Elements of Donald Trump's political posture on health care have changed in ways that were difficult to predict as recently as a few years ago. In fact, the president didn't use the word "Obamacare" at any point in his interminably long Republican convention speech last week -- and neither did any GOP elected official during the entire four-day affair.
As dramatic a departure as this is, there's an obvious explanation for the rhetorical shift: despite a hysterical crusade that's lasted much of the decade, the Affordable Care Act is both effective and increasingly supported by public. Late last week, the Kaiser Family Foundation published a report on the latest polling and concluded, "Opposition to Obamacare Becomes Political Liability for GOP Incumbents."
But to see this and assume that the president and Republican Party have quietly moved on from the issue would be wildly overstating matters. Trump and the GOP are, of course, still trying to destroy the Affordable Care Act in its entirety at the U.S. Supreme Court, with a case that will be heard the week after Election Day.
And then there's the president himself, who's facing an awkward deadline of his own making today.
Circling back to our earlier coverage, it was on July 17 when Trump sat down with Fox News' Chris Wallace, and the host asked about the president's ongoing efforts to tear down the ACA. The president replied that he still intends to "replace" the landmark health care law.
The host reminded Trump, "But you've been in office three and a half years, you don't have a plan." It was at this point that the president responded with an unexpected vow: Trump said he'd "sign" a "full and complete" health care plan "within two weeks."
As we've discussed, two weeks went by, and the "full and complete" health care plan was nowhere to be found. On July 31, pressed for some kind of explanation, the president told reporters, "We're going to be doing a very inclusive health care plan. I'll be signing it sometime very soon. It might be Sunday [Aug. 2], but it's going to be very soon." (He added earlier in the day that the upcoming White House health care plan will be "very big.")
Two days later, the Republican went golfing. He did not unveil or sign a health care plan. On Aug. 3, Trump presented a new timeline.
"I do want to say that we're going to be introducing a tremendous healthcare plan sometime prior -- hopefully, prior to the end of the month. It's just about completed now."
The president added that the new health care plan "will be very impressive to a lot of people."
I predicted at the time that Trump would neither unveil nor sign an "impressive" health care plan by the end of the month -- and the end of the month is today.
To be sure, there are still 14 hours left before the end of the month, and perhaps the president will surprise me, but I have a hunch my prediction will hold up.
Trump has spent more than four years assuring Americans that he and his team, any day now, will unveil an amazing health care plan that will offer more coverage at a lower cost. It's a promise that always goes unmet.
There's no great mystery as to why: the president, his team, and his party have absolutely no idea how to govern in the area of health care policy. (See chapter three of my book.) GOP officials have been promising a superior alternative to the Affordable Care Act since the summer of 2009 -- well over a decade ago -- and they've failed spectacularly because they don't know how to craft such a blueprint. It would require some form of federal investments and regulation of the marketplace, both of which the party rejects for ideological reasons.
Hating "Obamacare" is not a health care plan. Once Republican policymakers come to grips with this simple detail, they can either give up trying to take health security from tens of millions of Americans or they can roll up their sleeves and try to govern on the issue.
Either way, those waiting to see what Trump unveils are waiting for a mirage that will always remain on the horizon.