Just about every major health care group opposes President Donald Trump’s health care overhaul — and the self-styled negotiator-in-chief hasn’t tried cutting a deal with them.

The opposition from the deep-pocketed health care industry — and patient advocacy groups from the American Heart Association to the March of Dimes — has made it hard for Republicans to push Obamacare repeal through the House. And they could be a persistent obstacle if the legislation makes it to the Senate.


“A bill that’s completely opposed by the whole health care establishment is very, very difficult to pass,” said John Rother, who was AARP’s top lobbyist for more than two decades.

Hospitals and doctors are actively engaged in efforts to kill Trump’s plan, fearful that its severe cuts to Medicaid and insurance subsidies will wreak havoc on their bottom lines. Patient advocates object to again allowing insurers to charge sick people more. Notably, insurers are largely avoiding this battle, focusing instead on pressuring Republicans to keep paying out Obamacare subsidies.

Trump hasn’t made a serious effort to court any of these groups, potentially depriving himself of key allies who could have helped convert skeptical lawmakers and the American public. As the repeal effort has dragged on way longer than congressional leaders anticipated, polls have found little support for the GOP bill while Obamacare’s popularity has reached new heights.

Though Trump this week has dialed up reluctant Republican lawmakers on the repeal bill, his hands-off approach to the health care industry is a far cry from the Obama administration’s concerted effort to win over the groups as Obamacare was drafted. The Obama White House wound up cutting deals with every part of the health care industry — insurance companies, doctors groups, hospitals and the pharmaceutical industry — to get the Affordable Care Act passed in 2010. Though Republicans panned those deals as giveaways, and they even made some Democrats uncomfortable, they were key to holding the Obamacare coalition together all these years.

“Every single health care group was deeply invested in the [ACA],” Rother said. “It couldn’t be more opposite today.”

Those dynamics have left Republicans isolated amid the push for their first legislative victory of the Trump era. And recent changes to the House legislation meant to entice reluctant GOP moderates has only deepened the industry’s resolve.

“It’s worse. We hate it,” Illinois Health and Hospital Association spokesman Danny Chun said about the latest tweaks. “We’re still opposing it, and we’re again contacting our delegation, especially the Republicans: Do not support it when it hits the floor.”

It wasn’t long ago, however, that the health care industry wanted to help shape the GOP overhaul. In the wake of the GOP’s surprise sweep into power last November, major lobbying groups initially decided not to stand in the way of Obamacare repeal, seeing it as a foregone conclusion.

Hospital lobbyists quietly hoped to build on Obamacare’s coverage gains while reversing the health care law’s payment cuts to providers. Insurers pressed the incoming Trump administration for major regulatory changes aimed at stabilizing the wobbly Obamacare markets.

But that outreach yielded few returns. They say the White House and congressional Republicans showed little interest in calling on interest groups deeply invested in the health care system. Some groups have given up on working with House lawmakers altogether, and in some cases, early hopes that Senate Republicans will be more receptive have diminished in recent weeks.

“Stakeholders weren’t brought in to kind of troubleshoot some of the problem areas of the bill,” said Betsy Ryan, CEO of the New Jersey Hospital Association. “Hence, the almost uniform opposition.”

Morning eHealth A daily report on the intersection of health care and technology — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Provider groups are worried that the GOP is jamming through policy with little understanding of its implications, according to several lobbyists charged with establishing ties to the party. That’s pushed providers to the front lines of the effort to kill Republicans’ repeal bid, issuing dire warnings about the bill’s potential to leave millions more uninsured and cut crucial funding to health care facilities.

On the Hill, some Republicans acknowledge hesitation about working with groups that actively supported Obamacare, including the American Hospital Association and the American Medical Association.

“For some, there’s a little bit of suspicion about those organizations,” said Sen. Bill Cassidy (R-La).

There’s almost as little enthusiasm for Republicans’ repeal bill coming from the other corners of the health care industry. Insurers are busy with another pressing issue: whether the Trump administration will abruptly scrap crucial Obamacare cost-sharing subsidies worth about $7 billion this year. While they have major concerns about the GOP repeal bill, especially its nearly $900 billion cut to Medicaid, those are on the back burner as they press for subsidies.

“We have to have [the subsidies],” said Brad Wilson, CEO of Blue Cross and Blue Shield of North Carolina. “Clarity around what that means is absolutely critical.”

Trump has hinted he could nix the payments — which would likely collapse the Obamacare exchanges — to bring Democrats to the negotiating table on health care. But that would carry huge political risk for Republicans, with polls showing the public would blame them if the insurance markets implode and millions lose coverage.

“That’s the doomsday scenario that we’re all trying to avoid,” Wilson said.

Mario Molina, the recently ousted CEO of Molina Healthcare, said in an interview Wednesday that other health plans would like to return to the pre-Obamacare landscape.

“They don’t like the health insurance tax, and they would like to return to a time when they could exclude people with pre-existing conditions,” Molina said. “For them, it would be a good thing to go back to the old way of doing things.”

He said health plans have generally stayed quiet, concerned an aggressive stance could antagonize the Trump administration.

Meanwhile, the drug industry, which was the first to cut a deal with the Obama administration on health care, is laying low. While drugmakers were desperate to avoid major Democratic reforms to their industry eight years ago, they have relatively little to lose in the repeal fight. However, they would be happy to see Obamacare’s tax on branded drug sales scrapped in the repeal bill.

Drugmakers — already facing plenty of scrutiny over high-cost treatments — would like to avoid unnecessary attention. Trump says lowering drug prices is a priority, and the issue is likely to surface later this year in other must-pass health care legislation.

Drugmakers “do not want to open a second battle front when they already are fighting the drug pricing issue,” said Chris Meekins, a health policy analyst for investment bank FBR.