Health care failure contains hard lessons for President Donald Trump – but is he willing to learn them?
Trump did not take responsibility for the demise of his bill, preferring instead to blame Democrats for failing to support it
Blame for the failure of the Republican health care bill will fall on multiple parties, including House speaker Paul Ryan, who helped craft it, and the conservative and more moderate Republican factions that warred over its details and cost Republicans the unity they needed.
But the political impact will inevitably fall hardest on President Donald Trump, who presented himself in the presidential campaign as a man singularly positioned to serve as the ultimate dealmaker in Washington.
During the campaign, Trump mocked traditional politicians as negligent negotiators not up to the task of forging agreements for the benefit of Americans, whether in the area of trade or health care policy.
As Friday’s swiftly moving developments made clear, however, it was his administration that was not up to the requirements of pushing through difficult legislation. The White House proved unable either to craft a policy balance that could please enough Republicans or to come up with a compelling argument to persuade Americans to pressure members of Congress.
“To have the opportunity to do it, and not get it across the finish line – I don’t think it can be viewed in any way other than a big defeat,” said Lanhee Chen, a Republican policy specialist and veteran of past presidential campaigns.
Trump, in brief remarks after Ryan pulled the bill from consideration, did not take responsibility for its demise. He blamed Democrats for failing to vote for the measure but also suggested he would work with them for a bipartisan and “truly great health care bill in the future”.
Trump also indicated he would relegate health care to a lower position on his agenda and put a priority on tax reform, which he has suggested in recent days has long been his favourite topic. But any important legislation the president hopes to push could now be in danger from some of the same factors that doomed the health care measure.
For one, Trump has been reluctant to get into the policy weeds in a way that allows him to barter with legislators; in the weeks leading up to Friday, he stuck in public to generalised campaign-style descriptions of the plan.
Even when analysts suggested its costs would fall most harshly on some of his own voters – older, poorer Americans – he did not counter with any specific argument, other than the insistence that those voters should trust him.
The ideological divisions that marked the health care debate are likely to resurface during discussions of tax policy and the budget.
The tax fight is expected to feature wrestling between traditional Republicans seeking tax breaks for corporations and the wealthy, and more populist members who want to give greater help to the middle-class voters who contributed to Trump’s victory.
On the budget, Republicans are likely to be split between competing desires to cut the deficit and expand defence spending.
Trump’s stance in those fights is up in the air. Even more than most politicians, he has been reluctant to ask voters to accept trade-offs, putting him in a weak position to craft legislative compromises.
He is hurt further by entering these legislative fights from a vulnerable position. Trump right now is operating far below ground when it comes to voter support.
A Quinnipiac University poll published last week showed that 56 per cent of voters disapproved of how Trump was handling his job; only 37 per cent supported him. Other polls have shown similar numbers.
Worse for the president, some of the voter groups that have most strongly backed him have begun pulling away, the poll indicated.
Two weeks ago, a Quinnipiac poll showed male voters backed Trump by 4 per cent; in the latest poll, they disapproved by 9 per cent. His support among Republicans has fallen from 91 per cent – typical for a president to get from his own party – to 81 per cent. Among whites, narrow support has given way to a 6 per cent deficit, the poll found.
Among the group that arguably secured the presidency for Trump – white voters without college degrees – only 50 per cent approved of his tenure, to 43 per cent who disapproved, a stark difference from their enthusiastic approval of him earlier.
“We’ve been polling for 24 years and have never seen anything like this,” said Timothy Malloy, the assistant director of the poll. “Far and away, the worst numbers ever seen in a president.”
Malloy said the findings indicated Trump had been damaged by his contention that President Barack Obama wiretapped him in Trump Tower – a view which Trump has reiterated despite assertions by FBI director James Comey and others that no such activity took place.
Trump likely did not help himself by backing a health care plan even less popular than he is. The poll found only 17 per cent of Americans supported the Republican measure; more than two in five voters said they were strongly against it. Notably, Republicans were unenthusiastic about the proposal, while Democrats were energetically against it.
“There’s fear in those numbers,” said Malloy, referring to findings a majority of Americans feared the plan would diminish insurance coverage.
A big loss, even an early loss, does not necessarily presage a failed presidency. As Chen noted, Trump has nearly four years to go before his next election.
“People in politics have very short memories. I don’t think it sets the course for the rest of his presidency in any way,” Chen said.
So far, he added, Trump has accomplished “a lot of good combined with unforced errors”. But learning from the health care disaster will require not only a change of strategy, but an awareness of shortcomings for a president who, for all his attraction to disruption, has been stubbornly set in his ways.
The response of each of the two Republican leaders on Friday was as instructive as it was contrasting.
Speaker Ryan spoke of the difficulty of passing “big things” and took his own share of blame, conceding: “We’ve got to do better, and we will.”
Trump, however, indicated with some relish that he was looking forward to watching Obamacare “explode” – seemingly unconcerned about the human impact. “They own it,” he said of Democrats.
He praised his fellow Republicans. But in his one comment that indicated the loss might serve as a learning experience, he included the suggestion of payback against those in his party who had dared to vote against his wishes.
“We all learned a lot,” he said. “We learned a lot about loyalty.”