WASHINGTON — The Trump administration’s surprise decision to press for a court-ordered demolition of the Affordable Care Act came after a heated meeting in the Oval Office on Monday, where the president’s acting chief of staff and others convinced him that he could do through the courts what he could not do through Congress: repeal his predecessor’s signature achievement.
Mick Mulvaney, the acting White House chief of staff and former South Carolina congressman, had spent years in the House saying that the health law should be repealed, and his handpicked head of the Domestic Policy Council, Joe Grogan, supported the idea of joining a Republican attorneys general lawsuit to invalidate the entire Affordable Care Act.
That suit, and the Justice Department, initially pressed to nullify only the part of the law that forces insurance companies to cover people with pre-existing medical conditions as well as a suite of health benefits deemed “essential,” such as pregnancy and maternal health, mental health and prescription drugs.
But a district judge in Texas ruled that the entire law was rendered unconstitutional when President Trump’s tax law brought the tax penalty for not having health insurance to zero, and the administration faced a choice: stick with its more limited intervention or back the judge’s decision.
Mr. Trump has boasted that he has kept his promises, Mr. Mulvaney and Mr. Grogan argued, and as a candidate he campaigned on repealing the health law. His base of voters would love it. Besides, they argued, Democrats have been campaigning successfully on health care, and Republicans should try to claim the issue for themselves. This could force the matter.
Among those with concerns was Pat Cipollone, the White House counsel, who shared that the new attorney general, William P. Barr, opposed such a move. Vice President Mike Pence was concerned about the political ramifications of moving ahead without a strategy or a plan to handle the millions who could be left suddenly uninsured if the suit succeeded.
But Mr. Trump had been sold, and on Monday night, the Justice Department issued a letter saying it supported the Texas judge’s decision.
The blowback has been severe. Representative Kevin McCarthy of California, the House Republican leader, who is close with Mr. Trump, had privately warned the president not to interrupt the “victory lap” he should be taking after the delivery of the report by the special counsel, Robert S. Mueller III. Mr. Mueller, according to a letter by Mr. Barr, found no criminal conspiracy between the Trump campaign and the Russian government.
The reaction was even more intense in the Senate. Senator Mitch McConnell of Kentucky, the majority leader, had planned to use the week to publicize his floor vote to force Democrats to take a stand on progressives’ Green New Deal — an important party-building exercise for Republicans after Mr. Trump’s decision to declare an emergency at the border sparked an insurrection in their ranks this month.
Members of Mr. McConnell’s leadership team were incensed at Mr. Mulvaney and allies like the acting White House budget director, Russell Vought, for rekindling a fight that served Democrats so well in 2018 and could harm vulnerable incumbents in 2020. The maneuver may make it much less likely that Mr. Vought, the chief of staff’s handpicked successor to head the Office of Management and Budget, will be confirmed by the Senate, according to two leadership aides with direct knowledge of the situation.
And Democrats pressed their advantage.
“The equivalent of a nuclear bomb fell on our country when the president said what he said this week,” Representative Anna G. Eshoo, Democrat of California, said Wednesday as her House subcommittee began pushing through health care legislation. “This is deadly serious.”
But Mr. Trump doubled down while talking to reporters in the Oval Office. He predicted that the Texas decision would be upheld by the appeals court, then go to the Supreme Court.
“If the Supreme Court rules that Obamacare is out, we’ll have a plan that is far better than Obamacare,” he said.
What happens if Obamacare is struck down? Read more
White House press aides did not immediately respond to a request for comment. And one official, who asked for anonymity to speak about the meetings, insisted that Mr. Mulvaney had simply been convening people with various views so that the president could make his own decision. But Mr. Mulvaney was described as leading the charge to back the suit, in an account of the two meetings that was described by a half-dozen people with knowledge of what took place.
Politico first reported that Mr. Mulvaney pushed Mr. Trump to get involved in the suit.
Mr. Barr did not favor the move but did not object to the White House decision once it had been made, people familiar with what took place said. And one White House official said the administration faced a deadline imposed by the court if it wanted to support the suit.
But the decision to thrust Mr. Trump’s administration so directly into the lawsuit caught several people inside the White House by surprise, and took the focus off what was arguably the best weekend of the Trump presidency.
Mr. Trump did not seem to care about shifting the political focus toward an issue that Democrats far preferred to the aftermath of the Mueller report. He charged ahead at a Senate Republican luncheon, telling reporters as he went in, “Let me just tell you exactly what my message is: The Republican Party will soon be known as the party of health care. You watch.”
But Republicans in Congress have no obvious road forward on legislation to replace the Affordable Care Act that could pass the Democrat-controlled House. And House leaders have little political incentive to bow to Republican wishes on health care, an issue that they believe delivered their House majority and that they are eager to campaign on in 2020.
The Trump administration has tried to minimize and contain the Affordable Care Act over time. The president has been in favor of previous efforts to end the law. And Mr. Mulvaney has over time built up his internal political capital, and grown his team of loyalists.
Mr. Mulvaney is the first ideological purist who has served as Mr. Trump’s chief of staff. His critics inside the West Wing say he has tilted the voices Mr. Trump hears in favor of those who will back his own views.
As Republicans pointed fingers, House Democrats began moving legislation on Wednesday to protect people with pre-existing conditions and to hold down the costs of health insurance and prescription drugs. Ms. Eshoo, the chairwoman of the House Energy and Commerce Subcommittee on Health, said the bills were needed to counter what she described as “a monstrous attack” on the health law by the Trump administration.
Several Republicans on the panel distanced themselves from the administration’s position.
“I’m not with the president on eliminating pre-existing conditions,” said Representative John Shimkus, Republican of Illinois. Republicans, he said, believe in protecting people with pre-existing conditions.
The subcommittee approved a bill that would provide $100 million a year for insurance counselors known as navigators who help consumers enroll in health insurance plans under the Affordable Care Act.
The Trump administration “has slashed, practically eliminated, funding for the navigators,” said Representative Kathy Castor, Democrat of Florida.
Several Republicans said insurance agents and brokers were enrolling more people at a lower cost than the navigators, so the additional money was not needed.
The panel also approved bills to outlaw two practices that have been used by brand-name drug companies to stifle competition and delay the sale of lower-cost generic medications.
One measure would prohibit makers of brand-name drugs from paying off generic companies to delay sale of the less expensive products. Banning such “pay for delay” arrangements could save consumers billions of dollars over a decade, economists say.
Another bill approved by the House panel would require brand-name drug companies to provide samples of their products to generic drug makers.
Generic drug developers need samples of brand-name drugs to show that a generic copy is equivalent to the original. Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, has called on the industry to “end the shenanigans” that prevent consumers from getting access to low-cost generic drugs.
The House panel also approved on a party-line vote a bill to provide federal money to states to help pay the largest health insurance claims. Democrats said such “reinsurance” programs would lower premiums, as shown by the experience of Minnesota, Alaska, Maryland and several other states. Republicans said they worried that federal funds would go to health plans that covered abortion.