How health care wounded the Trump presidency

When a few weeks from now the assessments of the first 100 days of the Trump administration are written, the presidency will be described as a paragon of ineptitude and fraud.

Many positions remain unfilled simply because no nominees have been named or paperwork hasn’t been submitted. No one has been nominated to head the Federal Emergency Management Agency. Science and technology advisory positions are nearly vacant. Rather than drawing from experts in international affairs, Trump outsourced the Middle East peace process and relations with China to his inexperienced 36-year-old son-in-law. “Accomplishments” include stripping Americans of privacy protections for their internet use, limiting workplace protection, and ending the requirement that financial advisers must look out for their clients’ interests.

So far Trump’s biggest failure involved health policy. The initial effort engaged President Trump for less than three weeks and wasn’t critical enough for him to have made a single speech or a single road trip to promote the plan. Then Trump abandoned the bill.

Trump, who had promised “something terrific,” didn’t talk about any specifics to the public or, oddly enough, to legislators he was meeting with to negotiate a plan. Instead, behind closed doors Trump called the details that would affect millions of Americans “little shit” and told congressmen they should look at the “big picture,” which was just passing something and getting “a win.”

Some pundits wondered how the president could have negotiated a bill that so clearly hurt his rural, working-class base. One reason was simply that Trump has often seemed a salesman who exemplified the profession’s most negative stereotypes. Health policy turned out to be akin to Trump University, the fraudulent real estate training venture that drew in customers and upsold them to more costly commitments, leaving them nothing worthwhile.

President Trump speaks in the Oval Office on March 24 after Republicans yanked their health care bill. Olivier Douliery | Abaca Press via TNS

Since abandoning the AHCA Trump has blamed actors across the political spectrum for its collapse but not himself or his staff. He demonstrated his lack of knowledge about policy in portraying Obamacare like a business that could go bankrupt, tweeting that he would get a deal “as soon as ObamaCare folds.” While there are Obamacare issues that could be exacerbated by Trump, the system of exchanges, subsidies and Medicaid expansion were not only judged stable by the Congressional Budget Office but could cover more people as states like Maine that haven’t expanded Medicaid may do so in the next year.

Trump’s lack of concern with the actuality of health policy led him to support a bill that motivated massive citizen engagement in opposition and was seen positively by just 17 percent of the public. It would have meant 24 million fewer people with insurance, worse coverage for those who retained coverage, and big tax cuts to the wealthiest.

The entire effort made elements of Trump’s campaign case look dishonest — the populist appeals; the claim he was a great dealmaker; the promise to immediately repeal and replace Obamacare with something cheaper and better; the contention that everyone who had worked in government was stupid and had misled them, but Trump would be honest and trustworthy. This won’t be helped by a revised plan now being discussed that would break the promise to preserve coverage for pre-existing conditions; the plan would let insurers charge more to people who had illnesses or are sick now. Opponents call that a “sick tax.”

Thus the failure of Trumpcare left behind a litter of damage. Trump injured relationships with members of his own party by publicly rebuking them, ending negotiations quickly and showing a poor grasp of and interest in policy details. Efforts to pass tax reform were made more difficult because the AHCA would have cut subsidies and taxes, making further tax cuts easier under congressional rules involving budgets.

None of this means that Trump can’t accomplish anything. But Trump’s presidency has been wounded. Members of his party have less of a reason to commit to unpopular legislation Trump says he supports, and more probably will act like Rep. Bruce Poliquin, who never said whether he would vote for the AHCA. On the other hand, the strong majorities of Americans who disapprove of the job Trump has been doing, some of whom got involved to stop the health care bill, see they can succeed, and this episode will motivate further action.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.