Why Trump Can’t Sell Health Care Reform – and the Price He’ll Pay for It
Policy + Politics

Why Trump Can’t Sell Health Care Reform – and the Price He’ll Pay for It

Carlos Barria

In the six months since taking office, Donald Trump has turned the presidency, an institution Theodore Roosevelt once referred to as a “bully pulpit,” into a different kind of pulpit. It begins with B-U-L-L, but that’s where the similarity ends.

During the campaign, Trump promised to keep his hands off Medicaid ands other entitlements, out of concern for struggling families seeking health care coverage. He would make good on the Republicans’ seven-year long promise to “repeal and replace” the Affordable Care Act within a matter of months.

Related: There’s a Nasty Surprise Hidden in the Fine Print of the GOP Health Care Bill

Then in January, he flatly promised “insurance for everybody” as part of his health care reforms, and vowed to force unscrupulous drug companies to negotiate directly with the government on prices. Trumpcare would cover more people than Obamacare and cost a lot less in terms of premiums and out-of-pocket costs. People with pre-existing medical problems won’t lose their coverage or be forced to pay a lot more for their coverage. The mentally ill won’t get the short-shrift in a revised health care plan.

And, most importantly, he insisted, “People aren't going to be dying on the sidewalks and in the street.”

Over the weeks and months since he took office, there has been a slow but sure deterioration in both Trump’s approval numbers and in the public’s trust in its highest elected official. That is due, in no small part, to the fact that many of those promises Trump made turned out to be false.

He’s supporting a plan that doesn’t just “touch” Medicaid -- it grabs hold of it and wrings billions of dollars out of it to be spent on tax cuts for the wealthy. “Insurance for everybody?” Not even close. And if you have a pre-existing condition? Even the insurance industry concedes that you’re in big trouble under the plan Trump is backing.

Related: GOP Health Plan Hits Another Wall

Now nearly six months into his administration, Trump and his allies are paying the price.

The House of Representatives muscled through the American Health Care Act in May with few votes to spare. Since then, a senate version of ACA repeal has been struggling to find even a bare majority in that chamber.

On Monday night, Republican Senators Jerry Moran of Kansas and Mike Lee of Utah announced they would oppose the GOP bill, joining two other Republicans, Susan Collins of Maine and Rand Paul of Kentucky, in declaring their opposition.

Absent some extraordinary reversal of fortune, Trump and congressional Republican leaders will fail to deliver on the GOP's seven-year promise to repeal and replace the Affordable Care Act.

It’s now a time when the bully pulpit of the White House would, under other circumstance, be Republican lawmakers’ best friend. But the president, members of his cabinet and his senior advisers are all having trouble moving the needle at all when it comes to public opinion.

A big reason why the president and his surrogates have been ineffective in convincing the American public that the plans proposed in Congress would actually improve health care in the United States is that, by and large, Trump and his surrogates have squandered their credibility. A new president might get the benefit of the doubt from the public and from other politicians.

But a recent poll found that less than half of Americans trust that the president tells the truth, and in specialized polls, when Trump’s truthfulness has been pitted against targets of his criticism, like former FBI director James Comey or the cable network CNN, the president has come in far behind both when respondents were asked who they trusted more.

This, in turn, has made it easier for other politicians, including members of his own party, to defy Trump publicly.

Over the weekend, a conference of governors meeting in Providence, Rhode Island, provided a classic example of the pushback on health care policy the administration is receiving from Republicans and Democrats alike because of Trump’s credibility gap.

Related: Last Chance for the GOP Health Plan - Let the Arm Twisting Begin!

Despite the administration’s insistence that the evolving health care bill in the Senate strikes an important balance in achieving the goals of conservatives in dismantling Obamacare and meeting moderates’ demands to protect the most vulnerable Americans from deep cuts in Medicaid, many Republican governors weren’t buying it.

Republican Gov. Brian Sandoval of Nevada, a highly influential figure in the national health care debate who is closely allied with Nevada Sen. Dean Heller, voiced skepticism with Trump officials’ insistence that the Senate bill designed to cut nearly $800 billion from Medicaid in the coming years won’t hurt the poor and disabled in his state.

“I have to be comfortable that those 210,000 lives are going to continue to enjoy the quality of life and health care that they have right now,” he said, referring to the number of Nevadans who gained coverage through the expansion of Medicaid under President Barack Obama’s signature health law.

The Senate plan was attacked as well from the right. Gov. Matt Bevin of Kentucky, a Tea Party conservative who has been aggressively undermining Obamacare regulations since taking office in January, said the Senate plan was not nearly conservative enough. He strongly disagrees with a decision by McConnell to preserve a pair of Obamacare tax increases on high earners.

Related: McConnell Infuriates Some Conservatives by Preserving Two Big Obamacare Taxes

“They’re going to lose as many votes as they’re getting,” Bevin said of the decision to keep the tax increases in place, according to The New York Times. Bevin added that there was an understanding among Republicans that “those two taxes were going to be gone.”

But concern about Senate GOP efforts to slash Medicaid spending and change it from an entitlement to a per capita-capped block grant to the states were most prevalent at the meeting. Governors and senators are keenly aware of the current Medicaid funding levels in their states and are not easily persuaded that deep cuts in the programs will not result in a massive loss of coverage. The Congressional Budget Office recently forecast that 15 million of the estimated 22 million people who would lose coverage under the initial Senate GOP plan are currently on Medicaid.

On Friday, Vice President Pence delivered a speech seeking to assure the governors that “The Senate health care bill strengthens and secures Medicaid for the neediest in our society,” and that it puts the program for 70 million low income and disabled people “on a path to long-term sustainability.”

Pence’s speech drew strong criticism from Democrats, health care advocates and even some Republicans for exaggerating or mischaracterizing the likely impact of the Senate GOP plan, as The Washington Post reported.  Pence, the former Indiana governor, also struck a raw nerve with some Republicans by going after Republican Gov. John Kasich of Ohio, an opponent of the bill and a champion of expanded Medicaid, who didn’t attend the conference.

Related: Feds' Big Bust: $1.3 Billion Health Insurance Fraud Takedown

Pence falsely asserted that Ohio’s expansion of Medicaid under Obamacare head left nearly 60,000 residents with disabilities “stuck on waiting lists, leaving them without the care they need for months or even years.” Many of the Republican governors sitting in the office had supported expanded Medicaid, and analysts say that waiting lists for Medicaid’s home and community based services were not affected by the expansion.

"One of the problems with Mr. Trump [running] against his own party is that many within the party don't forget, especially when they are reminded daily that he is not one of them,” said John Zogby, a veteran pollster and political analyst. “That is what makes things much more difficult for Vice President Pence, who is considered a mainstream conservative but still has to be loyal to the man who got him where he is”.

“This bill is a disaster is so many ways and the sores that it has opened in the party will continue and hurt the rest of the president's agenda,” Zogby added.