Were Trump and Ryan Tone Deaf with AHCA?

Article originally published in the Philadelphia Business Journal on March 27, 2017

Effective leaders engender trust by keeping their commitments. President Donald Trump violated the trust of many of his supporters while trying to garner the conservative Republican votes needed to pass the American Healthcare Act (AHCA) in the House of Representatives.

Trump and Speaker of the House Paul Ryan (R-Wis.) suffered a major defeat on March 24 when they withdrew the AHCA from consideration by the House because it lacked the votes to pass. Had the legislation passed, it would have moved on to the Senate for consideration.

Members of the conservative Republican Freedom Caucus opposed the AHCA because it did not go sufficiently far enough in gutting many of the elements of former President Barack Obama’s Affordable Care Act, dubbed Obamacare.

Moderate Republicans opposed the AHCA because millions of elderly voters would have been unable to afford the high insurance premiums after they were placed in age and risk pools, and because of the highly adverse impact on women’s health. The Congressional Budget office projected that the number of uninsured individuals could grow by as many as 24 million over the next decade, which was unacceptable to moderate Republicans.

Republican and Democratic governors opposed the AHCA due to the block grant provision to the states that over time would not keep pace with medical care inflation and place an increasing financial burden on state budgets to fund Medicaid. There was significant opposition to the AHCA within the healthcare community due to people not being able to afford health insurance or when insurance is inadequate, people paying high out-of-pocket costs of health care. These concerns fell on deaf ears.

In an unsuccessful attempt to win over conservative Republicans, Trump supported last minute changes to the AHCA that wouldn’t require states to mandate insurance coverage for essential health care services such as pregnancy, mental health, drug addiction, and emergency room visits, a shocking change that basically gutted the AHCA of any semblance of health care insurance.

This was a violation of the commitment Trump made to the voters in November — a promise that he would provide less expensive and accessible health care to all those who wanted it. In the end, he was more interested in the “win” rather than meeting his commitments to his voters.

Trump said of the House Republicans, “We learned about [their lack of] loyalty.” What about Trump’s lack of loyalty to millions of citizens who voted for him, but would have been adversely impacted by the AHCA had it passed? Trump should have realized that House members are loyal to their constituents, and vote to reflect their strong views.

Republican conservatives are vowing to eventually replace Obamacare. One wonders whether they are pursuing their goal based on doctrinaire conservative principles or dislike of Obama and anything that the former president had accomplished.

A March 26 article in the New York Times is headlined, “Trump becomes ensnared in a fiery GOP civil war.” Given the unprecedented number of protests since Trump’s elections, one wonders if the citizens of the United States are now embroiled in an internal ideological war.

President Trump needs to realize that if he chooses to side with Republican conservatives, he will receive no support from Republican moderates fearful of being voted out of office in the November 2018 Congressional elections.

Trump also needs to be concerned about his own re-election in 2020. He needs to face the brutal reality that had 40,000 citizens in Pennsylvania, Wisconsin and Michigan switched their vote from Trump to Hillary Clinton, she would have won the Presidency by 278 to 260 electoral votes. He can ill afford to alienate voters who would be hurt by a revised version of AHCA.

There are aspects of Obamacare that need to be changed — the rapid escalation of insurance premiums, the exiting of insurance companies from certain markets due to financial reasons and the rising cost to the federal budget, to name a few. So, President Trump, why not fix Obamacare rather that toss it out and replace it with something that could cost you the presidency and cost the Republicans the House and Senate?

So where do we go from here? After the AHCA was withdrawn from a House vote, Trump quipped that Obamacare should remain in place until it collapses. Not the appropriate position of a president who knows that Obamacare needs to be fixed.

Ronald Reagan, the former president known for making deals across the aisle, would have been proactive and met with both Republicans and Democrats and solicited input from all stakeholders, working with them to find a pragmatic way forward. Given the current political environment, I am not hopeful that Trump and Congress will be able to do the same.

Stan Silverman is founder and CEO of Silverman Leadership. He is a speaker, advisor and nationally syndicated writer on leadership, entrepreneurship and corporate governance. Silverman earned a Bachelor of Science degree in chemical engineering and an MBA degree from Drexel University. He is also an alumnus of the Advanced Management Program at the Harvard Business School. He can be reached at Stan@SilvermanLeadership.com.