Trump's first big test as dealmaker-in-chief: health care

He has to woo balky Republican lawmakers and hard-line conservative groups to his side, and sway a public that is increasingly viewing Obamacare favorably.

President Trump, the dealmaker, faces his biggest sales job yet as president: persuading Congress and the country to accept the GOP’s health-care plan.

So far, the bill is on track in Congress. On Thursday, it passed two committees in the Republican-controlled House after marathon debates; Republicans are cautiously optimistic it will pass the full House in a close vote. But expect an even tougher slog in the Senate, where the Republicans enjoy only a two-seat majority and the war of words could really heat up.

Meanwhile, public support for the Affordable Care Act – a.k.a., Obamacare – is now at its highest level since 2010, when the law passed. Consumers have begun to focus on aspects of the law that they like and could lose if it is repealed, analysts say. Independents, in particular, have grown more positive about the ACA, which overall has 48 percent approval versus 42 percent disapproval, according to the latest Kaiser Health Tracking Poll.

Major groups representing doctors, hospitals, insurers, and older citizens have all come out against the GOP plan this week, expressing concern that it could leave vulnerable Americans without the care they need.

Moderate Republicans have their own reasons to oppose their party's plan, including for some the fact that it eliminates federal funding for Planned Parenthood.

Pushing against Trump from another direction are hard-line conservatives, both in Congress and in outside groups. They don’t like the GOP plan, they say, precisely because it preserves too much of Obamacare, including many of its regulations and the continued expansion of Medicaid until 2020, albeit in the form of block grants.

They’re also unhappy that it replaces subsidies for the purchase of insurance with tax credits, even to people who pay no federal tax – meaning these new tax credits would essentially become an entitlement, at odds with fiscal conservative principles.

Conservatives opposed to the House GOP’s health-care plan have branded it in the most cutting terms: Obamacare Lite. Obamacare 2.0. RINOCare – “Republican in Name Only,” code for not conservative enough.

Democrats, too, have their nicknames – Trumpcare or, less pithily, the Make America Sick Again Act. Because nothing ties a piece of controversial legislation around a president’s neck like putting his name, or a mocking version of his campaign slogan, on it. 

Trump administration officials and House Speaker Paul Ryan prefer the more pedestrian “patient care” or “patient-centered health care reform.” Its official name is the American Health Care Act.

As President Trump digs into his first foray into legislating, and seeks to unify Republicans around the plan to repeal and replace Obamacare, does the rhetoric really matter?

“It’s a big part of it,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania. “If the plan is labeled Obamacare Lite, it’s a much more difficult sell.”

And how much of the wordsmithing depends on Trump’s ability as a salesman, and how much on the political pros around him? Both are important, says Ari Fleischer, former press secretary to President George W. Bush.

“This really comes down to congressional leaders, twisting arms and being good leaders, in concert with Trump’s salesmanship and leadership,” he says. “It will be a test of the new White House.”

Why GOP is losing the war of words

To those receiving benefits from the ACA, the prospect of losing them is felt viscerally – and it makes the Republicans’ effort to overhaul the Obama-era reform a fraught process. 

“The rhetoric of change works really well during elections, especially after eight years of a presidency,” says Roderick Hart, an expert on political communications at the University of Texas, Austin. “The rhetoric of continuity is a much more powerful one when things are at risk.”

Republican pollster and wordsmith Frank Luntz blames proponents of the GOP bill for losing their edge in the war of words.

“They’ve lost the narrative, because they are defending against attacks rather than reminding people of what’s wrong with Obamacare,” says Mr. Luntz, referring to skyrocketing premiums and deductibles, among other problems.

“Their language is about driving costs down, rather than patients paying less,” Luntz says, citing one example. “They are focused on the ideology to win over conservatives rather than focused on a personalized, human approach to win over Americans.”

And what about the nicknames, such as Obamacare Lite? “They’re extremely harmful, but not deadly,” says Luntz. Trump and the Republican leadership “can overcome it.”

But Mr. Hart says it’s doubtful Trump and Ryan will be able to tamp down “Trumpcare” and “Ryancare” and all the other “cares.”

“If a new law is passed that dismantles a lot of the things that currently exist, Mr. Trump will own it all,” says Hart. “Like it or not, it’s going to be Trumpcare.”

Trump invites critics to White House

On Wednesday night, Trump met with half a dozen conservative groups at the White House, where the president reportedly hinted that the bill could be tweaked to address some of their concerns.

At the meeting was a representative from FreedomWorks, which slammed the GOP health-care plan in a fundraising pitch on Thursday. The email, labeled RINOCARE, went after House Speaker Paul Ryan and the “establishment RINOs,” and then criticized the “watered down version of Obamacare” put out Monday night as “RyanCare.”

Making concessions to right-wing activists, who say what they really want is a full repeal of Obamacare, isn’t going to make the harmful nicknames go away. But Trump’s willingness to engage with critics in his own party is important, say observers.

Almost from Day One, Trump has been inviting lawmakers to the White House for meetings, get-to-know-you dinners, and bowling at the White House bowling alley. This kind of personal touch was not President Barack Obama’s forte, and it hurt him when it came time to get legislation through Congress. 

“Congressmen and senators want to be listened to,” says Mr. Fleischer, the former press secretary. “They want to be able to say to the president, ‘I think you need to do this or that,’ and have some hope and faith that the president is listening. It makes a difference.”

“The challenge for Republicans,” he says, “is to really talk substance, not politics, from this point forward.”