President Donald Trump can’t seem to decide what he wants Congress to do on health care, but internally, aides say there isn’t much point in keeping him on message, and they’ve generally stopped trying.
“There is no mechanism in place for making sure the president stays on message when he doesn’t have one,” a senior Trump administration official told The Daily Beast on Wednesday. There’s also “no real [internal] effort to keep him from contradicting” himself on what, exactly, the GOP’s next steps on health care should be, the official said.
But it may not matter.
Though Trump exhibits a lack of understanding of the health care system he hopes to reform, and often makes public statements that contradict the official White House message, the legislative process, aides say, is mostly out of his hands at this point.
Trump will continue to be engaged in the fight for Obamacare repeal, White House and congressional officials said on Wednesday. But it’s not immediately clear that he has settled on what policy to push.
The president has floated no fewer than four different health care proposals in the past 48 hours. As the Senate GOP’s Obamacare replacement bill hit the skids on Monday evening, Trump mused that they should simply go for repeal and leave it at that. The following morning, as the repeal efforts prospect’s diminished further, Trump suggested leaving Obamacare in place—”as I have always said”—and waiting for what he’s described as its inevitable failure before officially repealing it and moving on a replacement.
On Wednesday morning, after Senate Majority Leader Mitch McConnell had admitted that the Republican repeal effort lacked the necessary support, Trump was back to promoting Obamacare replacement. “The Republicans never discuss how good their health care bill is,” he complained.
By Wednesday afternoon, the president was promoting health care policies that weren’t even in the Senate bill. That bill, he incorrectly claimed, would permit the selling of health insurance across state lines. “You’ll have forms of insurance you don’t even know about right now,” he promised. Selling insurance plans across state lines was one of Trump’s go-to lines on the campaign trail, but was left out of the Senate bill to allow it to proceed under rules requiring a simple majority.
It was a dizzying series of pivots for a president who often seems to want to get something done on health care more than he wants to get any particular thing done. It doesn’t help that Trump frequently confuses basic details about the U.S. health care system. Asked last month whether he understands the intricacies of that system, an administration official who works on health policy told The Daily Beast, “the president understands winning.”
As a result, Trump’s aides say, a bit of policy whiplash is unavoidable. But they add that it has no real impact on the outcome of the legislative fight over Obamacare.
“Nothing he says really changes what’s happening,” a senior White House official told The Daily Beast. “Mitch [McConnell] knows what the score is. He’s gonna do what he can do, and at the end of the day the president can say that’s what he wanted all along.”
Officials spoke to The Daily Beast on the condition of anonymity because they were not cleared to discuss legislative strategy.
The president’s apparently shifting positions nearly tripped up White House legislative affairs director Marc Short when he spoke with reporters about the progress on reform legislation on Wednesday.
"I think the president has been clear that what he wants is repeal and replace,” Short said. Asked how he squared that with the president’s tweets—specifically the one declaring that has “always said” Obamacare should be left to die on the vine—Short backtracked.
“What I think I said is the president’s preference has always been repeal and replace,” Short said. “If I didn’t, I apologize.” Asked whether there’s been inconsistency in the White House’s messaging, he reiterated, “we are for repeal and replace.”
The job of pressing that policy goal on Capitol Hill is falling primarily to other top Trump administration officials. Vice President Mike Pence, Health and Human Services Secretary Tom Price, and Center for Medicare and Medicaid Services chief Seema Verma will be on the Hill on Wednesday evening attempting to enlist the support of reluctant Republican Senators.
That’s probably a wise move for the administration, as President Trump has long exhibited a disdain for tackling policy minutiae, and veterans of his 2016 presidential campaign have no shortage of stories about Trump’s inability to grasp specifics on the American health care system.
A former senior Trump campaign official previously recalled to The Daily Beast several instances during the presidential race when Trump would privately appear to confuse Medicaid and Medicare, and the functions and purposes of each. He would at times conflate the two and had to be reminded by advisers of which one was which.
"There would be times when he would describe what was clearly Medicare...but say Medicaid, and when we pointed that out, [Trump] would say, 'That's what I said, Medicare and Medicaid,'" the source recounted.
The former aide added that campaign staff would move on instead of lecturing him on the policy specifics in part because no one wanted to risk making him look "dumb."