President Donald Trump's campaign to undermine, starve and dismantle Obamacare has hit a critical phase.
Public support for replacing the Affordable Care Act is slipping and both the Republican House and Senate health bills are deeply unpopular.
With Congress in need of White House leadership to help shore up support for the repeal effort, Trump instead has vented his frustration on social media.
"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 just last week.
It was another missed opportunity for Trump to help calm the political waters. Instead, he stirred the pot, adding an extra layer of pressure on wavering GOP senators headed home for the July 4 recess after failing to secure the 50 votes needed for Senate passage of Senate Majority Leader Mitch McConnell's health bill.
The Twitter episode, which continues to spark heated "repeal now" calls from conservatives, showed how Trump's efforts to influence the health care debate often hurt rather than help his cause, said John Hudak, deputy director of the Center for Effective Public Management at Brookings Institution in Washington.
"If he wanted to get engaged and he wanted to learn about this process and this policy, he could play a positive role. He just shows no obvious interest or ability to do that," Hudak said.
Having largely ceded the repeal effort to congressional Republicans, Trump's hands-off approach seemed to make sense.
"But this is a place where it's not working with the president being hands-off, and he's just incapable of being hands-on," Hudak said. "This is just a man who's not serious about the office. By most accounts, he has no idea what is in the House and Senate legislation."
Rather than follow a consistent policy compass, Trump often repeats "the last voice talking in his ear," said Thomas Miller, a resident fellow at the American Enterprise Institute who studies health care policy.
"Even if he was not necessarily correct in policy, if he was a little more consistent in direction, and basically used whatever persuasive power he had to drive (the debate) it in that direction, that could accomplish something," Miller said.
But Trump's frustration with the legislative process and clumsy forays into public policy also are understandable, considering he's the first president to come into office without a military or political background, said Robert Moffit, a senior fellow at the conservative Heritage Foundation.
"His frame of reference about what is and is not successful has nothing to do, really, with the kinds of calculations that are made by the Washington political class and its allies," Moffit said. "With Trump, his entire world is based on deals with deadlines. … If you have a Republican leadership that for seven years promised action on repealing a law that has been genuinely unpopular, and they don't do it, well, that is an abject failure of democratic governance."
As the legislative path slowly unfolds for the Affordable Care Act repeal, Trump hasn't exactly stood by and watched passively.
He used an executive order early in his term to articulate the administration's philosophy about the health law. He quickly cut funding for Health and Human Services work to promote HealthCare.gov, and his administration passed a series of regulations designed to help stabilize individual insurance markets.
His lack of a clear policy direction often complicates his efforts. Consider Trump's indecision on whether to reimburse insurers for billions of dollars in cost-sharing subsidies provided to low-income plan members.
"The future of those subsidies is, effectively, in his hands," said Craig Garthwaite, an associate professor at the Kellogg School of Management at Northwestern University.
The Trump administration's failure to enforce the individual mandate, the law that requires Americans to have health insurance or pay a penalty, is equally troubling for insurers, said Garthwaite, a Republican.
"His general unwillingness to provide certainty or act in a certain rational manner is giving insurance companies pause" about trusting his administration. "I just don't think we have that here and now," Garthwaite said.
Moffit said Trump could help the repeal effort by allowing his team at Health and Human Services to work more closely with Congress and by giving several policy speeches that outline a broad vision for the health changes he wants see.
"And he can't just say 'I want a terrific plan' or 'something that will be great,' " Moffit said. "He has to outline what kind of health care system he wants America to have."
In August 2009 when Sen. Ted Kennedy, D-Mass., died as the Affordable Care Act was languishing in Congress, many thought the health care reforms he championed most of his life would die as well.
But in a prime-time address on health care to a joint session of Congress in September 2009, President Barack Obama re-stated his case for health care reform and rallied House and Senate Democrats to stay the course. The legislation passed both houses of Congress by year's end.
If Trump could exercise similar leadership, he could help resurrect the floundering repeal effort, said Miller, of the American Enterprise Institute. Unfortunately, where Trump "wants to lead is wherever the parade is going," Miller said. "He wants to be there at the bill signing. He just doesn't know what they're going to deliver."
At a time when Congress needs presidential leadership and the president needs congressional cohesiveness, "we seem to be running a little low on both these days," Miller said.
About the Author
