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After President Trump and congressional Republicans admitted defeat in their effort to repeal the Affordable Care Act and replace it with the American Health Care Act, Trump publicly put the blame on Democrats. That, despite the fact that Republicans had enough votes to pass a bill without any Democrats onboard — if they could only come together as a party.
So when it became clear the GOP didn’t even have enough votes to pass the bill without Democratic support, they abandoned it. Trump said he’d move on to tax revision, promising to let the Affordable Care Act “explode.”
But is that politically viable? If the health-care system does implode, and Trump does nothing, he’s walking into a political minefield — it won’t really be practical for him to sit back and do nothing. Trump seems to have realized that, because now he’s singing a different tune about the future of health-care legislation.
“I know that we're all going to make a deal on health care,” he told members of the Senate on Tuesday at a dinner at the White House. “So I have no doubt that that's going to happen very quickly. I think it will, actually, I think it's going to happen, because we've all been promising — Democrat, Republican — we've all been promising that to the American people.”
Trump may have made a whole bunch of promises about health care on the campaign trail. But it's easier to make those promises than to keep them.
That’s because different factions in Congress want different things. For example, GOP members of the Freedom Caucus — members of Trump’s own party — opposed the AHCA because they said it didn’t go far enough in undoing mandates for essential care. But the mandates for essential care are one of the provisions Democrats care about most in a health-care law.
If Trump does make a real effort to come up with bipartisan legislation, it would have to look very different from the Paul D. Ryan-designed American Health Care Act to stand any chance of passing. And is Trump really likely to move that far away from what congressional leaders in his own party want?
It’s hard to say what Trump’s endgame is here. It’s possible he could come up with a plan that satisfies moderates in both parties, even enough to pass a bill. That would be a big step forward for a president who has found it difficult to work with Congress so far — and has an outright hostile relationship with Democrats.
But it’s also possible Trump thinks the Affordable Care Act is troubled enough that insurance premiums will rise dramatically, insurers will pull out of states entirely, and Democrats will eventually have to stop defending it. And that, he seems to think, is when he’d be able to swoop in and name his demands.