Stakes high for Trump on healthcare debate
Outcome will be crucial in defining his early presidency
WASHINGTON — Conservative critics launching daggers at the Republican healthcare bill emerged confidently from the White House this week, insisting President Trump was heeding their concerns. Texas Sen. Ted Cruz — a sometime rival — dined at Trump’s private residence. Renegade GOP lawmakers were invited to bowl at the White House.
This is what Trump looks like in “sell mode,” as his staff calls it.
Trump and his advisors have yet to utter the term “Trump care,” and some observers still doubt his commitment to the latest congressional plan to alter President Obama’s signature healthcare law.
But there’s little question that the outcome of the healthcare debate will play a major role in defining Trump’s first term in office, affecting his ability to deliver on other priorities such as a $1-trillion plan to rebuild public works, a multibilliondollar border wall and a daunting challenge to rewrite the tax code.
Aware of those stakes, Trump is engaging in the complex effort to change the health system, albeit cautiously after the tumult that grew out of his early actions on immigration and other issues. Selling the healthcare bill, which has already met sharp resistance within his party, will present the stiffest test yet of his pledge to play the deal-maker.
“No president wants to
have early in their administration a major legislative defeat because it makes them look weak,” said former GOP House Speaker Newt Gingrich, who has advised Trump in public and private.
And Trump, perhaps as much as anyone who has held the office, despises such perceptions. Unlike Obama, who shied from schmoozing or publicly confronting lawmakers from his own party, Trump seems to relish the art of puffing up friends and belittling those who get in his way. And despite low popularity ratings with the public at large, Trump maintains very high support in Republican congressional districts, giving him leverage over conservatives rebelling against the bill.
“Every conservative that has come out publicly opposed to this has been called by the White House and is being cajoled and wooed by the White House to give in,” Kentucky Sen. Rand Paul, a prominent Republican critic, said on MSNBC on Wednesday.
To get the bill passed, however, Trump will probably have to spend all that leverage. And even that may not be enough.
Among the problems to emerge so far is the broad array of conservatives who have attacked the plan, which was written by leaders in Congress after a year of listening sessions and policy conferences with rank-andfile lawmakers.
The Heritage Foundation, a conservative think tank that helped Trump craft much of his early agenda and staff his transition team, has said the president should drop it immediately. Its representatives were joined at a Wednesday meeting with Trump in the White House’s Roosevelt Room by a tea party leader, the head of a group backed by the powerful Koch brothers and another that helped pressure Republicans to shut down the government in 2013.
Breitbart News, the hard-right populist website with close ties to Trump’s administration, ran a series of critical headlines this week, including one that blamed House Speaker Paul D. Ryan (R-Wis.) for “Obamacare 2.0” and a companion piece that noted that “Trump supports, despite conservative dissent.”
Unlike Obama, who tried but failed to get bipartisan support for his healthcare plan, Republicans have shown no interest in courting Democrats, who face intense political pressure to avoid compromise.
At the same time, healthcare industry leaders, hospitals, doctors and nurses have become some of the most vocal and pointed critics of the bill, warning that it risks leaving millions of patients without access to health coverage. Health insurers caution that it could lead to the collapse of insurance markets across the country.
On Thursday, the legislation sailed through the House Ways and Means and Energy and Commerce committees after intense overnight sessions, but the slim resistance from Republicans on the panels suggested a lack of broad support.
As Republican leaders push the bill forward, it continues to face criticism from the most conservative lawmakers who complain it does not go far enough in fully repealing Obamacare as well as more moderate Republicans who worry their residents will be dumped from the Medicaid safety net.
Some Republican critics say they think Trump will drop the bill and let Ryan take the fall. Several GOP senators, including Utah’s Mike Lee, Florida’s Marco Rubio and Maine’s Susan Collins, have expressed reservations, urged Trump to slow down or insisted he start from scratch.
“House health-care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast,” Arkansas Sen. Tom Cotton, another conservative, said on Twitter.
But Trump’s advisors say that he remains committed to Ryan’s plan, even as he has signaled he is willing to make changes that could complicate efforts to pass it. They note that he campaigned on repealing and replacing Obamacare, as did most members of his party. And that is their chief selling point among the wavering.
Trump has told several conservative critics that he is open to changing the bill. But altering it to court conservatives in the House could make the bill harder to pass in the Senate, where statewide voting forces Republicans to hold more moderate positions.
“He’s certainly in salesman mode,” said one White House official. “I don’t think you take that position if you’re not owning the product.”
Trump has sent a few tweets touting the plan, including cajolery to Paul to fall in line and some pushback on Thursday against the notion that the bill is faltering.
“Despite what you hear in the press, healthcare is coming along great,” he wrote. “We are talking to many groups and it will end in a beautiful picture!”
But since the bill’s Monday night release, Trump has not done much public promotion. He has let Ryan and other congressional leaders handle the details, including a lengthy slideshow presentation the speaker gave on Thursday with his sleeves rolled and jacket off. Trump’s Health and Human Services secretary, Tom Price, presented details and took questions during a White House briefing with reporters on Tuesday.
White House aides said a variety of other officials — Vice President Mike Pence, Cabinet secretaries, press surrogates and Domestic Policy Council Director Andrew Bremberg — gave more than 70 interviews selling the plan on local and conservative radio and television stations this week.
Pence, in what many see as a warning shot to critical Republicans, plans to speak in Louisville, Ky., on Saturday. Trump scheduled a rally in Nashville for next week through his campaign. And White House Press Secretary Sean Spicer promised Thursday to make a more aggressive pitch throughout next week.
Gingrich said Trump is right to pace his pressure tactics, allowing Republicans in Congress to air their problems before tightening the screws.
“I don’t think he should go out this morning and try to defend the bill in its current form,” he said earlier this week. “That was the big Obamacare mistake.”
He believes Trump will unleash his full arsenal when it’s most needed, in “the final tussle,” when every president feels “a desperate need to pass things.”
That’s when the bombastic, confrontational Trump could return, should he choose, to unleash his passionate supporters on fellow Republicans with accusatory tweets, angry rallies or calls to protest at their district headquarters.
Many conservative lawmakers seem unmoved, so far, by White House arguments.
Rep. Scott Perry, a Republican holdout who has been invited to the White House, said a chat with Trump might help. But if it’s real negotiation, Trump needs to give something up, he added, comparing the transaction to haggling over the price of a car.
“Look, I’m a fan of the president, I support the president, but I have constituents I answer to,” said Perry, who represents the Gettysburg, Pa., area where Trump delivered a major policy speech during the campaign in which he promised to replace Obamacare. “I work for them.”
Christopher Ruddy, a confidant of Trump who publishes the conservative website Newsmax, said he believes this is Trump’s first major learning experience in dealing with Congress. And it’s also a learning experience for everyone else.
“The idea that it’s his way or the highway is a myth,” he said.
Ruddy believes Trump can escape blame if the bill fails because of intransigence in Congress, but he does not think Trump views it that way.
Trump’s reluctance to dictate the details is also a result of his lack of experience in legislating and his inability to fill out his administration with policy writers. He said recently that he was surprised at the complexity of the healthcare system, a comment that shocked policy experts and lawmakers who have spent decades trying to improve it.