the GOP conference on Tuesday.
By Wednesday, the group had pulled the ads from the air.