Obamacare repeal: Trump’s steep learning curve

The failure of the Republican health care reform bill has been a humiliating lesson for Donald Trump that governing requires different skills to campaigning. With words cheap on the stump, he promised to deliver a new health care plan that would be “unbelievable,” “beautiful,” “terrific.” It would be “less expensive and much better” than Obamacare while still guaranteeing “insurance for everybody.” Repealing the Affordable Care Act and replacing it with a far less expensive but still somehow more effective alternative was going to be the first sweep of his new broom in Washington. What happened instead was arguably the most crushing legislative defeat that any new president has suffered in more than half a century.

Consider the record of Trump’s predecessors. Franklin D Roosevelt set the gold standard by promoting 16 major pieces of legislation that formed the core of the New Deal within his first hundred days in office in 1933. No-one has come close to emulating this, but Ronald Reagan was well on his way to enacting the defining elements of Reaganomics—the 1981 tax cuts and spending retrenchment—within six months of taking office. Bill Clinton and George W Bush also opened their legislative accounts by securing a major bill pertaining to their domestic agendas. And Barack Obama had got the American Recovery and Reinvestment Act, the largest stimulus bill in US history, through Congress within four weeks of taking office.

The Obamacare repeal fiasco raises substantive questions about Trump’s capabilities in office. In 1960, political scientist Richard Neustadt published his seminal study, Presidential Power, with its core message that the perception of a president’s competence in the eyes of “the Washington community” was his essential instrument to persuade it to do his bidding. This still holds true today. Trump’s defeat makes him look amateurish—and no amount of early morning tweets that are music to the ears of the faithful outside the Beltway will erase that impression. Presidents derive political capital from legislative victories that can then be reinvested in pursuit of other measures. Trump’s just lost a lot of his. He self-evidently picked the wrong issue on which to launch his legislative agenda. It would have been much better to make tax reform the first big battle of his presidency: Republicans are more united on this issue and there would have been no troublesome bill that first needed to be removed from the statute book for progress to be made.

The Trump White House simply did not pay sufficient heed to the details of a very bad health care reform bill that was really the work of the Republican leadership in the House of Representatives. The now-dead measure would have made the Obama tax credits less generous and premiums more costly for lower-income, rural and elderly recipients. Most significantly, it would have phased out Medicaid expansion of Obamacare and gutted federal funding for this. Meanwhile, it provided substantial tax benefits for those on high-income and the insurance industry. And when it became clear that the votes were not there for enactment, the president supposedly skilled in the art of the deal sought to cajole rather than persuade Republican dissenters.

Presidents usually get saved from such humiliations by having politically savvy and pragmatic operatives as White House aides to help them in the task of governing. This was the role that Chief of Staff James Baker performed for Ronald Reagan. However, Trump is surrounded by ideologues like Steve Bannon who knew how to campaign but have little to no experience of governing. To make matters worse, the overall quality of his Cabinet is probably the lowest in nearly a hundred years.

Legislative leaders experienced in the ways of Washington might also have saved Trump from himself but the current Republican crop is still mired in an opposition mentality. The congressional GOP has been calling for repeal of Obamacare since its 2010 enactment without ever producing a viable alternative. It approved numerous reform measures in the last six years but never united around a single one. There was no need to do so because it was evident that Barack Obama’s veto would scupper any repeal bill. Now, of course, a Republican congressional bill was certain to be signed by a Republican president. This reality brought to the surface Republican differences on the detail of repeal that their hitherto united opposition to Obama had hidden.

The big question is whether Trump and his closest aides can learn from this setback. The president has spoken of the need for bipartisanship to get a better health care bill in the future. However, a middle way on the issue will be difficult to find without constructive engagement from the Oval Office occupant. For this to happen, Trump faces a steep learning curve to master policy details, something that he has shown no interest in or aptitude for doing so far. Until then, as House Speaker Paul Ryan reluctantly acknowledged, “[W]e’re going to be living with Obamacare for the foreseeable future.  I don’t know how long it will take us to replace this law.”