Trump Turns to Health Care With an Eye on 2020

Buoyed by word that the special counsel didn't find collusion with Russia, President Donald Trump is voicing new interest in policymaking, including a fresh effort to repeal and replace "Obamacare." But Trump has few detailed policy proposals to back up his words, suggesting he's as focused on highlighting issues that appeal to his political base as actually enacting legislation.

Trump stressed his desire to revive his failed effort to kill the Affordable Care Act on Wednesday, a pivot to health care that both broadens and complicates the administration's agenda. Many in the GOP remain skeptical that Trump can notch many policy wins in the divided Congress.

Speaking of a new health care proposal — still unproposed — Trump promised on Wednesday that "we're coming up with plans" and his GOP was the party of "great health care."

His administration this week surprised many when it asked a federal appeals court to strike down President Barack Obama's entire 2010 health care law, breaking with what had been a more modest effort to undo only parts of the act. The change in course by the Justice Department, backed by the White House, was encouraged by acting Chief of Staff Mick Mulvaney, a longtime Obamacare critic, said two people familiar with the deliberations who spoke on condition of anonymity to discuss private deliberations.

The idea was quickly embraced by Trump, the officials said. Trump, who met with aides to discuss the decision Monday, saw it as a way to deliver on his campaign promise to repeal and replace the law, as well as put pressure on congressional Republicans to act.

While aides expressed concern about a policy path forward — and many Republicans on Capitol Hill were reluctant to revisit such a thorny topic after repeal's spectacular failure in Congress in 2017 — Trump happily discussed his plans to make the GOP "the party of health care."

Left unsaid was that Republicans couldn't tackle health care when they had unified control of Washington, and the prospects in divided government are even bleaker. Instead, aides said, Trump's rhetoric largely amounted to a recognition of the political significance of the issue to his re-election prospects. His failure to repeal the Affordable Care Act constitutes a broken promise to his base.

Aside from this return to health care, the White House is pursuing a limited legislative agenda, with reining in prescription drug prices and passage of a new trade agreement with Canada and Mexico as its priorities.

Some allies are optimistic about the idea of a shift to policy. South Carolina Sen. Lindsay Graham encouraged Trump over the weekend to get back to governing to capitalize on good will generated by the end of special counsel Robert Mueller's probe. But health care has not been atop the GOP priority list in the House or Senate.

In fact, many Republicans were downright alarmed, preferring to put the focus on Democrats' interest in "Medicare for All," an idea the GOP has sought to brand as "socialism." House Minority Leader Rep. Kevin McCarthy phoned Trump to express his frustration with the administration's course reversal, warning that it made little political sense after the GOP's losses in the 2018 midterm elections, according to people familiar with the call. They spoke only on condition of anonymity to discuss private discussions.

Trump's White House had already been supportive in the lawsuit brought by Republican state attorneys general to challenge the law's requirement that insurance plans cover pre-existing conditions and certain "essential" health benefits, such as pregnancy. But the administration faced a deadline to stake out the extent of its request to undo the law after a Texas federal judge ruled that the entire Affordable Care Act had been invalidated.

The administration decision appeared rushed to some. Such a major change typically would involve considerable planning and discussion at the Department of Health and Human Services but that didn't happen, said a person familiar with the decision-making process. The person was not authorized to speak publicly and spoke on condition of anonymity.

The suit appears destined for the Supreme Court, which could find itself issuing another election-year opinion on the issue. The court has upheld much of the law previously, and should it be undone in its entirety, about 20 million Americans who have insurance under the law could be left in the lurch, a political and policy reality the White House has yet to prepare for, aides acknowledged.

Trump on Wednesday described the lawsuit as "phase one."

"If the Supreme Court rules that Obamacare is out, we will have a plan that is far better than Obamacare," he promised.

On another health care issue, the administration's efforts to push the poor toward self-sufficiency were dealt a blow Wednesday when a federal judge ruled that Medicaid work requirements undermined the program's mission of providing health care for the needy.

AP's VoteCast survey of more than 115,000 voters in the 2018 midterm elections found that health care was identified as the most important issue by 26 percent of voters, including nearly 4 in 10 of those who voted for a Democratic House candidate. Overall the issue was a potent one for Democrats, for whom those concerned most by health care voted by a 3 to 1 margin.

A GOP senators' lunch on Wednesday brought little, if any, discussion of a new health care push, according to those familiar with the private session.

Sen. Collins of Maine, who has pressed her colleagues to stabilize Obama's health care law, said she was "vehemently opposed" to invalidating the entire law, urging the administration to work with Congress to make changes.

Sen. John Kennedy of Louisiana said Obamacare should be struck down with "vengeance and furious anger." But he added "I don't think we should kill it until we have a replacement."

On other policy issues, Republicans have been exploring ways to reach across the aisle to make progress on reducing the cost of prescription drugs. White House staffers have been holding meetings with House Speaker Nancy Pelosi's staff, but aides cautioned the talks were still in their infancy.

Trump has also been reaching out lawmakers directly to talk policy. He spoke to Sen. David Perdue, R-Ga., about a number of policy issues Tuesday night, said a person familiar with the conversation who was not authorized to speak publicly.

Another issue Trump has talked about is infrastructure, raising it recently during a luncheon with Pelosi. But the White House has not planned to put out a proposal of its own, waiting to see what can develop on Capitol Hill. Discussions between the chairman of the Transportation and Infrastructure Committee, Rep. Peter DeFazio, D-Ore., and the White House continue.

Why are the issues now attracting Trump's attention?

"What is the number one issue still out there? It's jobs. The number two issue? Health care," said White House ally Rep. Mark Meadows. "And if we ignore both of those areas, and hope that the 2020 elections will be better somehow, without addressing real problems? Then we're making a mistake."

Associated Press writers Ricardo Alonso-Zaldivar and Alan Fram contributed to this report.