Role of President Trump in Healthcare Reform?

Over the past five months, it has become abundantly clear that the role of President Trump in healthcare reform is very different from the one taken by President Obama before him.  After witnessing President Obama play a major role before, during, and after the passage of the Patient Protection and Affordable Care Act (also called Obamacare (PPACA)) on March 23, 2010, many people (unrealistically?) expected the same presidential commitment and leadership for the Obamacare repeal and replace legislation that is currently underway.  The role of President Trump in healthcare reform is shaping up to be nothing like President Obama’s.

Let’s look at what our Constitution has to say about the role of the President of United States in lawmaking before we specifically look at the role of President Trump in healthcare reform.

The President’s Role in Making Laws—Civics 101

While it is not the job of the President of the United States to make laws (that falls on Congress), he influences laws in a number of ways:

  1. The president can suggest or propose laws.
  2. The president can also influence lawmaking by taking his/her ideas directly to the people (who then put pressure on Congress to act accordingly).
  3. The president has the power to either sign or to veto a bill passed by Congress.
  4. The president and the executive branch of government are charged with enforcing the laws passed by Congress.
  5. The president appoints many high officials, who write federal rules that put specific details into some of the laws passed by Congress. These officials are also responsible for giving advice to members of Congress for new legislation.

While the executive branch (headed by the President) is separate from the legislative branch (Congress), they often work together (especially if they are of the same political party) during the lawmaking process.

Out of the President’s Mouth

To understand the role of President Trump in healthcare reform, let’s look at a sampling of President Trump’s actions, speeches, interviews, and tweets on health care reform.

September 15, 2013 (example of tweet before becoming president)

role of President Trump in healthcare reform Mar 2013 tweetJanuary 14, 2017 (Washington Post interview)

“We’re going to have insurance for everybody.”
“There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

January 20, 2017 (action)
On his first day in office, President Trump signed an executive order  that, although it doesn’t advance his goal to repeal the law, it does weaken the implementation of Obamacare (PPACA) provisions. For example, the IRS is no longer rejecting tax returns if filers don’t say if they had health insurance during the year (individual mandate). How does this action square with the President’s constitutional duty to enforce the laws of the land (see #4 above)?

February 27, 2017 (meeting of the nation’s governors at the White House)

“We have come up with a solution that’s really, really I think very good,”
“Now, I have to tell you, it’s an unbelievably complex subject,”
“Nobody knew health care could be so complicated.”

March 23, 2017 (tweet)

role of President Trump in healthcare reform Mar 2017 tweet

Note: The Republicans’ Obamacare repeal and replace bills currently in Congress have gone by several different names–American Health Care Act (AHCA) in the House and Better Care Reconciliation Act (BCRA) in the Senate.  Both efforts are collectively called Trumpcare.

May 4, 2017.   (During a televised celebration in Rose Garden after the passage of the House’s American Health Care Act. (AHCA))

“What we have is something very, very incredibly well-crafted”
“We’ve come up with a really incredible health care plan, this has brought the Republican Party together”

June 13, 2017

It was reported that President Trump told Republican Senators who joined him for lunch at the White House that the American Health Care Act (House’s version of Trumpcare) was “mean.” 

June 23, 2017 (President Trump’s Weekly Address)

Expecting to see some positive comments about the just released Senate health care bill, President Trump simply repeats the same Republican mantra that “Obamacare is bad and must be repealed” speech.  As proof (?) he provides one family’s Obamacare “horror” story.

June 24, 2017 (the day after the Senate health care bill (Trumpcare Phase 2) was released to the public)

role of President Trump in healthcare reform tweet June 24 2017

June 25, 2017 (interview on “Fox and Friends”)

President Trump was asked about Obama’s Facebook post condemning the Senate health care bill (Trumpcare Phase 2).  This would have been a good time to elaborate why Trumpcare was in fact “better” than Obamacare. President Trump instead responded by saying that Obama copied him when he said the bill had “fundamental meanness at the core”. “Well he actually used my term, ‘mean.’ That was my term,” Trump said.

 White House’s website accessed June 25, 2017

REPEALING AND REPLACING: President Donald J. Trump supports the American Health Care Act (AHCA), which will remove Obamacare’s burden and put in place a responsible replacement.

A PROMISE TO AMERICA: President Trump Has repeatedly said he will repeal the collapsing Obamacare with real healthcare reform that will benefit all Americans.

The Role of President Trump in Healthcare Reform

roll of President Trump in healthcare reformThe role of President Trump in healthcare reform is very different from the one taken by President Obama.  While President Obama was instrumental in creating new healthcare reform legislation (Obamacare (PPACA),  President Trump’s single-minded efforts at “healthcare reform” to date appear to center around undoing what President Obama created!   It is clear from his actions, speeches, interviews, and tweets on health care reform that President Trump does not trouble himself with the details of the “responsible replacement” to Obamacare (PPACA) and expects the “fine” congressional Republicans to deliver it (and take responsibility for any bad outcomes).  It appears that President Trump will sign any law that repeals Obamacare even if it is projected to hurt millions of Americans.

The role of President Trump in healthcare reform has been to constantly criticize Obamacare (PPACA), tell Americans that it is bad (without any credible evidence to justify his assertion), and to make sure that any problems in health care be attributed to Obamacare (or the Democrats who created it).   The president never discusses details about Obamacare replacement provisions and the few words he does articulate are confusing, simplistic, and even downright childish.

Instead of explaining what he meant when he called the Republicans’ Obamacare repeal and replace bills “mean”, President Trump criticized President Obama for “stealing” his word!  (“Well he actually used my term, ‘mean.’ That was my term” ).  While the press has made a lot of the president’s use of the word “mean” to describe the legislation he actively supported, I question the more fundamental question of what does the word even mean? While many people think the word “mean” is a negative word, the president could have meant it in a positive way (like “tough” or “lean”).  Because President Trump has never told the public what he meant, we are left to guess. If President Trump ever communicated any substance to the Obamacare replacement discussion, perhaps the media would not have to spend so much time writing about President Trump and his use of the word “mean”.

As president, Trump is not “obligated” to get involved in the making of the Obamacare replacement legislation and he hasn’t.  When Congress finally comes up with Obamacare repeal and replace legislation, President Trump will only be obligated to either sign it into law or veto it. Given how frequently and vociferously Donald Trump derided Obamacare (PPACA) during the years before he became president, many Americans understandably thought that he was passionate about healthcare reform and had many ideas about how to make “better” healthcare legislation than Obamacare (PPACA).  They were obviously wrong.

In the end, the American public does not really know President Trump’s thoughts or ideas on Obamacare replacement because he has not articulated them to us.  I question if President Trump even cares about bringing affordable, quality health care to the American public.

If (or when) the Republicans’ Obamacare repeal and replace legislation finally makes it to his desk, Americans can be confident that the “win” will be celebrated on TV, with President Trump front and center eating up all the attention.  President Trump takes credit for any good news whether of his doing or not.  When there are bad results from his actions (and from those he has hired), you can be assured that someone other than himself will be blamed.

If (or when) a Republican Obamacare repeal and replace law is ever enacted, it will be interesting to see the role President Trump takes. I will be surprised to see President Trump defend it as vigorously as President Obama did against the  relentless assaults by Republican lawmakers to repeal or cripple Obamacare (PPACA) for six long years.

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