After weeks of staying on the sidelines of the Senate's Obamacare reform talks, President Trump dived into the debate this week with a characteristic mix of disciplined negotiating tactics and off-message detours.
Trump's increased role in promoting the healthcare legislation came as Senate Majority Leader Mitch McConnell headed into a weeklong recess with his caucus fractured and the fate of his Obamacare repeal measure uncertain.
But the president's personal involvement has not come without its disruptions. Trump rankled GOP leadership Friday when he tweeted support for a healthcare strategy that would involve repealing Obamacare immediately and replacing it later with a new system — an approach he had personally criticized in the past and one that is favored only by the most conservative members of Congress.
"Senate Republicans recognize that this a put-up or shut-up moment, and yet they are still gripped by inaction and are unable to do their job," said Ford O'Connell, a GOP strategist. "So, frankly, President Trump attempting to provide them cover to pass anything possible is certainly a welcome development."
O'Connell suggested the Republicans' inability to agree on a piece of legislation this week despite a full-court press from the Trump administration could demonstrate just how sharply the GOP is divided on healthcare.
"The fact that Senate Republicans are still not able to reach a verbal consensus shows the limits of White House power and how deep the rift is on this issue within the GOP Senate caucus," he said.
Trump began his efforts to help McConnell scrape together the 50 votes necessary to pass the Better Care Reconciliation Act last weekend by calling a handful of Republican senators who expressed doubts about the bill shortly after its release.
After McConnell delayed a planned procedural vote on the measure amid wavering GOP support, Trump invited all 52 members of the Republican caucus to the White House on Tuesday and conducted what was later described as a productive meeting about the need to move forward on an Obamacare repeal plan.
And, by Wednesday, Trump was projecting optimism that his party would soon deliver a "big surprise" on healthcare.
Officials in the cabinet and West Wing worked behind the scenes this week to supplement the president's public promotion. Trump dispatched White House chief of staff Reince Priebus and press secretary Sean Spicer to Capitol Hill on Wednesday to build support for the healthcare bill.
Health and Human Services Secretary Tom Price hosted a "listening session" for people affected by Obamacare in Utah and traveled to Dallas for another healthcare "listening session" with doctors on Monday, and he placed a pair of op-eds that the White House later promoted.
Just as he did when a similar Obamacare repeal plan was working its way through the House, Vice President Mike Pence has played a particularly active role in promoting the Senate's healthcare bill publicly and cobbling together support for it privately.
On Monday, Pence and Centers for Medicare and Medicaid Services Administrator Seema Verma hosted a "listening session" at the White House complex with "victims of Obamacare" — many of them from Missouri, where major insurer Blue Cross Blue Shield recently exited the individual market and left thousands of people facing the possibility of having zero coverage options in 2018.
Pence journeyed to Capitol Hill Tuesday for the weekly Senate Republican lunch and hosted a handful of GOP lawmakers at his home later that evening for dinner, where the group was expected to discuss the healthcare legislation.
On Wednesday, Pence traveled to Cleveland, where he toured a manufacturing plant and delivered a speech aimed at selling the bill in a state where the Republican senator stands opposed to the GOP plan as it is written. Ohio Sen. Rob Portman has expressed concern about the legislation's cuts to the growth of Medicaid.
Pence returned to the Capitol on Thursday for meetings with skeptical Republicans — including Sens. Ted Cruz, Susan Collins and Shelley Moore Capito — and held talks with McConnell, which he documented on his Twitter feed.
But the Trump administration's efforts may not be enough to persuade seven of the nine Republican senators who oppose the bill to support it. With objectors ranging from centrists who see the legislation's cuts as too dramatic to conservatives who fear the bill leaves too much of Obamacare's regulatory framework intact, McConnell could struggle to reconcile the diverse concerns coming out of his caucus.
And Trump's journey off script on Friday could further complicate the negotiations.
Kentucky Sen. Rand Paul, a conservative critic of the bill whose vote is seen as one of the most difficult to win over in the Obamacare reform fight, quickly agreed with Trump's suggestion that Republicans should cleanly repeal the Affordable Care Act before setting to work on a replacement. While few others rushed to affirm or condemn the president's tweet, the mere mention of the conservatives' preferred approach to healthcare from the president could empower other opponents of the BCRA to resist McConnell's efforts at winning them over in the hopes that Trump would support a delay between the repeal and the replacement of Obamacare.