One day before the House is scheduled to vote on the Republican plan to replace the Affordable Care Act, President Trump increasingly looks like a gambler who has pushed all his chips into the middle of the table. Trump has wagered his reputation as a dealmaker and a large share of the political capital that came with his election on his ability to ram the American Health Care Act through Congress. And he did it all without ever really looking at his cards.
Trump appears to have seriously miscalculated in at least three areas: First, members of the House Freedom Caucus are far more resistant to the persuasions of the dealmaker-in-chief than the president seems to have realized. Second, public opposition to the bill is much stronger than expected, meaning even its supporters aren’t deeply committed to it. And third, the bill faces adamant opposition from multiple Republicans in the Senate, where losing more than two votes would be fatal.
As a result, the president is facing the real possibility -- perhaps even the likelihood -- of an embarrassing defeat in his first major foray into the legislative arena.
The bill, formally part of a budget reconciliation measure, hangs by a thread in the House of Representatives, where GOP leaders are faced with lockstep Democratic opposition and can afford to lose only 20 of their members without killing the bill. Currently, more than two dozen members of the caucus have expressed serious reservations or outright opposition, leading to a flurry of last-minute meetings between Trump and recalcitrant lawmakers, including a high-profile presidential visit to Capitol Hill on Tuesday.
The president’s intense involvement suggests that Trump understands the gravity of the situation.
“If Trump can't make this happen within his own party after the GOP ran four consecutive elections against Obamacare, he'll take a big hit,” said Larry Sabato, director of the University of Virginia’s Center for Politics. “The chances that Trump will get other big bills through Congress are also diminished.”
Trump built his political success on his willingness to flout traditional “rules” of the game. But, Sabato warns, he’s now in real danger.
“A new President almost always gets his signature proposals from a Congress controlled by his own party,” he said. “If the health care legislation goes down, Trump will have broken another iron rule of politics--but this is a rule necessary for a successful Presidency.”
To be sure, a victory for Trump on the House vote would be a validation that his highly touted bargaining skills as a New York real estate mogul are indeed adaptable to his new role as president. If Trump shows that he can force recalcitrant lawmakers from both parties into line, that skill will be critical in steering the remainder of his top agenda items – including tax cuts, building up the military and constructing a wall along the southern border with Mexico -- through Congress.
But experienced analysts see little likelihood of things playing out that way.
“You want to score early, but you have to make sure what you’re doing is reasonably well thought out and not slapped together in the interest of haste,” said Ross Baker, a political scientist at Rutgers University and a congressional expert. “Given the kind of general disorder that has characterized the Trump administration, I don’t have a lot of confidence that this is thoughtful legislation.”
“And I think that legislation done in haste is likely to come back and haunt the people who wrote the bill – and that’s more the members of the House of Representatives than the president,” he added.
Trump’s first major misperception was that it would be a simple matter for him to bring the members of the House Freedom Caucus along with him, even if they weren’t enamored of all the elements of the bill. But the Freedom Caucus has demonstrated, time and again, that compromise isn’t in their DNA, and that they pay no price at the polls when they challenge party leaders from the right.
In his appearance on Capitol Hill Tuesday, Trump showed that he still doesn’t really understand what he’s dealing with when he confronted the holdouts with warnings that they will lose their seats in the next election if they don’t back him on this bill. But the members of the Freedom Caucus are, for the most part, bulletproof in their home districts.
“The Freedom Caucus members are solid electorally,” said UVA’s Sabato. “It would be tough to defeat any of them in a primary because they voted against what they'll insist is ‘Obamacare Lite’.”
It has also been difficult for the White House to gin up real momentum behind AHCA because the more people learn about it, the less they like it. The headline numbers from the Congressional Budget Office analysis released last week -- 24 million fewer Americans with insurance under the proposal and higher out-of-pocket costs for older people -- was a body blow to Republicans’ insistence that they were replacing the Affordable Care Act with something better in terms of cost and effectiveness.
A new poll by Morning Consult and Politico published Wednesday indicates that voters are growing uneasy about the Republican Obamacare replacement plan and that a “strong plurality” believe GOP lawmakers are moving too quickly to overhaul the country’s health care system, including Medicaid.
With a vote in the House likely to come on Thursday or early Friday, 43 percent of voters believe congressional Republicans should slow down the process while they take a closer look at the evolving replacement plan. Just 17 percent of voters say that the Republicans are moving at the right pace.
Notably, Obamacare continues to rise in popularity the closer the Republicans get to voting on a replacement plan. Despite the GOP’s relentless criticism of the programs’ inadequacies, 46 percent of voters currently support Obamacare -– one of its best showings since the advent of the 2010 legislation. By comparison, the popularity of the Republicans’ AHCA has been losing altitude in popularity.
Voters are divided over the likely impact of the GOP plan on the quality of their health care, with 32 percent saying it would make it worse and 28 percent saying it would make it better.
Finally, and perhaps most inexplicably, Trump and House leadership are fixated on passing AHCA through the lower chamber of Congress despite clear signs that it’s basically a suicide mission.
Senate Majority Leader Mitch McConnell (R-KY) vowed yesterday to try to bring the plan to a vote on the Senate floor next week if it survives its first big test in the House. “We’re not slowing down,” McConnell told reporters. “We will reach a conclusion on health care next week.”
However, key Republican members of the Senate could not have been clearer about their unwillingness to support the AHCA, meaning that unless something completely unexpected happens, the bill is dead on arrival in that chamber.
That means Trump is asking Republican House members to expose themselves to the downside of a vote for the bill with a near-guarantee that there is no upside.
Even for a supposed master of the “Art of the Deal,” that’s an awfully tough sell.