With the Republican push to revamp the Affordable Care Act stalled again, even some allies of President Donald Trump question whether he has effectively used the bully pulpit afforded by his office and are increasingly frustrated by distractions of his own making.
Trump has spoken out repeatedly during his tenure about the shortcomings of Obamacare, which he brands a "disaster." But he has made relatively little effort to detail for the public why Republican replacement plans — which fare dismally in public opinion polls — would improve on the former president's signature initiative.
The lackluster sales job, combined with recent controversial tweets and public statements targeting the media, has diminished the focus on the president's leading legislative priority at a key juncture in the Senate, allies and analysts say.
"It's a mystery," said Barry Bennett, a Republican operative who advised Trump's campaign last year and remains close to the White House. "I don't know what they're doing."
In recent days, Trump, who heads to Poland and Germany later this week, has seemed largely preoccupied by other things, including a Twitter feud with multiple news outlets. On Sunday, Trump sent around a video showing him body-slamming a CNN avatar, just days after calling an MSNBC host "dumb as a rock."
A top Trump lieutenant, Health and Human Services Secretary Tom Price, was pressed Sunday on whether the media attacks are interfering with the president's push of the unpopular Senate bill.
"The fact of the matter is that he can do more than one thing at a time," Price said during an exchange with host Chuck Todd on NBC's "Meet the Press" that grew testy at times.
Price argued that Trump has been holding "multiple meetings within the White House itself, with physicians, with small-business groups, with other folks who have been harmed by Obamacare, with patients, individual stakeholders from across this land who tell him and have told us repeatedly that the current system is collapsing."
Trump's public efforts to dismantle the health care law, however, contrast sharply with President Barack Obama's efforts to build support in advance of its 2010 passage. Obama gave a joint address to Congress on health care. He fielded questions at town hall meetings around the country. And he even bantered on live television with hostile lawmakers at a Republican retreat.
Not only has Trump been unsuccessful at swinging public opinion toward the legislation, but also "he hasn't really tried that much," said George Edwards, a professor of political science at Texas A&M University and author of "On Deaf Ears: The Limits of the Bully Pulpit."
"He hasn't been out there consistently making a case for the legislation," Edwards said of Trump.
It's not hard to imagine other things Trump could be doing to try to boost support for the GOP plan among the public and, by extension, on Capitol Hill, Bennett said.
Trump could make much better use of Twitter, urging his 33 million followers to call their senators and ask them to back the GOP bill, Bennett said.
Trump could have visited several states last week, holding events that highlight the sharp rise in premiums under Obamacare, he said. And Trump could mobilize his supporters to come to Washington and rally outside the Capitol, demanding passage of a bill.
Trump's seeming ambivalence about selling the GOP plan may reflect that he has always been more animated about getting rid of Obamacare than he has been about what should replace it.
To the degree he has discussed what the American health care system should look like, Trump has talked about "insurance for everybody" and coverage that would be "much less expensive and much better" — standards that the bills produced by the House and Senate don't come close to achieving, according to analyses.
Trump's public statements about the bills, at times, have risked doing more harm than help, leading to questions about how dedicated he is to the task at hand — a view bolstered by Trump's head-scratching comments that he considered the House bill "mean" and that it would be unfortunate but "OK" if senators are unable to pass a bill.
Trump further muddied the waters last week by floating the possibility on Twitter that lawmakers could repeal the ACA now and replace it later — a view that Price on Sunday emphasized is not the administration's preference.
White House press secretary Sean Spicer said there's no reason Trump should follow models used by Obama or other past presidents to build public support.
"You use the model that works for you," Spicer said, noting that Trump has advanced a health care bill further in the process at this point in his term than Obama. The ACA did not pass until the second year of Obama's first term.
"We've been more efficient," Spicer said.
Marc Rotterman, a GOP consultant based in North Carolina, said Trump needs to be more repetitive when speaking to the public about why the bill should pass.
"When you push a measure, redundancy matters, and these constant tweets against the media distract from the real issue, which is getting health care done," said Rotterman, adding that he'd like to see Trump deliver an Oval Office address on the subject.
To bolster support for their initiatives in Washington, presidents often travel to friendly territory outside the Beltway to make their case. Trump has traveled outside of Washington several times lately, but those events have mostly focused on other issues, and when he has mentioned health care, he hasn't dwelled on it.
During Trump's recent travels to Ohio and Wisconsin, he staged secondary events meant to highlight "victims of Obamacare."
In a mid-June trip to Milwaukee, for example, Trump invited two local families to join him on Air Force One to talk about their struggles to pay for insurance under the ACA. Afterward, Trump and the families spoke briefly to the news media on the tarmac, with Trump telling reporters, "these citizens deserve so much better."
His motorcade then whisked him to a technical college to talk about workforce development and apprenticeships — an event that received the majority of local coverage.
At a Trump rally late last month in Cedar Rapids, Iowa, the president could have made an extended argument about the need for moving forward on health care. But Trump didn't discuss the issue in much detail as he pledged to deliver a bill with "heart."
He made at least as many headlines for pledging to crack down on the use of welfare by immigrants and to use solar panels to help pay for a promised wall on the U.S.-Mexico border.
Ari Fleischer, the press secretary to former president George W. Bush, said Trump to this point deserves "mixed" marks for his use of the bully pulpit on health care.
Fleischer credited Trump with having "kept his foot on the gas" while the House was struggling to pass its version of the bill in early May.
In the Senate, Trump seems to be hindered by his low job-approval ratings, which have undercut his ability to reach out to some conservative Democrats, in particular, Fleischer said.
If Trump were more popular, Fleischer said, a handful of those Democrats would probably be more willing to support the bill, out of fear of incurring the president's wrath. Instead, they're now worried about drawing a Democratic primary challenger if they work too closely with Trump.
Since the focus turned to the Senate in recent weeks, Trump has also delegated much of the lobbying to Vice President Mike Pence and senior administration officials, who have more extensive knowledge of the bill and a better sense of how to bring senators on board.
Trump is also faced with the prospect of selling a very unpopular product. A Congressional Budget Office analysis of the Senate plan projected that it would lead to 22 million fewer Americans having coverage within a decade.
Only 17 percent of adults nationwide approved of the Senate health care bill, while 55 percent disapproved. according to an NPR/PBS NewsHour/Marist poll released Wednesday.
Even among Republicans, support was tepid, with 35 percent voicing approval and 21 percent saying they disapprove. Other recent polls have had similar numbers.
Meanwhile, even as Trump has repeatedly railed about shortcomings of the ACA, public support for Obama's initiative has increased, polls have found.
In December, as Trump prepared to take office, 43 percent of American adults viewed the ACA favorably, while 46 percent viewed it unfavorably, according to a Kaiser Health tracking poll.
In the June poll, 51 percent viewed the law favorably, compared with 41 percent unfavorably. That was the best the ACA had fared since Kaiser started its polling in 2010.
The term "bully pulpit" was coined by President Theodore Roosevelt, who used the powers of the office to court reporters and deliver major speeches on legislation related to railroad regulation and food inspection.
Frances Lee, a government and politics professor at the University of Maryland, said presidents traditionally have poor records of changing public opinion when pushing unpopular initiatives, as Trump is attempting to do.
"Use of the bully pulpit is mainly effective when presidents are pushing Congress to do something the public already favors," she said, citing the wide latitude Bush had with Congress after that Sept. 11, 2001, terrorist attacks.
Still, there is no shortage of suggested initiatives Trump could be taking that he has not.
After the House narrowly passed its health care bill in early May, Aaron Kall, the director of debate at the University of Michigan, penned a piece for the Hill newspaper, urging Trump to give an address to a joint session of Congress to bolster Senate support.
In an interview, Kall said he still thinks that would be helpful to Trump, given the large television audience such an address would command.
If Trump wants legislation to pass at this point, he "really needs to adopt some new tactics," said Kall, editor of "Mr. Speaker, The President of The United States: Addresses to a Joint Session of Congress."
Kall suggested that Trump also make himself available for television interviews focused on health care with outlets beyond the friendly confines of Fox News.
"I think we've underestimated him sometimes," Kall said. "With a few days' preparation, I think he could withstand an interview on this subject. He has a persuasive story to tell. It just needs to be packaged in the right way."
Others say that Trump would be well-served by putting down his phone.
Asked Sunday whether Trump's tweets made it harder to work on health care, Sen. Bill Cassidy, R-La., admitted that he gets "frustrated" when the media and lawmakers focus on what the president says on Twitter.
"Our focus cannot be on the tweet," Cassidy said on "Meet the Press." "Our focus has to be on that kitchen-table family paying $20,000, $30,000 and $40,000 for their premiums, wondering how they're going to make ends meet."
The Washington Post's Jenna Johnson and Ashley Parker contributed to this report.