Trump proves to be an unreliable ally to Republicans in the health-care fight – Washington Post

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President Trump is more than his own worst enemy. The damage he has inflicted during his first five months in office has undermined Republican congressional leaders, frustrated members of his Cabinet, exasperated top advisers and strained relations with some of the nation’s most important allies. This week’s case study is health care.

The most significant domestic initiative of the Trump presidency and the Republican Party is the fulfillment of a promise to “repeal and replace” the Affordable Care Act. That Republicans are struggling to find an alternative to Obamacare is plain to see. But as congressional leaders scratch to find the votes to pass a bill in the Senate, the president has demonstrated that he is an unreliable partner in the battle.

On Friday morning, as Senate Majority Leader Mitch McConnell (R-Ky.) was trying to balance potentially irreconcilable demands of hard-line conservatives and more moderate conservatives, the president decided to offer his own solution with a tweet: If the Senate can’t get there, why not just repeal now and replace sometime in the future?

Never mind that earlier in the year, he took the opposite position. At that time, McConnell and some others preferred to move with an immediate repeal vote that included a trigger for implementation sometime in the future, giving elected officials the ability to say they kept a promise and enough time to try to find a replacement. But the president overrode that idea, demanding that replacement had to accompany repeal.

Now, at the worst possible moment, Trump seemed to have shifted again, leaving Senate lawmakers frustrated and baffled.

Senate Majority Leader Mitch McConnell (R-Ky.) speaks with reporters after Senate Republicans had a meeting with President Trump in Washington on Tuesday. (Jabin Botsford/The Washington Post)

The idea of going to repeal now, replace later was not originally the president’s. His tweet came minutes after Sen. Ben Sasse (R-Neb.) made a similar statement on “Fox and Friends.” Sen. Rand Paul (R-Ky.), a holdout, has been saying the same thing.

The president appears to have no commitment to an explicit strategy for getting a health-care bill to his desk, only a desire for victory and limited patience for the legislative process. He also has no fixed views on the substance of health-care reform, having made contradictory statements about the topic throughout his campaign and since.

He has said he wants a health-care system with heart, one in which everyone is covered. But he embraces legislation that would leave 22 to 23 million additional Americans without coverage by 2026, according to the Congressional Budget Office. When the House passed its health-care bill in May, he showered it and GOP leaders with praise. Later he called the measure “mean.” He campaigned against cuts in entitlements — Medicare, Social Security and Medicaid. The congressional legislation would revamp Medicaid, significantly slowing the growth in spending.

Presidential leadership on these big domestic initiatives generally requires a combination of two things. The president is expected to act as the leading salesperson, making the public case while legislators make the sausage. Behind the scenes, a president works to bring along the last wavering lawmakers, calling, cajoling and applying the pressure. Sometimes it doesn’t work, but those responsibilities are part of the job description of the presidency.

Former president Barack Obama spent months publicly advocating in favor of the Affordable Care Act and the value of expanded coverage and trying to slow the growth of medical inflation. Despite his limited enthusiasm for interacting with Congress, he also spent hours in private conversations with legislators, including some Republicans. He never won GOP support, nor was his measure publicly popular while he was in office, but not for lack of effort.

Through the first five months of his presidency, Trump has yet to deliver a single comprehensive speech on the topic or subjected himself to extensive questioning from reporters that would give him a forum to make his case. Nor is there evidence that the president has proven effective with many individual lawmakers.

(Jenny Starrs/The Washington Post)

Trump’s business record suggests he is an enthusiastic salesman. But the kind of hyperbole that sometimes goes with real estate deals doesn’t work so well in government. Making the public case and persuading reluctant lawmakers requires a familiarity with the subject matter that he has yet to demonstrate. What is the affirmative case he makes for the replacement now under consideration?

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