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When the GOP’s proposed overhaul of the nation’s health-care laws was near death in the House in March, President Trump rallied 10,000 supporters in downtown Nashville and reassured his party’s base.

“It’s going to be fine,” Trump told the audience about 25 minutes into his speech. “We’re going to all get together. We’re going to get something done.”

But in the four months since, Trump has done relatively little to make it happen. The president has treated health care and a host of other legislative agenda items, from taxes to infrastructure, as issues to be hammered out by lawmakers with often-scant direction from the executive branch — and with decidedly mixed signals from Trump himself. 

Trump’s sporadic salesmanship on the bills and ambitions lingering on Capitol Hill has become a defining characteristic of the complicated relationship between the president and congressional Republicans. Although Trump routinely proclaims his desire for political victories, he has yet to make a full-throated case to the country about legislation that Congress is pursuing and has spent a modest amount of time attempting to twist arms in the House or Senate.

The White House on Friday launched a forceful push on health care at the National Governors Association meeting, but Trump himself was not involved and it was not clear how many minds the effort might change.

Trump — who relished his ability on the campaign trail to capture the public imagination and use his bully pulpit — more frequently plays the role of partisan cheerleader or frustrated onlooker from the White House. Executive actions, foreign policy flare-ups and the probes into Russian election interference have commanded much more of his time.

Several Republicans staffers said privately this week that they wish Trump would hold more rallies and other events aimed at bolstering Republican leaders’ efforts to advance health-care legislation and other key priorities. Instead, Trump has remained largely aloof save for stray remarks — such as his tweet calling for a straight repeal of the Affordable Care Act — that have only made cobbling together votes harder.

“For us to pass difficult things, we need Donald Trump to be fully engaged and to be pushing this with individual members and senators in their states,” said Doug Heye, a former senior House Republican aide. 

Others shrug off his hands-off style as classic Trump.

“He’s like a CEO rather than a traditional president,” Rep. Peter T. King (R-N.Y.), a Trump supporter, said in an interview. “It’s somewhat more detached, sure. What he wants to do is set the target and let others figure it out.”

The president did engage personally on health care earlier in the year, courting groups of lawmakers in the Oval Office and making rounds of calls, eventually claiming partial credit when a version of the legislation passed the House. But those overtures to reticent lawmakers over Diet Cokes have largely faded as Senate Republicans have labored to pass their version of the bill, long the party’s signature pledge to its base.

Trump, who has ventured west of the Mississippi River only once as president, has barely mentioned health care on his few stops outside Washington and his golf properties in Florida and New Jersey. He has done little beyond tweeting to rally his base in support of the plan and has not stepped foot in the state of a Republican lawmaker who might be needed to pass the bill in the Senate.

At his most recent political rally — in Cedar Rapids, Iowa, in late June — he made just a few scattered references to the issue.

“I think health care’s going to happen,” Trump said. “You’re going to have a lot of exciting things over the next few months.”

Republican aides credit Health and Human Services Secretary Tom Price, Vice President Pence and legislative advisers at the White House with having more prominent, constructive roles in the talks.

A person familiar with the White House-Congress relationship said that House Speaker Paul D. Ryan (R-Wis.) and Trump used to speak nearly daily on the phone when the House was mired in debating its health bill but that the calls have scaled back since it passed. Pence keeps in closer touch and was in Ryan’s office Tuesday, talking through upcoming legislation. 

Given the durability of the support for Trump among his populist coalition, many lawmakers are disappointed that he has not done more to give them political cover in their home states, especially as they prepare to meet voters during the late-August recess who are concerned over the legislation’s rollback of Medicaid.

“I think rallying public support is something that you really haven’t seen,” said one senior House Republican aide who requested anonymity to speak candidly. “You don’t have a lot of Trump supporters calling into Congress clamoring for repealing and replacing Obamacare.”

“It’s not putting the heat on our members — the outside heat from their constituents — that would probably be helpful,” the aide added.

Instead, Trump has been issuing infrequent ultimatums. “I am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,” Trump told the Christian Broadcasting Network in an interview this week, when asked about the health-care bill.

“He’s got to pull it off. Mitch has to pull it off,” Trump said, referencing Senate Majority Leader Mitch McConnell (R-Ky.).

Trump’s method is starkly different from many previous presidents who have sought to usher their high-profile aims through Congress and drive negotiations early in their first terms.

President Barack Obama delegated aspects of his health-care plan to Hill leaders, but he and his staff kept a tight grip over the proceedings and held numerous events across the country. President George W. Bush led the Republican effort to cut taxes in 2001, while President Bill Clinton’s White House spearheaded a sweeping health-care push two decades ago, although it failed to pass.

Trump associates said that he may be different but that, in a deeply divided Republican Party and in a Senate where McConnell struggles to find agreement, there is only so much he can do.

“ ‘This is their baby,’ ” Sen. Rand Paul (R-Ky.), who is friendly with Trump, said in an interview, describing Trump’s outlook on health care. “If we can’t get it done, I fully expect him to step into the fray.”

White House aides have promised for months that Trump would begin to actively work on selling the bill outside Washington but have retreated on those vows more recently.

Marc Short, the White House director of legislative affairs, said Trump has “remained engaged” in the Senate process, including making calls to senators from Paris on Thursday. The White House was also to devote Trump’s weekly radio address to the issue Friday. But Short acknowledged that the president’s travel schedule has not reflected a significant drive on health care, as officials had said it would.

“I think the president has been using the bully pulpit,” Short said. “The left clearly has been organized in their communications effort against the bill, and collectively Republicans have not messaged the benefits of the bill effectively.” 

“There’s been conversations about potential travel and for whatever reason or another there have been other priorities or crises that have occurred,” he added.

Yet Trump has proved that when he does weigh in, he risks upsetting the Republican leadership’s carefully balanced apple cart — at times contradicting his own aides and the strategy his administration agreed upon with House and Senate leadership earlier in the year, which was to begin with health care and use that as a starting point for broader legislation on tax policy. In one example last month, Trump angered many lawmakers by saying in a private meeting that the House legislation was too “mean” — just weeks after celebrating the legislation’s passage at the White House.

Trump’s staffers are regularly reticent to comment publicly or privately about the administration’s position on a number of health-care-related issues. In large part, they worry that Trump will almost immediately undercut them with his own words or tweets. 

He did just that in late June, tweeting out of the blue that Republicans should abandon their efforts to replace the Affordable Care Act if the current effort in the Senate fails. 

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump declared. 

On Capitol Hill, the comments produced a collective yawn. McConnell told reporters in Kentucky that “we are going to stick with that path,” nodding to his ongoing pursuit of passing a Senate GOP revision of the House’s passed bill. And administration aides at the Department of Health and Human Services had already told lawmakers that such a proposal was off the table. House and Senate Republicans had briefly considered the idea in February but rejected it as unworkable.

“That definitely didn’t result from any policy discussions,” said a Republican close to the White House who also requested anonymity to speak candidly. “It’s not that his aides lack confidence in knowing what he wants, but what he wants today and what he wants tomorrow are not going to be the same thing.”

Meanwhile, Trump shows no signs that he will launch a rally tour to push the issue or make a daily clamor for various policy planks on health care, as Obama did in 2009 and Clinton did in 1993 and 1994. His rallies, when they have happened, have remained rambling Trump spectacles with no focused message.

Paul, however, dismissed the suggestion that Trump could be doing more arena stops or other events to support congressional Republicans. 

“Oh, I hear that, that not enough is being done, but I see the glass as half full, not empty,” Paul said. “We’ve done a whole lot — repealing regulations, getting [Supreme Court Justice Neil] Gorsuch through in record time, and we still have a great likelihood of getting tax reduction through in the fall. It’s been productive.”

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