During his campaign for president, Donald Trump promised, “We’re going to win so much, you’re going to be so sick and tired of winning.” If the American Health Care Act that the House passed on Tuesday is an indication, perhaps what he meant was that citizens would be both ill and also exhausted from victories.
The celebration that Trump threw in the Rose Garden on Thursday, marking the House’s passage of the bill after a series of false starts, was strange for a couple of reasons. The first is that the bill had just barely passed the House, after an acrimonious fight that divided the Republican Party, and stands no chance of emerging from the Senate in a form remotely resembling the House bill. Furthermore, the House bill is a field of landmines for the GOP. Without a CBO score, no one really has a good sense what the bill will cost or what it will do.
Despite that, Trump threw a party at his house, inviting a beaming Republican delegation for press remarks. In contrast, when the House passed the Affordable Care Act in November 2009, Obama delivered brief remarks, alone, in the Rose Garden, recognizing that the bill had a long way to go before it passed the Senate. (Indeed, it took four months and nearly collapsed in between.)
Even stranger was the content of Trump’s statement. There was laughter and gaiety, but the president said literally almost nothing about what is in the bill or who would benefit from it. Here are all the parts of his remarks that touched on policy:
As far as I’m concerned, your premiums, they’re going to start to come down. We’re going to get this passed through the Senate. I feel so confident. Your deductibles, when it comes to deductibles, they were so ridiculous that nobody got to use their current plan—this nonexistent plan that I heard so many wonderful things about over the last three or four days. After that, I mean, it’s—I don’t think you’re going to hear so much....
And I think, most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it’s a great plan. And ultimately, that’s what it’s all about.
So, in sum: Trump says that the bill will reduce deductibles and reduce premiums. In fact, for most Americans, both of these statements may well be false. Because the CBO has not yet scored the current version of the bill, it’s hard to tell, but in its previous version, AHCA was set to jack up premiums and deductibles overall.
Most of what Trump said was a simple celebration of winning: “A lot of people said, how come you kept pushing health care, knowing how tough it is? Don’t forget, Obamacare took 17 months. Hillary Clinton tried so hard—really valiantly, in all fairness, to get health care through. Didn’t happen. We’ve really been doing this for eight weeks, if you think about it. And this is a real plan. This is a great plan. And we had no support from the other party.”
Of course, the reason it only took eight weeks is that the bill is held together with duct tape and spit. That’s also the reason Trump isn’t talking about the substance of the bill in his remarks. First, he does not have a good handle on what’s actually in it, or even what it purports to do; second, it’s hard to make concrete statements about what it will do without a CBO score; and third, it doesn’t remotely resemble what he claimed during the campaign that his health-care plan would achieve.
Trump made a series of promises during the campaign. He said his plan would guarantee coverage for all people. He said there would be no cuts to Medicaid. He said no one would lose their coverage. He said costs would go down. And he insisted the protections guaranteeing coverage for people with preexisting conditions would remain in place. The House bill fails on every one of these counts.
Once again, the contrast with Obama is instructive. He cared deeply about winning on health care, pushing forward on the bill despite political costs. His chief of staff, Rahm Emanuel, told staffers, “The only nonnegotiable principle here is success. Everything else is negotiable.” The law that became known as Obamacare was deeply flawed, as many Democrats now admit, and the party made a series of painful compromises to get a bill through.
Still, Obama kept the beneficiaries in the public spotlight and demanded an expansion of coverage and protections for people with preexisting conditions. When the House passed the ACA, Obama told the story of a woman he’d spoken with that summer. “Because of a medical condition, Katie's insurance policy was suddenly revoked when she needed it most, even though she was paying her premiums,” Obama said. “I called Katie this morning, and I told her that when the bill that passed last night becomes law, we'll be able to protect Americans just like her from the kinds of insurance company abuses she had to endure.”
When the law passed in 2010, Obama welcomed people who would benefit from the law, and family members of people who might have benefited, to the signing ceremony. And he spent much of his speech focusing on what the law would provide.
The absence of any such discussion, or examples, or guests at the Rose Garden is glaring. Trump not only couldn’t claim to have kept his campaign promises; he apparently could not or did not bother to make the case for who would benefit from the law. The problem may be, as Matt O’Brien argues, that the bill is “a tax cut masquerading as a health-care proposal,” and would make coverage worse by and large, which makes it challenging to portray as an improvement in coverage.
Setting aside the much-maligned homogeneity of the crowd at Trump’s announcement, the people who were not there were as conspicuous as those who were. Trump could have found people who would benefit from the law, and not merely wealthy people who might pay less. He could have brought forward some of the people who have had to pay more for insurance since Obamacare passed. The president even hosted a listening session with some of them in March.
But there was no mention of these people on Thursday. For one thing, it’s not clear the bill will help them. For another, Trump appears too focused on winning to care about what the bill actually achieves. After a series of setbacks in Congress and in the courts, he cares far more about the victory than the terms on which it was won. As the health-care debate moves to the Senate, the president may discover, like King Pyrrhus, that sometimes the costs of victory outweigh the benefits.