The president has been having a tantrum over health care ― calling the Senate’s failure to pass a bill repealing the Affordable Care Act last month a “disgrace,” and suggesting that McConnell, the Republican senator from Kentucky, should lose his job as majority leader if that’s where the repeal effort ends.
“I’ve been hearing repeal and replace now for seven years,” Trump said Thursday, speaking from his summer vacation in Bedminster, New Jersey. “Then I get there and I said, ‘where’s the bill, I want to sign it first day,’ and they don’t have it.”
Trump’s comments didn’t come out of nowhere. Days before, McConnell, during an appearance of his own, had suggested Trump still didn’t understand how long the legislative process could take ― prompting a series of tweets, subsequently amplified by Trump allies in the media, taunting McConnell and asking why he hasn’t produced a bill yet.
It’s a fair question. Ever since the Affordable Care Act became law in 2010, Republicans have been saying they would repeal “Obamacare.” All they needed, they insisted, was a president willing to sign their legislation. Now here they are, six months into the Trump presidency, and they’ve given him no legislation to sign.
But Republicans also made another set of promises ― to provide everybody with better, cheaper health care. And they don’t have a way to do that either. What they have, instead, is a set of plans that would take health insurance away from millions of people, while forcing those with serious or ongoing medical problems to pay a lot more for their care.
This mismatch between Republican promises and Republicans plans goes a long way towards explaining why the attempt to pass legislation has come up short. And while McConnell did his part to create a false impression of what the GOP intended to do, Trump did too.
Remember, it was Trump who made some of the most audacious promises about repeal, endorsing universal coverage clearly and explicitly. In September, 2015, during an interview with Scott Pelley on CBS “60 Minutes,” Trump went out of his way to suggest his determination to cover everybody differentiated him from traditional Republicans, who at least in modern political times had disavowed the goal:
Scott Pelley: What’s your plan for Obamacare?
Donald Trump: Obamacare’s going to be repealed and replaced. Obamacare is a disaster if you look at what’s going on with premiums where they’re up 45, 50, 55 percent.
Scott Pelley: How do you fix it?
Donald Trump: There’s many different ways, by the way. Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, “No, no, the lower 25 percent that can’t afford private.” But―
Scott Pelley: Universal health care?
Donald Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.
Trump made similar claims throughout the campaign. He promised not to cut Medicaid ― pointing out, again, that this was an unusual position for a Republican ― and he swore that, once Obamacare was gone, people would see both premium and deductibles come down. And after the presidential election, Trump reaffirmed his promise of universal coverage ― first in another “60 Minutes” interview, with Lesley Stahl, and then over the phone to Robert Costa of the Washington Post.
“We’re going to have insurance for everybody,” Trump told Costa in January. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Trump went on to say that, by the time Republicans were done, Americans “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
It was an absurd promise. The Affordable Care Act has left millions without coverage, and left millions more with insurance that carries high premiums, high deductibles, or both. But Republican plans were always bound to make these problems worse, because they called for rolling back expansions of Medicaid, reducing financial assistance for people buying coverage on their own, and scaling back regulations guaranteeing comprehensive coverage to everybody regardless of pre-existing conditions.
Confirmation of this came as early as March, when House Republicans introduced their version of repeal legislation, the American Health Care Act. It proposed to drain roughly $1 trillion from federal health programs, according to a subsequent analysis by the Congressional Budget Office, leaving 24 million more people without coverage.
Perhaps because of assessments like that, Trump eventually backed off the claim of “insurance for everybody.” But he never stopped making ambitious promises about repeal legislation, vowing over and over again that it would mean lower premiums and deductibles while protecting people with pre-existing conditions ― vows that, independent analyses showed repeatedly were simply not true.
It is possible that Trump understands he is lying when he says these things, and simply doesn’t care. It is also possible that Trump has no idea what’s actually in the recent Republican legislation and actually believes it would improve access and affordability. Nothing he has said or done, as a candidate or president, suggests he understands health care policy at even the most basic level.
Either way, the Republican dilemma remains the same. Their health care agenda is incompatible with their rhetoric and, from the looks of things, inconsistent with what the American people want as well. Instead of acknowledging this reality, and adjusting either what he’s been promising or what he’s been proposing, Trump is continuing to demand the impossible ― and then acting indignant when it doesn’t happen.