In the flurry of interviews before President Trump's 100th day in office, one of the remarks that stood out most for me did not come from Trump himself. It was a quick paraphrase in the middle of the Washington Examiner's recap of a Trump interviews on health care. After writing about Trump's criticism of the Affordable Care Act, reporter Sarah Westwood described how Trump talked about the American Health Care Act, which Republicans are trying to resurrect for a vote this week. “He extolled the legislation's virtues,” Westwood wrote.
What was he extolling, in particular? We don't know — but Trump has been answering any questions about his bill by firing off superlatives about how good it is, with little detail. We're now so used to Trumpisms, such as “people like it a lot,” that we hardly notice that Trump seems lost on the details of the bill itself. In fact, every piece of evidence suggests that he has blown off those details — which could change dramatically if the House passes a bill for the Senate to play with — and is more interested in being able to fulfill a general campaign promise than in the specifics of the legislation.
We know what's in the American Health Care Act and what's in the MacArthur-Meadows amendment that's been added to sweeten the bill for House conservatives. It cuts funding that states are now using to expand Medicaid by eliminating taxes that largely hit richer Americans. It creates waivers for states to undo the essential health benefits and protections for people with preexisting conditions. Millions of people who now are covered under Medicaid, or get subsidized insurance plans, would lose out; the ostensible winners would be people who would be able to pay less for newly legalized skimpy coverage plans.
Trump has a way of packing each news cycle into a rocket and shooting it at the moon, but it's worth ruminating on how little the president appears to care about the details of a major, transformational bill. During his campaign, he promised to “very quickly” repeal the Affordable Care Act, while assuring voters that everybody enjoying their coverage would get to keep it. In the first, failed push for the American Health Care Act, Trump reportedly told Republicans not to “focus on the little s---" but to pass a bill. On Saturday, at the president's rally in Harrisburg, Pa., he spent a little while talking about the “disaster” of Obamacare, then portrayed his fix in a glowing light.
We're going to get something great. We're going to get the premiums down. We're going to get the deductibles way down. We are going to take care of every single need you're going to want to have taken care of. But it's not going to cost that kind of money. We're going to bring it down. You're going to see it. Premiums down. We will repeal and replace Obamacare. You watch. We are going to give Americans the freedom to purchase the health-care plans they want, not the health care forced on them by the government.
The president promised that the GOP's bill would “take care of every single need you're going to want to have taken care of,” the sort of sweeping, unicorn-petting pledge he made throughout the campaign. And that quote didn't even make it into most coverage of the speech. This might be because Trump has frequently gotten over his skis on health care, promising that his health-care plan would “take care of everybody,” and so there's hardly a need for more Trump quotes that don't match reality.
Trump's Sunday morning interview with CBS News' John Dickerson was, if anything, even further from the facts. Vox's Sarah Kliff has annotated the transcript, clause by baffling clause, but the money part might be this exchange, in which the president makes up a policy that is explicitly not part of the amended American Health Care Act.
John Dickerson: In one of the fixes it was discussed preexisting was optional for the states —
Donald Trump: Sure, in one of the fixes. And they're changing it —
John Dickerson: — oh, okay. So it'll —
Donald Trump: — and changing.
John Dickerson: — be permanent?
Donald Trump: Of course.
John Dickerson: Okay. Well, that's a development, sir.
As Kliff points out, this is not a development in the House — it's just something Trump riffed on during an interview. Each time the health-care bill is discussed at length, Trump proposes an aspect that sounds politically fantastic but is not, in fact, in the bill.
So, here's the question: How much does the president's lack of interest in the details of the health-care bill affect his ability to reform health care? We're talking, after all, about the unwinding of a system that President Barack Obama spent most of his political capital to pass, a process that required his close, personal involvement and many, many speeches about what the bill would include.
Trump is doing none of that. Every day, often more than once a day, he steamrolls over the preferred Republican messaging by promising something that his party likely cannot deliver legislatively. But more than any recent president, perhaps more than any president ever, he has shown an ability to convince his base voters — who are overrepresented in key Senate race states and swing House districts — that what he says, Republicans are getting done.
Polling shows much of that story, with supermajorities of Trump voters adopting the president's positions on trade, on whether he was wiretapped by the previous administration and on nearly every other issue. But my favorite anecdotes regarding that phenomenon come from The Washington Post's Jenna Johnson, who two months ago found that Trump voters believed that the president had already fixed the health-care system. Just one example:
Soon after Charla McComic’s son lost his job, his health-insurance premium dropped from $567 per month to just $88, a “blessing from God” that she believes was made possible by President Trump.
“I think it was just because of the tax credit,” said McComic, 52, a former first-grade teacher who traveled to Trump’s Wednesday night rally in Nashville from Lexington, Tenn., with her daughter, mother, aunt and cousin.
For most of the media's history, politicians were held accountable if they promised a rose garden and delivered thorns. Trump, despite his low favorability ratings, has not really faced an electoral setback and is still cheered by thousands of voters whenever he makes a promise. Why would he stop making them?