For Republican leaders, the desire to repeal President Barack Obama’s signature health-care legislation, the Affordable Care Act (ACA), has been a unifying goal for seven years. So it was no surprise that after Donald Trump won the presidency and the Republicans retained both houses of Congress in the 2016 election, they made health-care reform their first order of business. What was surprising, including to the Republicans themselves, was how badly they botched the repeal. The debacle serves as a warning to negotiators preparing for complex multiparty talks of the need to plan carefully and dig deep into the details.
Dissent and doubts
The trouble began with the way the Republican health-care bill was drafted. House Speaker Paul Ryan and his team put together the American Health Care Act (AHCA) in “secretive locations at the Capitol” with input from White House Chief of Staff Reince Priebus, writes Tim Alberta for Politico. Trump himself stayed out of the fray, marveling publicly that health care had proven to be an “unbelievably complex subject.” After being leaked, the AHCA was released unceremoniously on March 6 as a take-it-or-leave-it document.
Apparently assuming that congressional Republicans would rally around the bill, Ryan didn’t develop a clear strategy for selling it to them or to the American people. He was reportedly unprepared when conservative pundits trashed the bill as “Obamacare lite” and moderates objected that it would harm millions, including many Trump voters.
As Ryan’s team hastily rolled out a PR campaign, Trump stayed on the sidelines. “Is this really a good bill?” he asked his advisers, according to the New York Times. Trump had promised Americans better, cheaper health coverage. But the Congressional Budget Office released a report estimating that 24 million Americans would lose health care under the AHCA by 2026 and that coverage would worsen for those with insurance.
Stuck in the middle with you
To pass the bill in the House and move it on to the Senate, Ryan and Trump faced the daunting task of winning votes from two factions that disliked the bill for opposite reasons. Members of the conservative House Freedom Caucus wanted a more complete rollback of Obamacare. Meanwhile, some of the members of the more moderate Tuesday Group, many of whom were spooked by the angry constituents who had been protesting the proposed repeal at town-hall meetings, felt the new bill needed greater consumer protections.
What tools of persuasion did Ryan and Trump have available to win some votes? Because a 2011 ban on federal earmarks remains in effect in Congress, Ryan couldn’t try to win over members with promises of pork-barrel spending in their districts. Throughout the negotiations, Trump hinted that he would work to keep “no” voters from being reelected in 2018, but in light of his low approval ratings, lawmakers seemed to shrug off these threats.
With few carrots and sticks at their disposal, the leaders were left to tinker with the contents of the bill, writes Paul Kane in the Washington Post. But that didn’t offer a clear path to victory, either. If they offered too many concessions to the right wing of the party, moderates would never sign on—and vice versa. “Every concession made to win conservatives . . . was destined to result in the loss of moderates,” Politico concluded. As for trying to pick off a few Democrats, Trump and Ryan didn’t see a point in even trying.
Personality trumps policy
Following a budget meeting at the White House, House Freedom Caucus leaders Mark Meadows and Jim Jordan nabbed an impromptu meeting with the president and complained that Ryan wasn’t soliciting their input on the Obamacare repeal and replace bill. Trump assured them that he himself was open to their ideas.
The president began courting House Republicans with invitations to the White House and unannounced phone calls. Speaking to Politico, congressmen recounted “colorful” talks full of “exaggerations and foul language and hilariously off-topic anecdotes.”
Trump seemed to relish the schmoozing and arm-twisting, but the details eluded him. As a business executive, “He’s really not used to getting involved himself,” one senior House GOP aide told Politico.
“If this was about personalities, we’d already be at ‘yes,’” Meadows later told the Post. Calling Trump “charming,” he added, “but this is about policy, and we’re not going to make it about anything else.”
Representative Dave Brat of Virginia recalled an unexpected phone call he got from Trump. “He’s selling. The salesman in sell mode. On that, he’s the best. Humor, heart, personality.” But with his policy concerns unaddressed, Brat was unable to get behind the bill.
An ailing agreement
In mid-March, Trump entertained Meadows at his private club in Florida. Back at the Capitol for a meeting the following Tuesday, March 21, the president told the Freedom Caucus that he expected them to support the bill as is. Trump singled out Meadows, saying he would “come after” him if he voted no.
The threat may have been a deal breaker for Meadows, whom some Freedom Caucus members perceived as already being too close to Trump. “Mark desperately wanted to get to yes, and Trump made it impossible for him,” one caucus member told Politico. “If he flipped after that he would look incredibly weak.”
Yet with the vote on the ACHA just one day away, Meadows joined other caucus members at the White House in the morning, expecting to talk policy with the president. To their dismay, they instead found themselves stuck in a “pep rally” led by Vice President Mike Pence and top Trump aides, according to Politico. The message? “Take one for the team.” After White House chief strategist Steve Bannon repeated the phrase, one congressman reportedly snapped at him not to talk to them like children. An awkward silence followed.
A failed resuscitation
On the day of the scheduled vote, March 23, Trump told Freedom Caucus leaders at the White House that he was willing to go along with their proposed cuts to so-called essential benefits—including outpatient visits, mental-health services, and maternity care. But Meadows and others wanted deeper cuts, which were even more likely to turn off Tuesday Group members and perhaps doom the bill in the Senate.
Eventually, Trump cut off the discussion. “Forget about the little [stuff],” he said, as reported by Politico. “Let’s focus on the big picture here.” Fretting about how the bill’s defeat would affect his reelection chances in 2020, the president warned the attendees that this would be the only chance he’d give them to reform health care—and that their constituents would punish them if they didn’t get the job done.
House members left the meeting with the impression that Trump hadn’t learned enough about health-care policy to know how to put together a package that could win in the House, let alone the Senate. Later in the day, reporters caught Trump off guard with the news that Ryan had postponed the vote until the following day.
Dead on arrival
With the bill seemingly headed toward failure, the major players switched into damage-control mode. Ryan’s allies began referring to Trump as “the Closer.” Trump aides told the Times that the president regretted going along with Ryan’s idea of putting health-care overhaul before tax reform.
That night, Trump instructed House Republicans to hold a vote on the ACHA even if they knew it would fail, apparently aiming to publicly identify and shame those who voted to leave the ACA in place. Trump again warned that he would not try to negotiate an Obamacare repeal again. That night, the entire House Republican Conference convened and tried in vain to resolve their disagreements.
The next day, after concluding that he didn’t have enough votes, Ryan visited the White House and convinced Trump that pulling the bill was their best option. In a contrite public statement, Ryan said that Obamacare would remain “the law of the land.”
Trump, for his part, called the Post and blamed Democrats for not supporting the bill. “Just another day,” he concluded. “Just another day in paradise.”
Negotiating “unbelievably complex” issues
- When preparing for multiparty talks on contentious topics, you would be wise to learn from Trump’s and Ryan’s mistakes:
- Look for early, easy wins. When negotiating with new partners, try to build momentum and rapport by discussing issues in which disagreement is low before moving on to more contentious ones.
- Involve others from the start. Instead of presenting fully formed plans, enlist interested constituents in the planning process to get their input and begin shaping a deal that everyone can agree on.
- Prepare, prepare, prepare. Charm and flattery will get you only so far. Immerse yourself in the details of the issues at stake so that you can make informed tradeoffs and win over potential deal spoilers.
- Make sure your threats have teeth. For a threat to be effective, it has to be motivating and you must be willing to follow through on it. When you’re negotiating from a place of weakness, a threat could backfire.