published Mar 20th 2017, 7:56 pm, by Shannon Pettypiece

(Bloomberg) —
President Donald Trump talks a lot about how bad he thinks Obamacare has been for the country, but he has so far mounted a lukewarm defense for the replacement plan House Speaker Paul Ryan plans to put to a vote this week, a bill that’s united conservatives and liberals in opposition.

Ryan has said he’s counting on Trump to be the “great closer” for his legislation, and the president is planning to visit Capitol Hill Tuesday morning to address House Republicans in person, according to two Republican aides.

But Trump has yet to make a forceful sales pitch to his core followers or try to drum up grassroots support. At a Trump rally Monday night in Kentucky, the home state of Senator Rand Paul and Representative Thomas Massie, Republicans who oppose the bill, the president said little about Ryan’s proposal. Instead, he revved up the crowd with campaign-style rhetoric about Obamacare and said he can’t move on to passing tax cuts he promised during the campaign until a health-care overhaul is wrapped up.

“Thursday is our chance to end Obamacare and the Obamacare catastrophe and to begin delivering the reforms our people deserve,” Trump said at the rally in Louisville. “The end result is going to be wonderful and it’s going to work great.”

So far, Trump and his vice president, Mike Pence, have both taken a light touch promoting the House bill, suggesting the White House is more interested in maintaining some political distance in case it fails than in pushing it over the finish line. The Congressional Budget Office has estimated the legislation would lead to 24 million Americans dropping or losing their health insurance over 10 years, at a savings of $337 billion for the government.

“If anyone can generate public pressure, it’s President Trump,” said Frank Luntz, a Republican pollster. “It’s time for him to activate that army.”

One-Minute Mention

The army is dormant so far. At a Tennessee rally last week, Trump devoted only about a minute of a 38-minute speech to the House Republican plan to replace Obamacare. Over the weekend, Trump traveled to his Palm Beach estate where he golfed and met with senior staff and Marvel Entertainment CEO Ike Perlmutter, delegating the task of publicly promoting Obamacare’s replacement to Pence, who spoke to a group of business executives in Jacksonville, Florida and then to a meeting of the Club for Growth, a conservative activist group that opposes the House bill, down the street from Trump’s Mar-a-Lago home.

Pence didn’t mention Obamacare until he was about 11 minutes into his Jacksonville speech, and then called the House bill “an important step in the right direction.” At the Club for Growth meeting, he again made no mention of Obamacare for 10 minutes before emphasizing that the House bill would “repeal hundreds of billions of dollars in taxes.” The group’s members offered light applause in response.

A White House aide said that the president has communicated with his base and shown his support for the House bill through social media and meetings he’s hosted at the White House, including with Republican leaders and people who claim to have been harmed by Obamacare. He’s also leaning on surrogates like Health and Human Services Secretary Tom Price, who has defended the plan on television.

From the beginning of their effort to replace the Affordable Care Act, House Republican leaders and the White House made little attempt to muster support for the legislation among the health-care industry, rank-and-file Republican members of Congress and certainly Democrats. Some of Trump’s long-time friends and advisers blame Ryan for not crafting a bill with broader support from conservatives.

“It is very clear now to anyone that this plan wasn’t well thought out nor did it have the support needed to get passed,” said Chris Ruddy, the chief executive of Newsmax.com and a friend of Trump’s. Ryan “did a disservice to the president.”

A senior congressional aide involved in drafting the bill said Trump, Pence and White House Chief of Staff Reince Priebus were heavily involved in crafting the legislation and that it would be a mischaracterization to lay any criticism solely on Republican leadership. The person asked not to be identified publicly discussing internal deliberations.

Hospital Ads

Neither the White House nor Ryan reached out to some of the largest conservative activist groups before the bill was introduced, resulting in swift backlash. Within hours, one conservative organization aligned with the Tea Party movement got thousands of emails from members upset that the plan didn’t go far enough to repeal Obamacare. Two other groups, Tea Party Patriots and Freedom Works, have held rallies against the White House-backed plan and encouraged members to contact their elected officials.

The country’s largest doctors and hospital associations have also mounted opposition to the bill, including the American Medical Association and American Academy of Pediatrics. They too say no one from the White House or Congress reached out to them before or shortly after the legislation was introduced. The American Hospital Association began running television ads against the bill last week, saying it would cause millions of Americans to lose their health insurance.

The Republican aide said GOP leadership is in regular contact with conservative groups, who are often in opposition to their agenda, and that it isn’t a surprise that medical groups, who were involved in crafting Obamacare, wouldn’t support its repeal.

Support for the Affordable Care Act has meanwhile grown since Trump’s inauguration. Fifty-one percent of Americans don’t think the law should be repealed, according to the Kaiser Family Foundation, which has tracked public sentiment on Obamacare since before it passed Congress.

The law’s defenders have packed town hall meetings hosted by Republican members of Congress and have demonstrated outside Trump’s and Pence’s public events. Pro-Obamacare groups have spent $2.2 million on advertising this year through March 13, twice as much as those calling for the law’s repeal, according to data compiled by Bloomberg.

While his public sales effort has been light, Trump has courted members of Congress on the House bill. Numerous senators have visited the White House in the last two weeks for face time with the president, and he hosted a meeting with members of the Republican Study Committee, a conservative faction, last week. White House officials say Trump, Pence and top aides have all made calls to recalcitrant lawmakers.

Ryan says he is confident there will be sufficient votes on Thursday to pass the legislation and send it to the Senate. The House speaker has made a point to celebrate Trump’s role in persuading Republicans to support it, including the RSC meeting, which produced changes expected to be incorporated into the final version of the bill.

“The reason I feel so good about this is because the president has become a great closer,” Ryan said on “Fox News Sunday.” “He’s the one who has helped negotiate changes to this bill with members from all over our caucus.”

Focus on Votes

However, by focusing on votes, Trump risks signing legislation that’s only popular among Beltway Republicans — and widely unpopular everywhere else, said one Trump associate who asked not to be identified discussing White House strategy. Just 24 percent of likely voters support the White House-backed plan, and among Republicans, 37 percent favor it, according to a March 15 survey by Public Policy Polling.

Trump’s supporters could be especially hurt by the legislation. The CBO found that the plan would cause 14 million people to lose health insurance in its first year and drive up costs, especially for older, lower-income adults. A 64-year-old making $26,500 a year would see his health costs increase nearly $13,000, according to the CBO’s estimates.

White House budget director Mick Mulvaney said the administration believes leaving Obamacare in place would be worse for Trump’s supporters. Trump has repeatedly described the law as failing, and has publicly mused that a better political strategy would be to let it collapse before trying to pass a replacement.

“We know who his voters are and we’re going to take care of them,” Mulvaney said on Sunday on CBS. “But that doesn’t mean we’re leaving Obamacare in place because that would actually hurt them dramatically.”

Ryan said Republicans are discussing changes that would provide more financial assistance buying insurance for older, lower-income people. The bill is expected to be put to a vote on the House floor on Thursday, but not before several changes are made to the current draft.

–With assistance from Billy House, Anna Edgerton and Justin Sink.To contact the reporter on this story: Shannon Pettypiece in New York at spettypiece@bloomberg.net To contact the editors responsible for this story: Alex Wayne at awayne3@bloomberg.net Michael B. Marois, Kevin Whitelaw
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