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Trump Has No Good Options On Health Care

UPDATE (March 23, 8:43 p.m.): Late on Thursday, Budget Director Mick Mulvaney told reporters that Trump is demanding the House vote on the GOP health care bill on Friday. Mulvaney also said that if the bill doesn’t pass, Trump will move on to other issues. We’re not sure if this is a call, fold or a raise — it’s sort of a combination of all three. But it underscores that Trump is in a tough position.


Sometimes in a poker hand, you find yourself with no good choices. You’ve invested a lot of money in the pot. But then your opponent unexpectedly makes a large bet and you have a marginal hand. Your options — folding, calling and reraising (as a bluff) — are all money-losing plays.1 But you have to pick one of them, and it’s a matter of finding the least-worst outcome. It’s the situation every poker player hates the most.

President Trump finds himself in a similar predicament on health care, now that GOP leaders have announced they’re delaying a vote on the House GOP’s bill to repeal and replace Obamacare and seemingly have no clear plan to secure the votes for passage. Trump has a series of bad options for how to proceed:

  • Trump could fold. This would involve making some public declaration that the Republicans needed to go back to the drawing board on health care or move on to other priorities. While this might allow Trump to save some face, it would nevertheless be a costly play. He’d concede defeat on one of his signature priorities, his reputation as a dealmaker would take a hit, and The House Freedom Caucus would feel as though they had a notch in their belt. It would be embarrassing — and if the past is any guide, Trump wouldn’t handle his embarrassment very well.
  • Trump could raise, going “all-in” on the bill and doing everything he could to secure passage. This would probably involve making further compromises with the House Freedom Caucus — pushing the bill further to the right and perhaps making it even less popular — and then threatening moderate Republicans who dared to defect from the bill. It just might work to get the bill across the finish line in the House. Then again, it might not, and Trump would have wasted more political capital without getting anywhere. Or the bill could pass the House and then die in the Senate, putting House Republicans in a position where they’d taken a roll call vote on an extremely unpopular bill and had nothing to show for it. Or perhaps the bill eventually would pass the Senate and become law, only for Republicans to discover that the public wasn’t bluffing when they told pollsters that they hated the bill, hurting Trump’s approval rating and costing Republicans dozens of seats at the midterms. Republicans might face another round of political backlash, furthermore, once millions of Americans discovered they were no longer able to afford their health insurance or their policies didn’t cover as much as they used to.
  • Finally, Trump could call — which would mean distancing himself from the bill without a clear plan for what came next. He wouldn’t officially declare the Republicans’ health care efforts dead; in fact, he and Press Secretary Sean Spicer would stubbornly resist the “FAKE NEWS” narrative that the bill had failed. But he’d largely stop lobbying Republicans on behalf of the bill, instead telling House Speaker Paul Ryan to figure things out for himself. The risks here are obvious enough. Trump — who remains popular with rank-and-file GOP voters and members of Congress — is the best salesmen Republicans have. Without his working on its behalf, the GOP bill would probably become even more unpopular. But Ryan might not have an exit strategy and relations between the White House and Capitol Hill could fray. The whole process could play out for months, exerting a continuous drag on Trump’s popularity, as the Democrats’ health care bill did to President Obama.

What play should Trump make? If he took my advice (he doesn’t), he’d probably fold, declaring that the GOP’s bill hadn’t kept the promises he made to voters. He’d ask Congress to start over on the health care bill, moving along to tax reform in the meantime. Perhaps he’d pass some incremental health care bill later on, just as Bill Clinton eventually passed SCHIP (although not until four years later) as a consolation prize for his own failed health care program in 1993. As I said, however, folding would hardly be a risk-free alternative and conceding a loss would be out of character for Trump.

Here’s the thing, though, about a poker player — or a president — who finds themselves in this situation. It’s usually their own damned fault.2 In poker, being in a no-win situation is often the result of playing a hand you should have folded to begin with or otherwise having misplayed it earlier on.

Trump, and Republicans, have likewise made a lot of mistakes on health care. They didn’t lock down key constituencies before they rolled the bill out, leading to it being attacked from every angle — from the right wing of the GOP, from moderates and from conservative policy experts — upon its debut earlier this month. Instead of taking a populist approach, they adopted a bill with many provisions that were likely to be unpopular and no clear strategy for selling it to the public. They ignored the lessons that Obama and Clinton had learned from their struggles to pass a health care bill. They’ve tried to rush the bill through at a time when the White House faces a lot of competing priorities and distractions. They adopted a bill that predictably got a miserable score from the Congressional Budget Office. And for years, they’ve made all sorts of promises to voters on health care that they knew they couldn’t keep.

Health care policy isn’t easy even under the best conditions. But Trump has misplayed his hand from the start.


  1. Relative to if you’d never played the hand in the first place.

  2. At least in part.

Nate Silver founded and was the editor in chief of FiveThirtyEight.