Donald Trump’s The Art of Health Care: Strengths and Consequences of President Trump’s Approach to the American Health Care Act

Since Donald Trump’s inauguration, the daily news cycle has become a whirlwind of information. When he was elected, his constituency expanded to the entire nation and his blustery approach to politics lost its effectiveness. As evidenced by his involvement with the GOP’s recent attempt at a health care bill, President Trump’s loyalty to conservative elites and their health care agenda alienated supporters and opponents of further government involvement in affordable medical care and weakened the public perception of his leadership.

On March 20, 2017, House Republicans introduced the American Health Care Act that would have eliminated the expansion of Medicaid and begun the process of “repealing and replacing” the Affordable Care Act. As soon as the bill was released, Trump gave it his support, reneging on a campaign promise from November of 2015 when he said, “People love Medicare. And it’s unfair to them…I’m not going to cut it.” (Sanders, 2017). Many elements of Trump’s campaign became relevant again as he tried to whip enough votes to pass the AHCA, but it must first be evaluated how Trump sought to advance a political agenda provided by Paul Ryan.

During the Obama administration, Republicans spent four consecutive elections running on the platform of “repeal and replace” for the ACA with Trump taking this position in the 2016 election, but this process was fundamentally flawed in two different ways. First, some Republican politicians were guilty of lying to voters about the ACA since it passed as they first proclaimed the act was a form of tyrannical government and after this was proven false, they transitioned to a promise that, if Republicans were elected, then they would lower premiums and deductibles, among other things. (Barro, 2017). This itself was flawed because of the inescapable notion that most Republicans believe government should not have a role in affordable health care for citizens, but this is not what members of Congress or President Trump embraced while campaigning. (Rhodes, 2017). Instead, when they were forced to develop something resembling an affordable health care bill, Paul Ryan rushed through a process of presenting a bill that had no time for debate or amendments, leaving many Republicans optionless. (King, 2017). Trump took it upon himself to force a blind vote of approval out of Republican members of Congress on a bill that lacked a Congressional Budget Office rating and any real sense of the effect it would have on the constituents of legislators. (Yglesias, 2017).

When the AHCA bill ultimately failed, it was because of Trump’s inability to keep both political challengers of the bill satiated. The freedom caucus was dissatisfied with the AHCA because they believed it did not go far enough in repealing the ACA, as they are of the political belief that the government should not be involved in providing affordable health care. (Bade, Dawsey, & Haberkorn, 2017). As for moderate Republicans, who believe the government should have minimal involvement, many lived in districts that voted for Hillary Clinton in the 2016 presidential election and were concerned of potentially losing their next elections due to the overwhelming support the ACA received in town halls during the Congressional recess. (Pear, Kaplan, & Haberman, 2017). Whenever Trump would attempt to make concessions to either faction, he would anger the other so his process of negotiation was continuously dismantled and never received the momentum it required to pass in the House, especially considering its rocky beginning as it polled at an approval rating of seventeen percent. (Klein, 2017).

As Trump made attempts to appeal to Republican elites like Ryan, Reince Priebus, and Steve Bannon, he ignored the desires of the freedom caucus, moderate Republicans, and Democrats until this became too late to reconcile and the vote on the AHCA was canceled. Additionally, President Trump was trying to simultaneously appeal to and ignore the same base of voters who facilitated his election in the first place and this became more evident through the strategies he utilized when trying to pass the AHCA. The aforementioned effects of his campaign process still linger in the manner by which Trump governs to a point where it seems as if he is still entirely in campaign mode. He regularly poses questions about Clinton that are better suited for campaign season attack ads like when he tweeted, “Did Hillary Clinton ever apologize for receiving the answers to the debate? Just asking!” (Trump, 2017). Not only this, but Trump’s election mindset is exacerbated by the campaign-style rallies he still finds time to hold regularly and the idea that he has already begun running for president in 2020, too. (Graham, 2017). This attachment to elections and campaigns likely stems from the growing concern from Trump that he will not be re-elected to the presidency in four years, illustrated by his approval rating, which on the seventy-sixth day of his administration is thirteen percentage points lower than George W. Bush and twenty-one points lower than Barack Obama when they were at the same moment of their presidencies and also by the wild unpopularity of the AHCA, which he is responsible for attempting to force through Congress. (Bycoffe, Mehta, & Silver, 2017). He shares this desire to be re-elected with Congressional representatives as they lobby for what constituents desire in their particular areas. (Rhodes, 2017). For example, Kentucky Representative Thomas Massie received two hundred and seventy-five phone calls of opposition to the AHCA from his constituents and only four phone calls in support of it. (Mazza, 2017). So while Donald Trump enacted his campaign-era approach to the political system, complete with forms of name-calling and hypocrisy regarding topics like protecting Medicaid, he subscribed to the adage of “if it’s not broken, don’t fix it” and  failed to distract from the substantive policy issues at the forefront of the health care debate. Supplementally, Trump’s campaign assurance that he was a dealmaker and an outsider served as one of his strategies for the attempt to force the AHCA to pass. During a Republican debate in February of 2016, Trump said, “With Congress you have to get everyone in a room and you have to get them to agree… you have to get people in, grab them, hug them, kiss them.” (Hains, 2016). Dating back to the days when Trump was merely an accomplished businessman, he has believed his negotiating tactics to be his strongest talent so it would make sense for him to apply that same logic to his political endeavors. With the AHCA, though, desires for re-election prevailed over political pressure. Despite claims to the contrary, it was clear that negotiation was the only strategy he used to attempt to make a policy change because Trump demonstrated a shaky knowledge on the contents of the bill and gave no speeches in support of it, showing he does not entirely value the importance of policy. (Terkel, 2017). 

Ironically, it could be a political victory for Trump that the AHCA did not pass because of the limited knowledge a majority of constituents apply to legislative matters. As written in class reading, “‘Very substantial portions of the public hold opinions that are essentially meaningless-off-the-top-of-the-head response to questions they have never thought about, derived from no underlying sort of principles.’” (Menand, 2004). Despite Trump’s theatrics, people know whether or not they have health insurance. The fact that twenty-four million more people would lack coverage by 2026 is not something Trump can mask. (Kurtzleben, 2017).

Trump’s approach does have some strengths as he rallies his fervent base by portraying himself as their equal through the use of a common enemy, which is more often than not the Democratic Party. As his policy goals move beyond health care, it seems that the strategies Trump embraces will remain in place for further endeavors (like tax reform) as he put the blame for the AHCA’s failure on democrats and even alluded to the idea that “repeal and replace” is not resolved yet because of his latest talking point that the ACA will eventually collapse. (Yen, 2017). Throughout the health care process, Trump placed partisanship above the best interests of his constituency in terms of importance, most notably when he said, “I was a team player, and I had an obligation to go along with this.” (Costa, 2017). This directly contrasts the course textbook’s views on the executive branch as the authors write, “This notion that the president is above party politics seems reminiscent of a…king who would brush aside selfish claims of manipulative courtiers and rule in the best interests of all his subjects.” (Lowi, Ginsberg, Shepsle, & Ansolabehere, 2014, p. 297). While Trump regularly maintains his base of voters, this approach alienates the rest of his constituency and contributes to his plummeting approval rating. He neglects the people who voted for him because they merely wanted change and not because they were infatuated with any presidential candidate. The bluster of his public persona and the political pressure he placed on conservative politicians were not as effective as the people who organized and went to town halls to make it known that a repeal of the ACA would result in electing their representatives out of office, even in districts that did not vote for Clinton because people did not vote for Trump to be given the agenda of Paul Ryan. (Favreau, 2017). 

Now that the AHCA failed, Trump has sought to blame myriad people and organizations for the unsuccessful health care bill, including Paul Ryan, the freedom caucus, and, of course, democratic politicians. While this can be an effective strategy in that some members of Trump’s base avoid assigning blame to President Trump, most people are going to blame the person who is at the head of the executive branch, the person they see on television every single day. When it comes time for re-election, voters will understand that one party controlled the executive and legislative branches of government and still could not pass an affordable health care bill.

References

Bade, R., Dawsey, J., & Haberkorn, J. (2017, March 26). How a secret Freedom Caucus pact brought down Obamacare repeal. Retrieved from http://www.politico.com/story/2017/03/trump-freedom-caucus-obamacare-repeal-replace-secret-pact-236507 

Barro, J. (2017, March 22). Republicans lied about healthcare for years, and they’re about to get the punishment they deserve. Retrieved from http://www.businessinsider.com/republicans-ahca-health-care-obamacare-2017-3 

Bycoffe, A., Mehta, D., & Silver, N.  (2017, April 5). How popular is Donald Trump? Retrieved from http://projects.fivethirtyeight.com/trump-approval-ratings/ 

Costa, R. (2017, March 24).  ‘Hello, Bob’: President Trump called my cellphone to say that the health-care bill was dead. Retrieved from http://www.washingtonpost.com/powerpost/president-trump-called-my-cellphone-to-say-that-the-health-care-bill-was-dead/2017/03/24/8282c3f6-10ce-11e7-9b0d-d27c98455440_story.html?utm_term=.f850a09b3e73 

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Graham, D. (2017, February 15). Trump Kicks Off His 2020 Reelection Campaign on Saturday. Retrieved from http://www.theatlantic.com/politics/archive/2017/02/trump-kicks-off-his-2020-reelection-campaign-on-saturday/516909/ 

Hains, T. (2016, February 6). Trump On Dealing With Congress: “Grab Em, Hug Em, Kiss Em, And Get The Deal Done.” Retrieved from http://www.realclearpolitics.com/video/2016/02/06/trump_on_dealing_with_congress_grab_em_hug_em_kiss_em_and_get_the_deal_done.html 

King, R. (2017, March 26). GOP senator blames Ryan’s rushed process for healthcare failure. Retrieved from http://www.washingtonexaminer.com/gop-senator-blames-ryans-rushed-process-for-healthcare-failure/article/2618479 

Klein, E. (2017, March 24). How Paul Ryan played Donald Trump. Retrieved from http://www.cnbc.com/2017/03/24/how-paul-ryan-played-donald-trump-commentary.html 

Kurtzleben, D. (2017, March 13). GOP Health Care Bill Could Leave 24M More Without Coverage By 2026, CBO Says. Retrieved from http://www.npr.org/2017/03/13/520031463/gop-health-care-bill-could-leave-24m-without-coverage-by-2026-cbo-says

Mazza, E. (2017, March 23). GOP Rep. Thomas Massie Says Trump Could Be A ‘One-Term President’ If Health Care Bill Passes. Retrieved from http://www.huffingtonpost.com/entry/thomas-massie-one-term-president_us_58d34d79e4b0b22b0d19d176 

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Pear, R., Kaplan, T., & Haberman, M. (2017, March 24). In Major Defeat for Trump, Push to Repeal Health Law Fails. Retrieved from http://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?rref=collection%2Fbyline%2Fmaggie-haberman 

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Terkel, A. (2017, March 24). Trump Worked A Few Weeks On Health Care. White House Claims He Gave It ‘His All.’ Retrieved from http://www.huffingtonpost.com/entry/trump-health-care-tries_us_58d55f7be4b03787d3582f55 

Trump, D. realDonaldTrump. (2017, April 3). Did Hillary Clinton ever apologize for receiving the answers to the debate? Just asking! Retrieved from http://twitter.com/realDonaldTrump/status/848857910297980928 

Yen, H. (2017, March 26). Trump blames Republicans for defeat of health bill. Retrieved from http://www.bostonglobe.com/news/politics/2017/03/26/trump-blames-republicans-for-defeat-health-bill/05FwATp1Lbom1ANWPlXQyO/story.html 

Yglesias, M. (2017, March 10). Voting on a bill without a CBO score is just plain foolish. Retrieved from http://www.vox.com/policy-and-politics/2017/3/10/14858028/ahca-cbo-score 

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