Why Trump is battling in wake of healthcare defeat

President Donald Trump, flanked by Health and Human Services Secretary Tom Price, left, and Vice President Mike Pence. Photo / AP

After Donald Trump's healthcare defeat, his opponents in and outside his party scent blood.

It was bad enough that the White House and Republicans in Congress made a mess of their first big legislative test.

What gives this capitulation an outsized impact is that it loudly exposes what we've gradually suspected watching the Trump Administration battling its way through weeks of strife.

Trump keeps crashing in the credibility gap between what he has promised and brags about, and what follows. It's the Art of the Oversell followed by the Don't Worry about the Detail reality.

Essentially, the self-described dealmaker couldn't make the deal on healthcare.

Boston Globe columnist Michael Cohen tweeted: "The reason this is so bad for Trump is it punctures his image as a guy who would go to Washington & get things done."

A Politico report was brutal: "The businessman president, who sold himself to tens of millions of disillusioned voters last year as the only outsider who could tame a broken capital, ended his first confrontation with lawmakers overmatched, out-maneuvered and ultimately empty-handed".

In the New York Times Nicholas Kristof wrote: "Trump is a world-class boaster. He promised a healthcare plan that would be "unbelievable," "beautiful," "terrific," "less expensive and much better," "insurance for everybody". But he's abysmal at delivering - because the basic truth is that he's an effective politician who's utterly incompetent at governing."

Atlantic writer James Fallows wondered: "Is there ANY prev example of a new admin, w control of both houses, losing on first big, trademark legis fight"

Why does this feel like a dam-busting, reputation-crumbling moment?

Because - just 64 days into Trump's presidency - it sits on top of a pile of failures, missteps and scandals.

The stalled immigration bans, the Russia investigations, the false wiretap claim, the National Security Adviser's resignation, the Attorney-General having to recuse himself, the cost of the wall, the blatant false statements, the mixed messages from senior officials, the staffing slowness with less than two dozen nominees confirmed so far.

Kristof added: "One of President Trump's rare strengths has been his ability to project competence... The Trump Administration is increasingly showing itself to be breathtakingly incompetent ... The Administration proved unable to organise its way out of a paper bag."

New York Times columnist Frank Bruni climbed in: "Washington under [Trump] doesn't resemble the same old swamp. It looks like a sandbox. There's commotion aplenty, noise galore and not much evidence of adult supervision".

Here Trump refers to the specifics of Americans' health care as "little shit," compared to his reelection prospects. https://t.co/QfTU4YOlZP

— Steve Silberman (@stevesilberman) March 26, 2017

Conservative writer Ross Douthat, also of the New York Times, lays some of the blame on Trump's advisers.

"Trump's presidency is flailing for many reasons, but lack of close advisers who've thought about translating populism into policy is key," he tweeted.

"Trump made a lot of big, heterodox promises on the campaign trail. Now clear nobody in his circle of trust thought about how those cash out."

Crises brief and ongoing have become the overall narrative of this Administration.
With Trump having about 37 per cent job approval on Gallup, it will be hard for him to dig out of this hole.

Usually this is the best time for presidents when they are high in the polls and can use that to get projects through. Trump has limited presidential 'capital' to spend. The bad news for Trump is that the story of the healthcare failure clarifies that the President lacks the clout and ability to get the job done and have his wishes obeyed.

In February Trump said: "Nobody knew healthcare could be so complicated". In the end, he was unable to muster enough support for the American Health Act to replace Obamacare - failing in one of his key campaign promises.

For the Republican Party, seven years of promises to repeal and replace the Affordable Care Act were ditched after 17 days. Speaker Paul Ryan said the US will be "living with Obamacare for the foreseeable future" and it remains the "law of the land".

The past three occupants of the White House all got big-ticket items through in their first 100 days. President Barack Obama's economic stimulus package had passed both houses by mid-February. There were seven bills passed during President George W. Bush's first 100 days, including a US$1.6 trillion tax cut; 11 in Obama's and 24 in Bill Clinton's, including a US$1.5 trillion budget outline.

Of the three, Clinton had the most early difficulty, including over health reform, staff appointments, and allowing gays to serve in the military. Obama, Bush and Clinton all rated over 50 per cent in job approval after 100 days.

Trumpcare would have thrown millions of Americans off health insurance and given a tax cut to the wealthiest Americans. A Quinnipiac poll showed only 17 per cent of Americans supported the bill, with 56 per cent opposed.

Its unpopularity was obvious in videos of strained Republican congressmen holding town hall events with their constituents.

There was a Democrat-encouraged push for people to phone in their views to congressional representatives.

Washington Post reporter Philip Bump tweeted: "My tally of calls reported by (mostly Dem) House members on the GOP bill: 1130 for 59,337 against." The New York Times reported that Thomas Massie, a Kentucky Republican, had received 275 calls against the bill and only four in favour. Dan Donovan, a New York Republican, said the calls to his office were about 1000-to-1 against the bill.

Trump got caught up in the fault lines of the Republican Party.

There were two rebellious camps among House Republicans: About two dozen centrists, under pressure from the activist constituents to reject the bill; and the right-wing Freedom Caucus, opposed to government involvement in healthcare. Together they numbered about 50 representatives - more than twice as many votes as the party could afford to drop. Taniel, a political statistician, tweeted that "of roughly 32 House Republicans who were public 'no's when the vote was cancelled, I count only about 15 who were in Freedom Caucus".

"I make deals." @AC360's mashup of Trump talking about his negotiating skills https://t.co/OIp9CRB5pr

— Brian Stelter (@brianstelter) March 25, 2017

But Trump's negotiating style and reported lack of knowledge of and interest in policy have been savaged.

FiveThirtyEight reports: "None of his negotiating moves worked. In meetings with members of Congress, he bluntly called out those who were not yet behind the bill, an intimidating approach that presidents often avoid. He tried to negotiate the details of the bill with the Freedom Caucus, while also using his Twitter feed to pressure them".

According to NBC's Benjy Sarlin: "Trump was light on policy knowledge and his ideas only became less clear with time".

Politico reported that: "For weeks Trump had seemed disinterested and disengaged from the specifics of the healthcare fight, both behind closed doors with his aides and at public rallies. Trump 'just wanted to get something he could sign,' said one adviser. 'He was over it'."

Budget Director Mick Mulvaney laid down an ultimatum from Trump, telling members that the President wanted a vote and would move on if it failed. White House press secretary Sean Spicer called Trump "the closer". But the moderates paid more notice to the people who can vote them out and members of the Freedom Caucus maintained their independence from Trump's control.

Politico's Tim Alberta writes: "Through charm, force of personality and sheer intimidation, Trump did move some votes into the yes column. But GOP leaders were left wondering why he didn't do more ... The answer, to Republicans ... is obvious: Because he lacked familiarity with the legislation itself, and thought it was Ryan's job to sell the specifics".

Alberta summarises: "If the bill failed because Trump is a great salesman with a poor grasp of policy, it also failed because Ryan is poor salesman with a great grasp of policy".

Obama White House veteran David Axelrod implied a contrast between the two presidents. "The ACA passed, against all odds, because of the sustained, personal commitment of a president to the cause, the details and the process."

Interesting theory here from @juliettekayyem ... but key word here is "theory" https://t.co/WzqE2slBxT

— Michael Cohen (@speechboy71) March 26, 2017

There is some political upside for Trump.

He no-longer has to handle months more of legislative fighting over an unpopular issue, and as Stephen Bush notes in the New Statesman: "The appearance of weakness and failure is less electorally damaging than actually succeeding in removing healthcare from millions of people, including people who voted for Trump."

Having anger and fear over healthcare with them would have fuelled the Democrats' campaign next year for the Midterm elections. But resistance over the immigration bans and healthcare will be giving the Democrats confidence they can harry Trump after the loss last November.

Republican political analyst Steve Schmidt believes "Trump voters will not blame Democrats or Trump. They will blame the House GOP. This is a political disaster for Congressional GOP".

Analyst SeanTrende of RealClearPolitics.com tweeted: "Looking more and more like Carter: POTUS tries different direction, but has a hard time getting party to come along. But, it's early."

Trump says he will move on to tax reform but that won't be an easy process. Kevin Brady, the Ways and Means chairman told Alberta: "Tax reform is the hardest lift in a generation. So that would be a big challenge."

Josh Holmes, a former chief of staff to Republican Senate Majority Leader Mitch McConnell, told Politico: "The Republican Party is still operating as an opposition party. If they can't break the fever...it says an enormous amount about the prospects of tax reform, infrastructure and some sort of immigration proposal".

Unless Trump gets more help in the White House and Congress to translate his vision into legislation, there's no reason to be confident those projects will pass.

The factions in his party remain and have seen how he caved on healthcare. The Democrats will be confident in the path of constant resistance. His job approval rating is low. The evidence of incompetence in Trump's Administration is mounting.

And the clock is ticking to the Midterms.