For any president, wading into the health-care debate is a risky proposition. Polling on every possible option confounds all logic. Americans overwhelmingly dislike the individual mandate and prioritize lowering the cost of health care over all other health problems in the country, but a majority of Americans do not want to roll back Obamacare’s guaranteed coverage of pre-existing conditions. Just a quarter of Americans are happy with Obamacare as-is, but a mere 12 percent favor the now-dead Senate health-care bill.
And it’s not just the public that is economically and politically illiterate. Politicians also want to have their cake and eat it too. Republicans adopted the fallacious metrics of Obamacare when discussing repealing and then replacing the bill. Rather than emphasizing the role or long-term effectiveness of the market, they built seven years of party momentum around the promise of replacing Obamacare with a plan that would simultaneously maintain coverage rates, lower premiums, and keep the pre-existing-condition coverage mandate.
The details of the plan itself, however, included not much more than “get[ting] rid of the artificial lines around the states.” When pressed by Senator Marco Rubio during a primary debate, Trump failed to exhibit any understanding of the issue’s complexity.
“You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York or Texas, you’ll have many,” Trump said. “They’ll compete, and it’ll be a beautiful thing.”
“The nice part of the plan — you’ll have many different plans! You’ll have competition, you’ll have so many different plans!”
A month into his presidency, Trump observed that “nobody” — except for everyone else in the Republican field — “knew health care could be so complicated.”
Rather than begin his tenure with legislation set to gain bipartisan, or at least Republican, approval, Trump dived into the most complex cornerstones of GOP dogma without a real plan or the discipline to sell it to the American people. After publicly pressuring Paul Ryan to ram through a notoriously unpopular bill in the House, Trump slammed it as “mean.” The Senate then had to rewrite major aspects of it — while navigating even more difficult political terrain, because Republicans have a smaller majority in the upper chamber than they do in the House. With a full-scale assault from the media and leftist shrieks that Mitch McConnell wanted to personally murder millions of Americans, the bill’s popularity plummeted, even as county after county continued to suffer the failures of Obamacare and see a total exodus of insurers from exchanges.
With the Republican party spending the better part of the last decade promising to repeal Obamacare and many would-be Never Trumpers casting a ballot for Trump on this issue alone, Trump’s legacy is contingent on the salvation of the health-care system. He has the single largest platform from which to influence public opinion on this matter, but instead he tweets about Mika Brzezinski’s face and loops the news cycle back to his relationship with the Russian government. As the leader of the party and the country, he has a duty to bring the country around to supporting Obamacare repeal, but instead he is happy to let the Republican agenda, Americans’ insurance access, and one-fifth of the American economy “crash and burn.”
Conservatives rightly slammed Obama for forcing a wildly unpopular bill on the American people in the most unorthodox of manners. Even so, Obama spent enough time wining and dining the right media personalities and political demographics to bring much of the public to swallow Obamacare, even if it wouldn’t go down too easily. Sure, maybe the marriage was arranged and the bride unwilling, but the groom seemed nice enough and the other options were sufficiently awful.
Trump could not even bring half of his so-called die-hards to approve of the bill.
Trump couldn’t even bring himself to pretend to flirt, or at the very least buy the constituents some flowers. For all the talk of the devotion of the MAGA base, Trump could not even bring half of his so-called die-hards to approve of the bill.
Those on the Trump train have quickly unsheathed their knives, going after everyone from conservatives such as Mike Lee to the Planned Parenthood–allegiant Susan Collins. Some of the blame, especially for those like Rob Portman who have pulled a 180 on the notion of a full-scale repeal of Obamacare (an alternative McConnell is now touting), is warranted. But in the end, with virtually no support from constituents, the political price of owning a half-hearted Obamacare bailout and a future Medicaid reform that the Senate majority leader himself said might not happen proved too high.
Critics have used Trump’s apathy toward specifics as a defense: He would have signed any bill, so the onus was on congressional Republicans to bring him something to approve. But the president is not supposed to be just an “R” and a pen waiting at the finish line. Leading not just the White House but the Republican party as a whole, Trump bears the central responsibility for selling a true Obamacare repeal and, hopefully, a market-centric replacement — be it now or in the future — to the American people.
For all the fuss about Trump’s communication directly to the people and ability to broker deals, he’d better be able to get 50 votes in the Senate for ending Obamacare once and for all.
— Tiana Lowe is an editorial intern at National Review.