President Donald Trump is giving Washington a case of whiplash when it comes to his plan for Obamacare, saying one moment that he’s going to kill it and replace it with something “great” and then publicly flirting with letting it implode the next.
Whether the White House can repeal and replace the law this spring — as Capitol Hill leaders say is the goal — largely depends on the president’s ability to focus and outline the specifics of what he would like, while convincing reluctant GOP members to back a plan. So far, his rhetoric has been all over the place, offering differing timelines and ideas, depending on the venue and the person he’s speaking with.
“Nobody knew that health care could be so complicated,” Trump said Monday morning. He added to the GOP’s nervousness by refreshing the idea that Republicans should maybe just let Obamacare collapse under the weight of rising premiums and volatile exchanges — though he claimed it wasn’t an idea he would pursue.
“Let it be a disaster, because we can blame that on the Dems that are in our room — and we can blame that on the Democrats and President Obama,” Trump told Republican governors. “But we have to do what’s right, because Obamacare is a failed disaster.”
Huddling with insurance CEOs, Trump talked up how fantastic his Obamacare replacement would be without giving details. Separately Monday, he said it would be very difficult to do something good.
“Costs will come down, and I think the health care will go up very, very substantially,” the president said. “I think people are gonna like it a lot. We’ve taken the best of everything we can take.”
Republicans, meanwhile, don’t know exactly what to believe. And they have grown increasingly concerned that the law is becoming more popular among Americans while the White House is dithering away. Trump is not focusing his first major address as president on repealing and replacing Affordable Care Act, according to allies and Capitol Hill aides briefed on the remarks set to be delivered before Congress on Tuesday — though he is expected to touch on the law. In recent weeks, the president has expressed conflicting opinions on what he’d like to see done — and when — depending on his audience.
With Trump so far lacking message discipline, Republicans say the law’s advocates are hijacking the conversation.
“The folks who are avowed fans of Obamacare are really a small subset of the population yet they are controlling a large part of the debate,” said Josh Holmes, a former top aide to Senate Majority Leader Mitch McConnell. “The administration has the capability of reversing that.”
Trump has taken a particular interest in what to do about Obamacare, calling House Speaker Paul Ryan, frequently asking New York allies what they would do, and listening to a range of opinions — like he often does on subjects. While Andrew Bremberg, a top policy adviser, is studying the portfolio and working with Republicans on Capitol Hill, Trump also quizzes Vice President Mike Pence, son-in-law Jared Kushner and strategist Steve Bannon, among others. He calls Secretary Tom Price after talking to others and shares what he has heard.
He has seemed, at times, to not understand the intricacies of policy, according to friends, associates and others who have spoken with him, while at other times asking sharp questions. These people say Trump is acutely attuned to the potential for political damage and wants to be careful — and make sure Democrats are blamed if there is any fallout or concerned. Trump, who decries polls as “fake news” also closely follows them and has noticed the law’s popularity ticking up.
“My experience with President Trump is, he’s a sponge. He’s listening and constantly asking questions and so hopefully in the state of the union he’ll talk about where he is,” said Gov. Rick Scott of Florida on Monday about Trump’s focus on Obamacare.
While Trump is expected to address the law in his speech Tuesday night, he is unlikely to offer a detailed plan, several advisers say, and the thinking remains fluid on the law. After meeting with Ohio Gov. John Kasich last Friday, he seemed to show the governor support on his plan and had Secretary Tom Price meet with Kasich on Saturday, even though Kasich’s plan contrasted with current Washington thinking. Kasich came away unclear whether his plan would get any more traction.
“The president can play a major role in endorsing a plan he wants to sign into law, and I think it’s absolutely essential that he takes a lead role,” said Rep. Chris Collins, a top Trump ally in the House of Representatives.
House leaders are hoping that Trump will come around to their plan and let them do the heavy lifting. Republicans in the House want to take down major parts of the law that form the foundation of Obamacare, including significantly rolling back Medicaid spending, and eliminating the individual mandate and the law’s taxes.
They’d like to finesse the details with outreach to conservative groups and line up votes, like they would do with other Republican presidents. But the Senate has expressed some hesitation at the plan, and whether the two can be meshed through reconciliation seems unclear. Some members, like Rep. Peter King of New York, say they are leery of supporting the plan because they aren’t sure what it will be replaced with. And they are facing resistance from the right. Rep. Mark Meadows, who leads the Freedom Caucus, said he wouldn’t vote for the House plan Monday. He is influential among conservatives and often sways a number of votes.
So far, Trump has liked to critique the law but has offered few significant, tangible options. A leaked House Republican plan that would gut major parts of Obamacare was a draft that does not reflect lawmakers’ current thinking, GOP senators and governors said Monday after they met in Washington to discuss health issues. The draft legislation, among other things, would replace Obamacare’s income-adjusted tax credits for ones tied to individuals’ age and scrap the law’s expansion of Medicaid. But Republican governors said they were told that it’s far from etched in stone.
“That was a draft document. It wasn’t even near close to being a final product,” Nevada Gov. Brian Sandoval, whose state expanded Medicaid under Obamacare, said Monday after meeting separately with Republican and Democratic lawmakers to discuss the path forward on repeal.
“They were told that that does not reflect current thinking,” said Texas Sen. John Cornyn.
Republicans in Congress are witnessing growing pushback on their plans to dismantle core pieces of the law, including the federal funding boost it gave to states to expand their Medicaid programs. GOP governors also do not have consensus on how to proceed on Medicaid expansion as well as broader changes that would cap federal spending on the program, but several leaders from states that took the law’s expansion have been outspoken about the need to preserve it.
“We’re going to come up with a solution that makes it more affordable to the states and [bends] the cost curve for the federal government, but at the same time does not rip the heart out of the health care systems that have been built in the states,” Arkansas Gov. Asa Hutchinson said.
What Trump needs to do, according to legislators, senior GOP aides and longtime political observers is clearly delineate what he wants a plan to say. He needs to huddle frequently with congressional leadership and discern the pressure points. And he needs to control his remarks, making sure they are aligned and his allies are on the same page.
Holmes said the president has a “much larger platform” to get health insurers, lawmakers and others to the table, where he can “rule things in and out.”
Trent Lott, the former Senate Majority leader and an uber-lobbyist, said the complaints will “dissipate a little” if people will get in a room “behind closed doors, and hash it out.”
John Weaver, a Kasich adviser briefed on the meeting, was less than certain that could happen.
“We spent a lot of years railing against it,” he said. “I don’t think that prepared us to govern.”
Brianna Ehley contributed to this report.