President Trump’s biggest political asset is his base’s unyielding support, and it’s the clearest reason why health care reform is likely to pass through the House on Thursday—if only by the narrowest of margins. The president belatedly decided to spend his political capital this week by meeting with House Republicans to rally them behind health care reform, and threatening them with primary challenges if they’re disloyal. He echoed House Speaker Paul Ryan’s reminder that if health care fails, his entire agenda is in jeopardy. Those pleas should be enough to keep the GOP’s health care overhaul alive.
Trump and Ryan are fighting a two-front war in their attempts to persuade skeptical members about the merits of the health bill. To placate swing-district members, Ryan has been feverishly working to increase financial assistance for older voters worried that they would be paying more for health insurance under the Republican reforms. To prevent hard-line conservatives from defecting, Trump has been dispatched to leverage his own popularity in their districts against them.
Both sides have much at stake: Trump will be testing the degree of goodwill he has with members representing districts where he won overwhelmingly. Throughout the campaign, Republicans with political futures to protect fell in line behind Trump—despite all his baggage—because of the degree of loyalty rank-and-file Republicans had towards their nominee. That degree of partisan loyalty hasn’t changed since the election, and it’s the most effective tool for Ryan to utilize as he lobbies his wavering members. But if enough hard-line conservatives stick to their principles to scuttle the bill, or privately fear a backlash from constituents over the health care changes, the perception of Trump being a world-beater will take a beating.
Congressional Republicans attribute growing momentum behind passage in the House to Trump’s last-minute engagement. For a while, he kept some distance from the signature legislation. In public statements, he sounds all too eager to delegate the dirty work to Ryan and Senate Majority Leader Mitch McConnell. Despite his bully pulpit, he has only sparingly used his Twitter feed and its 26 million followers to sell his supporters on the legislation. At campaign-style rallies, he frequently buries his health care salesmanship at the end of his speech.
At a rally in Kentucky on Monday, Trump hardly sounded enthusiastic about the merits of the health measure. He instead framed it as a necessary prerequisite so Republicans could then focus on cutting taxes and negotiating tougher trade deals. He didn’t try to sell any of the specific aspects of the legislation, only noting that it would repeal Obamacare. As Politico’s Shane Goldmacher put it: “Trump is increasingly talking about health care like the vegetables of his agenda—the thing he must begrudgingly finish in order to get what he really wants.”
Trump considers himself a master in the art of the deal, but in reality he’s as masterful in the art of deflection. So his mere ownership of the bill—and the threat of political consequences—at Tuesday’s Republican Conference meeting was an important sign that he’s fully on board with Ryan’s agenda. (For his part, Ryan has praised Trump’s efforts effusively, a sign of Trump’s importance in the equation.)
Ryan, meanwhile, needs to convince most of the 24 House Republicans who represent districts that voted for Hillary Clinton in 2016—along with another dozen or so members representing competitive districts. Ryan has strong relationships with these members, and has been particularly effective in selling the merits of the legislation to these vulnerable representatives. My colleague Daniel Newhauser reported that several of these endangered members were among late-breaking supporters Trump recognized Tuesday, including Reps. Martha McSally, Tom MacArthur, and Carlos Curbelo. If Ryan can hold most of those in the middle, he can afford to lose some defectors from the party’s right flank.
The math in the Senate is much more difficult. Already two Republican senators—Kentucky’s Rand Paul and Arkansas’s Tom Cotton—sound unyielding in opposition to the latest House legislation. The two Republican senators facing competitive reelections in 2018—Nevada’s Dean Heller and Arizona’s Jeff Flake—will be challenging to win over. Unpredictable moderates such as Maine’s Susan Collins and Alaska’s Lisa Murkowski will be tough sells, as well. As impressive a strategist as McConnell is, there may be no way to thread together the competing, disparate interests.
The political geography is different in the House, where Ryan’s goodwill with moderates and Trump’s deep popularity in ruby-red districts should get Republicans to the 216 votes they need. If the legislation doesn’t pass that bare threshold, it raises serious questions about their political clout—and the future of more ambitious efforts going forward.