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Why Trump supports health bill even many Republicans can't get behind

President Donald Trump
Nicholas Kamm | AFP | Getty Images
President Donald Trump

President Donald Trump keeps revealing he either doesn't know or doesn't care about how Republicans pass a health care bill — he just wants something done.

On Friday, after a week of campaigning for the Senate's health bill, Trump tweeted that he would also support just a clean Obamacare repeal bill now with a replace bill "at a later date," presumably being tipped off to idea after watching Sen. Ben Sasse (R-NE) float it on Fox & Friends.

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The Senate health bill — the Better Care Reconciliation Act of 2017 — which makes dramatic cuts to Medicaid and overhauls the program's structure, scales back Obamacare's subsidies for the individual insurance marketplaces, and slashes some of the taxes that almost entirely hit the wealthy, has already failed to gain enough support among Senate Republicans. It did have the stamp of approval from the president, however.

But then again, Trump also supported the House version of the health bill, which, while mirroring many of the Senate's goals, was far more conservative.

In its original form, the Senate health bill keeps much more of Obamacare's core structure than the House version did, making it inherently a more moderate bill — though it still makes massive cuts to Medicaid, a program that covers the nation's most vulnerable.

Conservative members of Congress have certainly noticed the difference, withholding support for the bill's passage. Needless to say a repeal-and-replace-later strategy, like the one Trump is now tweeting about, would move Republicans' health reform plans in a completely different direction, and would require Republicans to work with Democrats to replace the program. It also goes against what Trump said in January, promising that Obamacare would be repealed and replaced "essentially simultaneously."

Trump doesn't seem to have a policy preference: He has been in favor of every iteration of Congress's health bill plans — no matter how much or little it differs from the last version, or how much it breaks the many campaign promises he made last year.

Health care reform is a personal policy area for almost all Americans, and the president's blind support for "repealing Obamacare" has already put millions of lives at stake. But Trump just wants a political win — and badly.

Trump clearly doesn't care about the details

From the start, the White House had minimal policy demands on health care. They've just wanted Congress to pass something.

Let's go through the timeline:

  • House Leadership proposed the first health bill in early March. Trump was for it, tweeting that it was "wonderful."
  • When it was made apparent that conservatives wouldn't vote for the original House bill, Speaker Paul Ryan proposed an amendment that made harsher cuts to Medicaid and created a reserve fund for older Americans. Trump was for it then too — giving Republicans an ultimatum to vote for it.
  • Conservatives still wouldn't get behind the bill, negotiating even more reforms, moving the health bill even further to the right; Trump was for it.
  • The House's health care bill passed in the first week of May, and Trump celebrated with a party in the Rose Garden. "Make no mistake: This is a repeal and replace of Obamacare," he said then.
  • The Senate scrapped much of the House's health care bill. It proposed its own, which rolled back some of the conservative demands and reintroduced much of Obamacare's structure. Trump was, you guessed it, in support of the bill.
  • Sasse went on Fox & Friends and said Republicans should just pass a repeal bill now and replace later, if they fail to pass the health bill currently being negotiated. Trump tweeted in support of the idea, despite assuring the public that repeal and replace would be paired.

From the beginning of this process, Republican lawmakers said President Trump needed only two assurances to approve of a health bill: that premiums would go down and that people with preexisting conditions would be totally protected, Rep. Mark Meadows (R-NC) said.

In the eyes of most expert analysts, the House and Senate's bills don't even meet those minimal tests. The House took a step back from the cost protections provided to people with preexisting conditions under Obamacare, and the Senate bill could also roll back some of Obamacare's protections for those people.

Trump is selling the plans anyway. It doesn't matter that the bill has been ping-ponging between poles of the Republican Party, with proposals that could impact millions of Americans. Trump isn't sweating the details.

Trump wants to move on to tax reform

It's not that Trump has never outlined clear promises on health care.

As Vox's Matt Yglesias has pointed out, Trump has specifically spoken to particular health care programs, beyond just repealing Obamacare.

"I'm not going to cut Social Security like every other Republican and I'm not going to cut Medicare or Medicaid," Trump told the conservative Daily Signal in May 2015. "Every other Republican is going to cut, and even if they wouldn't, they don't know what to do because they don't know where the money is. I do."

Then he made an even bigger promise. "I am going to take care of everybody," he told 60 Minutes in September 2015. "I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."

But that was political rhetoric. Those promises have been broken — and it's clear Trump was not at all invested in making the case to protect Medicaid, which would see close to $880 billion cut from the program over the next 10 years (a number that was estimated for the House bill, but that should be close to the Senate's).

The word among Republican aides on Capitol Hill is that Trump is going to be more involved when it comes to tax reform.

Even Trump has let on that that's what he cares about more. In his Rose Garden speech in May celebrating the House's passage of the health care bill, he failed to speak to any of the specific provisions in the policy. Instead, he talked about the politics of party unity, and how this will free up Congress to move on to tax cuts:

This has really brought the Republican Party together, as much as we've come up with a really incredible health care plan. This has brought the Republican Party together. We're going to get this finished, and then we're going — as you know, we put our tax plan in, it's a massive tax cut, the biggest tax cut in the history of our country. I used to say the biggest since Ronald Reagan. Now, it's bigger than that. Also, pure tax reform. So we're going to get that done next.

Since health care reform became the Senate's responsibility, the White House has been remarkably quiet on that front.

Other than promising to repeal and replace Obamacare, Trump isn't communicating the same sense of urgency as he did with the House's health bill. As with every other iteration of Obamacare repeal, he's for it.

And he seems even willing to drop the "replace" part of the repeal-and-replace promise.

Commentary by Tara Golshan, a policy and politics writer at Vox. Follow her on Twitter @t_golshan.

For more insight from CNBC contributors, follow @CNBCopinion on Twitter.