Infighting, turf wars and a president more concerned with the stock market and media coverage than policy have defined the Trump White House. They have also defined how it has handled a pandemic.
Senior aides battling one another for turf, and advisers protecting their own standing. A president who is racked by indecision and quick to blame others and who views events through the lens of how the news media covers them. A pervasive distrust of career government professionals, and disregard for their recommendations. And a powerful son-in-law whom aides fear crossing, but who is among the few people the president trusts.
The culture that President Trump has fostered and abided by for more than three years in the White House has shaped his administration’s response to a deadly pandemic that is upending his presidency and the rest of the country, with dramatic changes to how Americans live their daily lives.
It explains how Mr. Trump could announce he was dismissing his acting chief of staff as the crisis grew more severe, creating even less clarity in an already fractured chain of command. And it was a major factor in the president’s reluctance to even acknowledge a looming crisis, for fear of rattling the financial markets that serve as his political weather vane.
“What begins every kind of mobilized response by the president — clear assignments and some sense that this is an absolute priority — none of that seemed to be a part of the president’s discussion,” said Kathleen Sebelius, who served as the health and human services secretary under President Barack Obama. “The agencies were kind of left to their own devices.”
Crises are treated as day-to-day public relations problems by Mr. Trump, who thinks ahead in short increments of time and early on in his presidency told aides to consider each day as an episode in a television show. The type of long-term planning required for an unpredictable crisis like a pandemic has brought into stark relief the difficulties that Mr. Trump was bound to face in a real crisis.
Mr. Trump has refused repeated warnings to rely on experts, or to neutralize some of the power held by his son-in-law, Jared Kushner, in favor of a traditional staff structure. He has rarely fully empowered people in the jobs they hold.
John F. Kelly, the second White House chief of staff under Mr. Trump, tried to change the president’s habits, limiting who could reach him and how many people he could solicit fringe information from. But Mr. Trump found ways to get around Mr. Kelly’s edicts, calling people on his cellphone and issuing orders he did not tell Mr. Kelly about.
“Part of this is President Trump being Donald J. Trump, the same guy he’s always been, and part of it is a government he has now molded in his image, rather than having a government as it has traditionally been, to serve the chief executive, and to serve the job of governing the country,” said David Lapan, a former spokesman for the Department of Homeland Security and the Pentagon, and a former aide of Mr. Kelly.
To his critics, it was only a matter of time before the president’s approach to governing would have severe consequences not only for him but also for the country at a time of crisis.
“In some ways, Trump has been one of the luckiest presidents in history, because that crisis didn’t come till his fourth year,” said Ron Klain, an adviser to former Vice President Joseph R. Biden Jr. and the so-called czar handling the response to the Ebola outbreak under President Barack Obama. “But it was inevitable, sadly, that it would come, and here it is.”
Without the dedicated pandemic team on the White House’s National Security Council, which was disbanded in 2018, the management of the government’s vast coronavirus response fell to Alex M. Azar II, a former drug executive and Mr. Trump’s health and human services secretary.
But almost as a matter of course Mr. Trump did not want to highlight the virus as a public health threat when it was developing in China in January. Concerned about rattling financial markets, he signaled to advisers that he wanted to play it down, seizing on a health expert’s belief that the coronavirus might follow traditional influenza patterns and weaken after April. He told members of his private club, Mar-a-Lago, and said publicly that any danger would pass by April 1.
As the threat of the coronavirus accelerated, Mr. Azar and a small group of health officials with decades of government experience, including Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, Dr. Robert Kadlec, the assistant health secretary for preparedness and response, and Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, began daily meetings on the sixth floor of health and human services’ Washington headquarters.
The group was officially designated as a 12-person “task force” in late January by the departing chief of staff, Mick Mulvaney, but personal disputes quickly sprang up as pressure grew from other agencies and departments to be involved.
Among the members of the task force, Dr. Fauci, an infectious disease expert who first became prominent explaining the AIDS epidemic to President Ronald Reagan, emerged as an effective spokesman who did not shrink from contradicting Mr. Trump.
But senior administration officials have criticized Mr. Azar for what they believe was a decision to leave key health figures off the task force early on, particularly Dr. Stephen Hahn, the F.D.A. commissioner and an accomplished oncologist, and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, the agency in charge of health care for tens of millions of older and poor Americans, absences the officials attributed to petty turf wars.
A health and human services official defended Mr. Azar, saying that the department included the Medicare agency and the F.D.A. in coronavirus meetings well before the two joined the task force.
Ms. Verma, who has feuded so intensely with Mr. Azar that it led to an intervention from Mr. Trump, was a top Indiana health official during Mr. Pence’s time as governor in the state, as was Dr. Jerome Adams, the surgeon general, another new member of the task force.
Joe Grogan, the White House Domestic Policy Council director who has feuded with Mr. Azar over drug policy, and Larry Kudlow, the president’s top economic adviser, have irritated some health officials over comments they made about the potential economic impacts of virus containment.
At one point early in the crisis, while the president was at the World Economic Forum in Davos, Switzerland, Mr. Grogan tried to consolidate coronavirus work within the Domestic Policy Council, which the National Security Council had taken the lead on at the White House, irking health officials.
At times the internal tensions have broken out in the open. In an Oval Office meeting last week, Mr. Trump was told that Dr. Redfield had told Politico reporters about a looming shortage in materials the C.D.C. uses to extract genetic material from patient samples.
After Mr. Trump asked about the supply problem, Mr. Azar turned to his C.D.C. chief and asked whether he was going to answer the president, according to three senior administration officials who heard about the testy exchange.
In an implicit rebuke of Dr. Redfield’s testing oversight, Mr. Azar announced on Friday that the assistant secretary for health, Adm. Brett P. Giroir, would oversee the federal government’s revived testing efforts, with Dr. Redfield and Dr. Hahn reporting up to him.
But Mr. Azar has hardly escaped Mr. Trump’s criticism. The president has complained about Mr. Azar’s television appearances, and prefers to see Ms. Verma, who has been jostling for a more prominent position on the task force, giving interviews, people familiar with the discussions said.
As the threat to the United States from the coronavirus became more acute, congressional Republicans urged Mr. Trump for a more aggressive response. Mr. Trump considered Chris Christie, the former New Jersey governor whom Mr. Kushner has repeatedly sought to block from the administration, and Dr. Scott Gottlieb, the former commissioner of the F.D.A., for a role as “czar,” but he turned to Mr. Pence.
The choice was initially denounced by the president’s critics, who thought Mr. Pence would simply affirm the president’s desire to play down the looming threat. But some of those critics and several governors grappling with virus outbreaks have changed their mind about Mr. Pence, who has given near-daily briefings and, they said, has become a reassuring presence even as Mr. Trump has intermittently tried to retake the stage.
Still, Mr. Pence has his own critics: At least one White House adviser privately urged people outside the administration to go on television and criticize Mr. Pence and his aides. But Mr. Pence tried to navigate the internal dynamics. And then Mr. Kushner stepped in.
Mr. Kushner’s early involvement with dealing with the virus was in advising the president that the media’s coverage exaggerated the threat. But when Mr. Pence’s chief of staff asked him to help merge the Pence and Trump communications operations because the two-person shop in the vice president’s office found itself overwhelmed and trying to keep up, Mr. Kushner, long critical of the White House communications shop, tried to supplement the vice president’s team with other aides. One of them was Hope Hicks, the former White House communications director, who recently rejoined the administration as Mr. Kushner’s aide.
But Mr. Kushner also sought to take on a more expansive role for himself despite his lack of knowledge on the topic and without talking to most of the task force members or public health experts.
Mr. Kushner’s involvement has also introduced a new but familiar face at the Department of Health and Human Services: Adam Boehler, a close friend of Mr. Kushner, a former Centers for Medicare and Medicaid Services employee and the head of the U.S. International Development Finance Corporation. Mr. Kushner dispatched Mr. Boehler to work with the department in its renewed efforts to increase testing, a move that Mr. Azar told associates he welcomed.
Mr. Kushner’s influence was immediately felt. He urged his father-in-law to go ahead with a ban on some travel from Europe and to declare a national emergency, after Mr. Trump had dithered and second-guessed himself for agreeing to it. He got executives at several pharmaceutical corporations to agree to help with mobilized testing efforts, and has pushed for an increase in medical supplies to hospitals.
But after Mr. Trump delivered an error-ridden Oval Office address last week, the president followed it with an appearance Friday in the Rose Garden in which he said Google had developed a coronavirus testing website that did not exist. Mr. Kushner was deeply involved in both efforts, and had sold his father-in-law on the website as a smart concept.
By Sunday evening, Mr. Trump was raging to aides that the press coverage was terrible after the promised national website failed to materialize. And on Monday, after Mr. Pence had been praised for his calm demeanor, Mr. Trump decided to answer questions from reporters himself.
“They’re working hand in hand,” Mr. Trump said in a White House news conference, flanked by members of the task force. “I think they’re doing really a great job.”
As for his own performance during the crisis? “I’d rate it a 10,” Mr. Trump said.
GOP opponents to Senate health-care bill see vote delay as an advantage
A vocal conservative opponent of the measure, Sen. Rand Paul, predicted the delay would strengthen critics’ position by giving them more time to mobilize against the bill.
“The longer the bill is out there, the more conservative Republicans are going to discover it is not repeal,” Paul (R-Ky.) said Sunday in an interview with CBS’s “Face the Nation.”
Paul said he spoke with Trump on Friday and suggested the president support repealing the Affordable Care Act and deciding the details of a replacement plan later if the latest version of the bill does not pass.
.. Trump administration officials failed to gain support from influential Republicans such as Nevada Gov. Brian Sandoval (R). Opposition from Sandoval and others will make it easier for undecided Republican senators from those states to vote “no” on the bill, potentially further endangering its prospects.
.. (63 percent) believes it is more important for the government to provide health coverage to low-income people compared with cutting taxes (27 percent). Among Republicans, 48 percent favored cutting taxes, compared with 39 percent who favored providing health coverage for low-income people.
.. “President Trump and I believe the Senate health-care bill strengthens and secures Medicaid for the neediest in our society,” Pence said
.. Collins strongly disagreed in an interview Sunday with CNN.
“You can’t take more than $700 billion out of the Medicaid program and not think that it’s going to have some kind of effect,” she said during an appearance on “State of the Union.”
.. “This bill imposes fundamental, sweeping changes in the Medicaid program, and those include very deep cuts that would affect some of the most vulnerable people in our society, including disabled children and poor seniors. It would affect our rural hospitals and our nursing homes, and they would have a very hard time even staying in existence.”
.. Pence’s speech was criticized by Democrats, health-care advocates and even some Republicans for mischaracterizing the possible ramifications of the GOP bill.
.. During the same speech, the vice president went after Ohio Gov. John Kasich (R), a critic of the legislation, by suggesting his state’s expansion of Medicaid left nearly 60,000 residents with disabilities “stuck on waiting lists, leaving them without the care they need for months or even years.”
The claim alienated many at the meeting, partly because waiting lists for Medicaid’s home- and community-based services were not affected by the program’s expansion under the ACA, and partly because many interpreted Pence’s remark as an overly aggressive shot at Kasich. The Ohio governor’s stance against the bill could shape the position of Sen. Rob Portman (R-Ohio), a pivotal vote for Republicans who is undecided on the current version. Some fear Pence missed an opportunity to woo Portman with his remark against Kasich.
.. Collins estimated Sunday that there are eight to 10 Republican senators with “serious concerns”
.. Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, worked to undermine that report and a forthcoming analysis by the Congressional Budget Office showing the legislation’s cost and insurance impact.
.. The Avalere study projected marked reductions in federal Medicaid funding to all 50 states, ranging from 27 percent to 39 percent by 2036.