The celebration was more subdued than after the House passed its repeal bill in May, which Trump marked with a Rose Garden bash with congressional leaders. But it was still an important win. Barely 24 hours earlier, the Senate seemed incapable of even opening debate, much less passing any bill. That was certainly the case last week, when a distracted Trump suddenly realized that the Senate didn’t have the votes and began taking action.
Senate Majority Leader Mitch McConnell deserves a greater share of the credit than Trump, but the president upped his involvement. He invited senators to the White House to discuss health care, where he shamed them for not getting things done. “I don’t think we should leave town unless we have a health-insurance plan,” he said. He also had a veiled threat for Nevada Senator Dean Heller, who had been a holdout on the bill and was seated to Trump’s right. “Look, he wants to remain a senator, doesn't he? ” Trump quipped.
During his bizarre appearance at the annual Boy Scout Jamboree in West Virginia, he publicly bullied both Health and Human Services Secretary Tom Price and Mountain State Senator Shelley Moore Capito, another holdout. “You going to get the votes?” Trump asked Price. “He better get them. He better get them. Oh, he better—otherwise, I’ll say, Tom, you're fired. I’ll get somebody. He better get Senator Capito to vote for it.” As the coup de grace, Trump got the clinching vote from John McCain, the GOP elder statesman he’d derided during the campaign, who flew in just days after surgery and a brain-tumor diagnosis.
But Trump’s most important role was simply his refusal to let the bill die. Republican legislators have recognized the dilemma that faces them: It’s very hard to find any bill that can pass both houses of Congress, satisfying both the conservative and centrist wings of the party, and any bill that does will fall well short of the promises that Republicans—most especially Trump—have made. There’s simply no solution that will reduce premiums, expand or maintain coverage, cut costs, and stabilize the insurance system while eliminating the individual mandate, insurance regulations, and Medicaid expansion. But after the House bill failed, and Trump took heat for it, he insisted that the House take it back up. Then he did the same again when the Senate bill looked dead.
Trump still seems to have little understanding of how the health-insurance system works. During a recent New York Times interview, he delivered an inscrutable riff about insurance costs that bore no resemblance to the actual system. During his lunch with senators, he once again promised to drastically reduce premiums, something that no GOP proposal actually does. And the struggles of the House and Senate bills are partly his fault, since he has declined to set any real (or realistic) parameters for a bill and has largely stayed out of the arm-twisting process until things are falling apart, in both cases.