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Trump's pivot to health care catches Republican lawmakers flat-footed

Trump: "I understand health care now"

Fresh off what he and his allies saw as a major victory in the conclusion of the special counsel investigation, President Trump surprised his party this week by embracing a politically perilous subject: health care.

"We're gonna be the party of great health care," President Trump said in the Oval Office on Tuesday, a day after his Justice Department sided with a district court's judgment that the Affordable Care Act should be overturned. "Obamacare doesn't work, it's too expensive...It's a disaster for our people."

Democrats greeted Trump's declaration with glee, having won their House majority largely by campaigning on the issue of health care. Republicans, meanwhile, were left scratching their heads, wondering why the president would bring up a sore subject when he had better news to tout.

"I just don't understand how many times we have to play this game to finally learn the lessons. We have seen how this turns out, and it ain't pretty for us," one Republican strategist who worked on midterm elections told CBS News. "The strategy needs to be keeping the focus on Democrats...not on us."

The GOP's failed attempt to repeal Obamacare in 2017 had a galvanizing effect among Democrats. CBS News exit polling from the 2018 midterms found health care to be the top issue for voters in an election where Democrats picked up 40 House seats. And 54 percent of midterm voters disapproved of the president. 

"I feel comfortable saying that I speak for almost, if not all, Republican senators when I say that this is the last thing they want to discuss," said one senior Republican leadership aide. "Whoever planted this idea in the president's head should be drawn and quartered." 

The issue of health care is again center stage for Democrats as their 2020 presidential primary ramps up. Most candidates have embraced some form of universal health care, and many support Sen. Bernie Sanders' "Medicare for All" plan. Republicans see an opportunity to exploit that support, painting Democrats as advocating for socialized medicine.

"The Democrats have an offer — Medicare for All — which takes away all private insurance for individuals," said House GOP leader Kevin McCarthy, though not all Democratic candidates support eliminating private insurance. "The Republicans believe in pre-existing conditions. We believe in lowering the cost and that's what we are working on." 

But the Department of Justice's decision to support nixing Obamacare, which prohibits people with pre-existing conditions from being denied health insurance, makes it difficult for Republicans to make that case. 

"I think politically it's not smart," said New York Republican Rep. Tom Reed. "But more substantively, we should be finding areas where we can fix healthcare, and not continue this division of [repealing] Obamacare with no hardcore proposal as to what we're going to do about the millions of folks that are potentially adversely impacted."

Reed said that while overturning the law could potentially give Republicans leverage to craft their own alternative, "it's going to cause chaos...why put millions of Americans in harm's way because you want to create a political environment to legislate?"

Republican Sen. Susan Collins, who voted against her party's repeal effort in 2017, said that if the administration is opposed to Obamacare, "the answer is for the administration to work with Congress and present a plan to replace and fix the law, not to, through the courts, seek to invalidate it altogether."

While Republicans largely oppose Obamacare on its merits, they have not been able to coalesce around an alternative when they controlled both chambers of Congress and the White House. In a divided government, the task is infinitely more difficult. And Republicans lack a central figure to effectively make the case to the public.

"There is no Bernie Sanders of free market health care in the Republican Party...there's no Alexandria Ocasio-Cortez," said Michael Cannon, director of health policy studies at the libertarian Cato Institute.

"I would be thrilled if the Republican Party just tried to compete on the issue of health care," Cannon said, arguing that the administration has been effective on conservative policy, such as expanding short term health care plans. Still, Cannon said he's skeptical of the administration's new approach. 

"Republicans could have mounted a highly effective counter attack on health care in 2018. Democrats have fumbled the ball and Republicans are just looking at it lying on the 50 yard line." 

CBS News' Rebecca Kaplan contributed reporting to this story.