What If the Health-Care Collapse Saves Trump's Presidency?

Despite the damage done to his reputation, the defeat may liberate him to pursue the agenda his voters support—not the one the Republican establishment favors.

Carlos Barria / Reuters

Friday was the worst day of Donald Trump’s young presidency—an unprecedented defeat on his first legislative priority, which also happened to be his party’s signature promise for the last seven years and one of his own top campaign promises. What’s more, the collapse undercuts the central premise of Trump’s political identity, his supposedly formidable reputation as a dealmaker.

But what if, instead, Trump dodged a serious bullet on Friday, setting him up for a recovery? If that’s the case, Friday might even have perversely been the best day of Trump’s presidency so far—or at least the point where he hit rock-bottom, allowing him to turn things around.

This is not to argue, as Hugh Hewitt did, that last week was “a very good week for the conservative cause generally” and even less so, as Hewitt did, for “President Trump specifically.” Whatever progress was made on Neil Gorsuch’s Supreme Court nomination, Trump’s approval rating continues to plunge and his administration is under siege. Still, the coverage of the collapse has been so uniformly apocalyptic, and the press’s animosity toward Trump so manifest, that it may be useful to consider things from a fresh perspective.

With the failure of the repeal-and-replace effort, Trump—despite his own best efforts—unwittingly rescued himself from the passage of a hugely unpopular bill that would have hurt his own voters most. In a broader sense, Congress’s fractiousness saved Trump from having to follow through on an impossible campaign promise to repeal Obamacare, replace it with a conservative alternative, and expand coverage. Looking forward, post-health-care tension threatens to drive a wedge between Trump and Paul Ryan’s agenda, which is in many ways anathema to the Trump coalition.

Start with the bill in question. Trump had promised during the campaign to repeal and replace Obamacare “immediately” with something that would avoid mandates but maintain popular provisions that prohibit discrimination for preexisting conditions and allow people to stay on their parents’ insurance plans until 26. He also planned to make coverage available to anyone who wanted it, and to not touch Medicare and Medicaid. There is a plan that would do this: a single-payer universal health system. But since that wasn’t going to happen with a Republican president and Republican Congress, there was no obvious way for Trump to fulfill his promises.

Even by those standards, the American Health Care Act was politically toxic—which is, of course, one reason it failed in Congress. One poll found it had 17 percent approval. It would have cut federal funding for Medicaid, and it would have dramatically increased premiums for many voters, including Trump supporters. In the short term, the demise of the AHCA was a political disaster for the Trump administration, but in the long run, passing it might have been a greater disaster.

One side effect of the bill’s failure has been strain between Trump and House Speaker Paul Ryan. The two were always an odd pair; they disagreed on a range of fundamental issues, especially entitlements (Ryan wants to cut them; Trump promised to preserve them) and free-trade agreements (Ryan likes them; Trump hates them). They were temperamentally different; Ryan was obviously skeptical of Trump during the election, while the Trump-friendly site Breitbart had long sniped at Ryan.

Yet for a brief moment it seemed like there might be a productive truce between the two sides. Ex-Breitbart boss Steve Bannon, now Trump’s chief strategist, met with Ryan in January and managed to find some common ground. Trump allowed Ryan to direct the design of the health bill and the process for passing it. On Friday, Ezra Klein wrote that despite promising to change the way Washington and the Republican Party worked,

Trump has become a pitchman for Paul Ryan and his agenda. He’s spent the past week fighting for a health care bill he didn’t campaign on, didn’t draft, doesn’t understand, doesn’t like to talk about, and can’t defend. Rather than forcing the Republican establishment to come around to his principles, he’s come around to theirs — with disastrous results.

Immediately after Ryan and Trump agreed to pull the bill on Friday, Trump insisted he didn’t blame Ryan. But White House officials were already placing the blame at his feet in anonymous quotes to reporters. Trump also enigmatically encouraged his Twitter followers to tun in to Jeanine Pirro’s Fox News show on Saturday; she led off her show calling for Ryan to step down, which White House officials insisted was merely coincidental.

Although Ryan doesn’t seem to be going anywhere, a split with the speaker might be the best thing that could happen to Trump in political terms, freeing him up to pursue the deficit-bloating spending agenda he laid out during the campaign, rather than the far more austere and fiscally conservative one that Ryan desires. Say what you will about Trump losing the popular vote; his agenda still has more of a voter mandate than Ryan’s does. The tax reform that Ryan and Trump still say they will pursue is likely to be highly regressive, and if the failure of the AHCA makes it harder to push through a regressive tax plan, that too may be a case of Trump unwittingly dodging a bullet.

Rather than attack Ryan, Trump lashed out at the House Freedom Caucus on Twitter. The staunchly conservative faction has shown that it can withstand pressure from Ryan. Though it withstood Trump’s apparently clumsy last-minute charm offensive, a sustained attack from the White House might be one of the few things that could break it. (One member, Representative Ted Poe, has already left over the health-care failure.) And even if it doesn’t work, this gives Trump an excuse to reach out to Democratic lawmakers on future plans. He attacked them on Friday, but there’s already a growing sense that Republicans will have to reach across the aisle.

Trump enters the final third of his first 100 days with his political capital much depleted, a cratering approval rating, and his presidential campaign at the center of an FBI investigation. It’s an ample supply of lemons, but there are ingredients for lemonade, should Trump decide to make it. As I reported last week, Bill Clinton’s chaotic early presidency holds out an example of how a president can execute a successful turnaround.

If the past is precedent, Trump won’t do that. The AHCA debacle showed that Trump has little handle on the way Capitol Hill works, and minimal interest in learning. As a general rule, he lacks discipline. Moving to take advantage of the moment would also require a unified, concerted effort from a White House that has shown little ability to act in that way; and Chief of Staff Reince Priebus, who is perhaps best positioned to lead a turnaround, has come out of the health-care experience weakened internally. Still, if the failure of repeal and replace turns out to be an unmitigated disaster, that will only be because Trump missed a golden opportunity.