his acute sensitivity to being overshadowed. Ken Blackwell, who ran the domestic policy wing of Pence’s transition team, put it this way in early 2017: “Mike Pence has a very full and complex portfolio in his briefcase. And he has to carry it like there’s a bottle of nitroglycerin inside.”
Pence had spent the final days of March coaxing the president in private conversations. The vice president explained to Trump, ever so gingerly, that while he didn’t want to second-guess his decision to move on from health care, it would hurt him politically. Republicans on the Hill, Pence said, would be eager to negotiate after the backlash from their constituents. He asked for permission to spearhead a new repeal-and-replace effort. And he assured the president, in so doing, of the myriad benefits it would have for him.
Pence had learned the same lesson as Ryan: Trump responds to what’s good for Trump.
With the president’s blessing, Pence met with warring factions of the House GOP—the Freedom Caucus and the moderate “Tuesday Group”—to pitch them on his proposal. It would allow states to opt out of certain Obamacare requirements. The debate over what insurance plans would be required to offer had been a sticking point in past negotiations, and Pence’s idea was a waiver to give states flexibility.
Both sides expressed interest. Pence’s office drafted language, and he got busy selling it to both tribes—first, Mark Meadows and his Freedom Caucus, and then, in a separate meeting, to New Jersey congressman Tom MacArthur, the leader of the Tuesday Group. After a joint gathering to iron out details, Pence had one request: He asked them to stop referring to the idea as the “Pence amendment.” He didn’t want or need any recognition.
Sure enough, the compromise on state-based waivers became known as the “MacArthur amendment,” and it led to the House of Representatives passing the American Health Care Act on May 4. Trump was ecstatic. Calling Ryan to congratulate him, the president told the Speaker, “Paul, you’re not a Boy Scout anymore. Not in my book.”
Ryan was taken aback, finally realizing that it had never been a term of endearment to begin with. “It’s like a dupe, a stupid person,” Ryan says, rolling his eyes. “Boy Scouts are stupid because they don’t cut corners, they’re not lethal, they’re not killers.”
The mood was festive in the Rose Garden a few hours later as House Republicans assembled behind the president for a celebratory press conference. Rarely had Trump seemed to enjoy his new job. But that afternoon, with the smell of his first significant presidential victory wafting through the springtime air, was an exception.
“How am I doing? Am I doing okay?” he said, laughing. “I’m president. Heh! Hey, I’m president!”
Pence kicked off the victory lap, which lasted nearly forty minutes and included speeches from no fewer than ten people, with a simple message. “Welcome to the beginning of the end of Obamacare,” the vice president declared.
It was a tad premature.
ALMOST IMMEDIATELY, REPUBLICAN SENATORS SIGNALED THEIR OPPOSITION to the House legislation. Mitch McConnell announced that he and his colleagues would devise their own health care bill, with the aim of merging it with the House version in a conference committee down the road. Trump was mystified by this. The intricacies of the legislative process and the complexities of the interchamber relationship—any aspect of governance that did not fit neatly into a tabloid headline, really—did not interest him. All he knew was that House Republicans had finally passed a bill repealing Obamacare, and now his advisers were telling him it wasn’t good enough for Senate Republicans. No wonder everyone hates Congress, the president groaned.
McConnell hadn’t invested much energy in the anti-Obamacare effort up until that point. For one thing, privately, he saw the benefits of the Affordable Care Action back home in Kentucky. The uninsured rate there had plummeted over the past six years thanks to the law’s Medicaid expansion, a provision that had become enormously popular in the deep-red state.1 The success stories in Kentucky were so plentiful that the new governor, Republican Matt Bevin, decided to leave the state’s Obamacare-driven Medicaid program alone after promising its demise as a candidate.
More to the point, McConnell had believed it was highly unlikely that House Republicans would pass a bill. There was no point driving into a legislative cul-de-sac, he told colleagues, when there were dozens of federal judicial vacancies in front of them waiting to be filled. When the House version passed, and Trump relayed his displeasure to McConnell at not