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How Trump the Dealmaker Failed on Health Care

Health care was the first test of Donald Trump’s business skills. It didn’t go well.
Image: Trump speaks about the health care overhaul bill
President Donald Trump, flanked by Health and Human Services Secretary Tom Price, left, and Vice President Mike Pence, meets with members of the media regarding the health care overhaul bill on March 24, 2017, in the Oval Office of the White House in Washington.Pablo Martinez Monsivais / AP

The closer is now the loser.

President Donald Trump’s plan to repeal Obamacare and overhaul the health system crashed into the ground on Friday as Speaker Paul Ryan pulled a bill shortly before a scheduled vote.

The two-month drama was the first test of Trump’s ability to apply his business skills to the Congress, a historic graveyard for presidential priorities.

It didn’t go well.

Trump, who ran as a self-proclaimed master negotiator and who White House Press Secretary Sean Spicer touted "the closer" in the final stages of the health care talks, bet everything on a power play Thursday night in which the White House dared members to either vote yes or keep Obamacare.

It was right out of "Art of the Deal," Trump’s old business book in which he stressed the importance of being ready to walk away to force a sale.

But Republicans called his bluff. Some of them had studied the "Art of the Deal" themselves — Sen. Rand Paul (R-KY) handed out copies to Freedom Caucus members — and reached a similar conclusion.

“The person who enters the negotiation looking like they have to do the deal is in a disadvantage,” Rep. Andy Harris (R-MD), a holdout from the House Freedom Caucus who read the book last week, told reporters on Friday.

Ryan and the White House gushed about Trump’s unprecedented engagement, but the president found there were limits to schmoozing — even with members with close personal ties.

Rep. Dan Donovan (R-NY), the lone GOP member from Trump’s hometown of New York City, told reporters he had been a personal friend of the president for two decades. But that didn’t change his “laundry list” of complaints, from Medicaid cuts to tax credits that didn’t go far enough.

Trump's limitations

The president's disinterest in policy and his refusal to guide the process until after a bill was nearly complete created unique problems.

On health care, Trump instinctively sided with the more moderate wing of his party, and arguably even more with Democrats.

He promised universal coverage, lower deductibles, zero cuts to Medicaid, Medicare, and Social Security, touted a Democratic plan to negotiate prices with drug companies, and even flirted with heretical ideas like Obamacare’s individual mandate and single-payer healthcare in prior years.

But Trump was light on policy knowledge and his ideas only became less clear with time. During the campaign, he proposed achieving universal care through vague ideas like deals with hospitals” or by allowing insurers to sell across state lines, a policy that was at best tangential to the overall health care debate.

This lack of basics left him reliant on others to carry out his vision. In his case, he drew from conservative ranks: Ryan, Health and Human Services Secretary Tom Price, and Office of Management and Budget Director Mick Mulvaney.

RELATED: Trump says Obamacare will "explode"

The marriage was an awkward fit for policy purposes. Trump had relied on conservative groups like the Heritage Foundation for advice throughout the campaign and his burn-it-down rhetoric often drew him closer to tea party politicians.

But his stated policy goals were still much closer to politicians like Sen. Susan Collins (R-ME) and Bill Cassidy (R-LA), who urged Trump to negotiate with Democrats and adopt their own bill that would allow states to keep Obamacare or adopt a system with universal catastrophic coverage.

Some in Trump’s orbit noticed this dynamic and warned that trouble was brewing. Newsmax editor Chris Ruddy, a Trump confidant, argued he should ignore Ryan, dump conservatives, and establish a bipartisan commission to expand the safety net through Medicaid.

Even as Trump placed his trust in conservative advisers inclined toward smaller government, he kept promising better, cheaper health care that covered more people. If anything, his promises escalated, culminating in a pledge to provide "insurance for everybody" in a Washington Post interview.

The combination left lawmakers more and more confused. A civil war was in the making and Trump offered few details as to which side he favored or how to resolve their differences.

He promised an imminent White House plan while House leaders worked on their own and it wasn’t clear for weeks that they were ultimately the same thing. All the while, conservatives, moderates, and White House officials rushed to claim they were on the same page as the president.

This split was a major contrast with the way President Barack Obama led Democrats in passing the Affordable Care Act after over a year of near-death experiences.

The party had spent decades forging a consensus through failure after failure before the 2008 wave gave them the votes to try again. By then, they had negotiated buy-in from every wing of the party on a plan to expand private insurance through a regulated exchange with subsidies. There were major fights over whether to include a public option or how to handle coverage for abortion, but they never threatened the basic structure and goals they agreed to at the outset.

RELATED: Republicans pull health care bill

“We didn't struggle with health care because we're stupid, we struggled with it because it is an incredibly complex, massive challenge,” Adam Jentleson, a former top aide to retired Senator Harry Reid, told NBC News. “They convinced themselves that we were just idiots and they would quickly take care of it.”

The final push

Facing a divided party and unpredictable president, House Republicans finally settled on a plan with the White House to release a finished bill almost out of nowhere and pass it as fast as possible.

In doing so, they skipped the usual process of painstaking hearings, town halls, and negotiations that characterized Obamacare.

Within days, though, it became obvious the plan that tried to placate all sides left no one satisfied and many deeply upset. The party’s goals were fundamentally different, not just their methods.

As for Trump? He didn’t have much to say publicly, especially when it came to the specifics of the legislation and how it would help the average American.

Even in speeches promoting his plan, he told audiences he had considered letting Obamacare remain in place rather than handing Republicans ownership of health care. He said he was eager to move on to tax reform, but had to take care of health care first for procedural reasons. This made for an odd pivot when he warned conservatives in the home stretch that they would be wiped out in 2018 if they failed to support his bill.

This ambivalence, though, might explain why Trump sounded almost relieved on Friday to be back in his old comfortable position of dumping on Obamacare rather than slogging through the hard work of passing landmark legislation and then spending his presidency defending it.

"I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare, they own it 100% own it," he said on Friday.