I Should Have Known That Obamacare Repeal Was Doomed

Three White House moments that form a cautionary tale for Republicans

Your humble correspondent, talking health care with her boss (immediate left) and The Boss, and other colleagues.

[We interrupt our previously scheduled series on ending secret prices in health care to bring you breaking news: Republicans Are About to Blow it Again on Obamacare.]

It was my first time in the Oval Office. I mean, with the president. I had once been given an after-hours tour with my family during the second Bush administration as a favor by my sweet friend whose unfortunate White House job was to “liaise” with (i.e. babysit) Senate health staffers.

It was just me in there with my boss, the head of the Domestic Policy Council (a brilliant, hilarious, passionate and ethical friend, who later became the U.S. ambassador to wherever and left me in the middle of the price transparency fight).

Here we are on election night 2016 which, at this time in our story, had been just a couple months prior.

We were a few days into the new administration, January 2017, and health care was up at bat in the first inning.

Spoiler alert: Mistake #1. (Don’t do the hardest stuff first like health care – get some easy wins before you risk losing).

My boss reminded the president who I was (the health care girl on his team). The president, ever the charmer, was flattering and claimed that he’d been told (“many people are saying”) how amazing I was. This was definitely not true (neither how amazing I was, nor that he’d been told so by anyone), but it was adorable how he tried to make people feel like a million bucks.

I was literally frozen and could barely speak. The past few days had been surreal.

I was a jaded former Hill staffer who had been in DC for almost twenty years at that point. It was quite hard to impress me with famous people or fancy buildings. But everything about that first week in the White House felt like I had landed on the moon.

On inauguration day, a little white bus drove the new Domestic Policy Council - about a half-dozen of us - over from the federal building a few blocks from the White House where the transition team had been holed up since the election.

As we went through a series of imposing gates groaning loudly as they opened, guarded by bomb-sniffing dogs and U.S. Secret Service inspections, the 18-acre complex unfolded before us.

We didn’t have any furniture or supplies. Although our boss, along with the heads of the NEC and NSC, worked in the West Wing – about the size of my Capitol Hill townhouse – the rest of us had managed to box out the speechwriters and scored the absolute best suite on the first floor of the Old Executive Office building, facing the West Wing. This was conveniently close to the entrance so that we could run back and forth between the two, fifty times a day (for all those very, very important meetings… well, and also, the 24/7, unlimited Diet Coke supply on the first floor).

I had picked out an office and could not believe my view.

January 20, 2017, the afternoon after the Inaugural.

So all that to say, I was exhausted, starstruck, and uncharacteristically tongue-tied, as I sat in front of the president at the Resolute Desk for the first time, about to brief him on the doomed Obamacare plan.

We began.

Thirty seconds later, he interrupted and said “you guys want to see something amazing?”

I very much did want to see something amazing.

He leaned over his desk with the excited expression of a 10-year old boy and, with his pointed index finger, pushed a big button on a little wooden box next to his phone.

We froze and waited. About five seconds later, a steward from the U.S. Navy came in and asked if we’d like anything to drink. The president said “you guys want a Diet Coke?”

I very much did want a Diet Coke.

But I demurred, because being served a Diet Coke – literally on a silver platter – by a member of the Armed Forces seemed decadent and weird (I eventually got less rattled by this as they serve at all the events and receptions on campus, but still). Also, we needed to get back to health care, since you never know how much time you’ll get in the Oval.

As we prepared to continue, the president interrupted us again.

“You wanna do it again?”

And again, the finger to the button, and the Navy steward coming in with the Diet Coke.

After he left, the president leaned in close and lowered his voice like he was letting us in on a secret.

“Can you believe this?” He whispered, incredulous. “Now, I’ve been in magnificent places, like the most beautiful and magnificent places. But this place is unbelievable! No wonder everybody wants this job!”

In other words, he was having the exact same reaction to being in the White House as I was.

And he shared my Diet Coke addiction.

I thought I loved the guy before, but this really sealed the deal.

Later in the term, Coca-Cola gifted him a six-pack of rhinestone-encrusted bottles and, given my weakness, one of them found its way to my desk.

We got about one or two more minutes of health care briefing before the NEC director and a couple others wandered in and started chit-chatting. He asked everyone if we wanted to take this party to the attached Map Room where the TV was and “watch Spicer.”

Yes, it was time for the daily press briefing by Press Secretary Sean Spicer, and the president loved seeing Sean mix it up with the hostiles.

We all sat around a conference table in the Map Room – of blue dress fame – and watched TV (a Samsung, reminding the president of the South Korean trade relationship, which diverted the conversation for a while).

And so it went for another hour or so and we never got back to health care.

That should have been my first clue.

Donald Trump, although extraordinary, is also totally normal in many ways.

And health policy makes normal people’s eyes glaze over. It’s way too convoluted and, when forced to focus on it, most people just get depressed and angry. Since the president doesn’t do depressed and angry, his cope was to change the subject.

It should have been a flashing red alert: “Danger! Danger! Voters will hate you for making them think about this!”

Understandably, they just want you to make it cheaper, like right now, and if you don’t, they’ll let you have it at the ballot box.

As the Reagan people used to say, “if you’re explaining, you’re losing.”

The second clue came a month later, at Mar-a-Lago

HHS Secretary Tom Price, MD, former US House Budget chairman – a lovely and affable man – got pushed out of office only a year in. The excuse was presumably because he flew too much on a government plane. This always seemed like a peccadillo that wouldn’t have taken anyone else out (at least not in a different administration). My theory is that he was the fall guy for our collective failure to get health care reform done. The president never got over it.

Anyway, speaking of that government plane…

The Secretary was summoned to Mar-a-Lago to have a health care meeting with the president and some of his top strategy advisors.

That meant I was summoned with him and we all jetted down on the (admittedly nice) plane, and took in the bright sun and gilded decor of the president’s over-the-top-beautiful coastal home.

At least for the five minutes we had to enjoy it going from the car to the meeting room and back.

Inside the ballroom, usually used for wedding receptions, were about a dozen people, including, if my memory serves, Stephen Miller, Jared Kushner — the president’s son-in-law, and Steve Bannon, lurking silently in the back of the room, as he customarily did.

They eagerly awaited the unveiling of the product of years of Congressional wrangling, conservative think-tanking and campaign promise-making.

This bill was supposed to deliver justice for all those Americans who hadn’t been able to keep their plan or their doctor if they liked them, and who were now being taxed for the privilege of being uninsured.

The Secretary launched into the complex repeal-and-replace plan, replete with acronyms, formulas, pay-fors and a bunch of other voodoo that fewer than two dozen people in Washington probably understood (not always clear if I was one of them, to be honest).

Immediately, the barrage of questions came. There was a robust discussion, and Secretary Price, unlike most principals at his level, was knowledgeable enough to answer questions without needing anyone else. But still, he got flustered as the political peril of the whole enterprise was exposed by the discussion.

You see, the “replace” bucket in all Republican proposals over the years – including this one – was never quite as generous as what was in the “repeal” bucket. By design.

At one point, Jared Kushner banged the table, announced, “this is bullshit” and left the room.

So, it wasn’t going well.

Again, normal people get depressed and angry when you make them focus on health policy. The president changed the subject. Jared stormed out of the room.

I don’t remember much else from that meeting. Jared’s understandable response to our hocus-pocus is seared in my memory as one of the defining moments of the entire repeal-and-replace process.

Probably because his one-word evaluation of the bill would be shared by the midterm voters.

If you’re explaining, you’re losing.

The third clue came from the White House communications team

We continued working with Congress on the bill, and the draft was repeatedly leaked, in every iteration, along the way.

As such, Democrats and the media (but I repeat myself) were in full attack mode.

The White House communications team, led by the heroic Sarah Huckabee Sanders (now Arkansas Governor, but who had then replaced Sean Spicer as Press Secretary), was treading water.

Because we hadn’t actually released the bill formally, no one had any communications products that are typically prepared to support a planned roll-out. So Sarah’s team was scrambling to respond to the hostile incoming without yet understanding all the details.

Eventually, though, they needed some reinforcements.

I was summoned to one of the regular meetings of a few dozen comms staffers in Sarah’s office. My charge was to explain to everyone what the bill did and why all the attacks were untrue or unfair.

I spent an hour in that interrogation, while the comms team kicked the tires on my messaging.

At the end of the hour, I had fast-talked my way through a zillion questions but the looks of continued confusion on the faces in the room are still as clear now as if it was yesterday.

This dog wouldn’t hunt. They knew it and they were starting to panic.

I realized it just took too many words, caveats, qualifiers, statistics, legal citations, and jargon to describe what the hell we were trying to do and why America was gonna love it.

If you’re explaining, you’re losing.

And I do mean losing.

That’s one of the reasons why I eventually fell in love with price transparency and other more populist reforms taking on the Bond villains in the health care industry.

“End secret prices” rolls off the tongue in a way that “restructure APTCs into an age-stratified, flat, refundable credit, and block-grant Medicaid with a CPI-indexed cap, while returning the expansion population FMAP to the ABCD threshold” just doesn’t.

It wasn’t over yet.

Next week: What happened when we ignored all these warning signs and pushed the bill through anyway.

Spoiler alert: We lost the House. And the argument.

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