Feature | In Ryan health-care defeat, lessons for speaker in age of Trump

U.S. House Speaker Paul Ryan, a Republican from Wisconsin (center) holds up a copy of the American Health Care Act

Two weeks ago, Paul Ryan rolled up his shirtsleeves to deliver an energetic PowerPoint presentation of a health-care bill he said conservatives have been “dreaming about.” On Friday, a chastened Ryan stood in the same spot, admitting that Obamacare would remain the law of the land.

Ryan sees himself first and foremost as a policy guy. But this was an attempt at pure power politics: redo the nation’s health-care system only 17 days after first revealing the legislative text to all of his Republican colleagues.

The result was an embarrassing defeat for Ryan and an early lesson in the limits of unified government, where control of both chambers of Congress and the White House isn’t enough to ensure that even the party’s highest priorities can get enacted.

For Ryan, who has been speaker for 17 months, the question is whether he can take anything away from this episode to help him wrangle his divided conference, accustomed to obstructionism not action under eight years of Barack Obama. To have any hope for success on other Republicans goals such as tax overhaul, Ryan must also learn to work with an unpredictable president in Donald Trump, who insists he is standing by Ryan.

In this case, Ryan came up with a bill that he presented as a “binary choice” – repeal or keep Obamacare – but even scheduling a floor vote on the seventh anniversary of Obama signing the original law couldn’t rally enough Republicans to his side.

“The path to this ‘binary choice’ with no amendments and an artificial deadline, driven by an anniversary rather than progress on the bill, have caused this pause,” said Representative Warren Davidson, a Freedom Caucus member who now represents former Speaker John Boehner’s district in Ohio.

Need for speed

Ryan’s strategy was built on speed: move before industry groups, such as doctors, hospitals, pharmaceutical companies, could ramp up their lobbying efforts and gum up the bill. But the whole thing just moved too quickly for a plan overhauling an industry that directly employs more than 12 million people.

“You can’t set a date and work back from it,” said Drew Hammill, deputy chief of staff for Democratic leader Nancy Pelosi, who shepherded Obama’s Affordable Care Act through the House in 2009 without any Republican votes. “You have to build consensus first.”

And even as GOP lawmakers in both chambers were pleading for Ryan to slow the process down, outside voices wondered what was taking so long to deliver on the rallying cry that has helped secure electoral victories for Republicans since 2010.

“It’s a no-win situation for Ryan,” said William Hoagland, a former congressional GOP budget aide who is now at the Bipartisan Policy Center in Washington. “You’re going to either die by the gunshot or you’re going to be hung by a rope.”

Bound by pledge

Hoagland, who has known Ryan since they were Senate staffers together in the 1990s, said the speaker would have preferred to start with a tax overhaul, rather than health care, but Republicans felt bound by years of pledging to do away with Obama’s signature law. He said Ryan’s share of the blame lays with trying to rush the bill through the House to let the Senate straighten out the policy.

“Everyone wanted to get this out of the way quickly,” Hoagland said. “As fast and as far away from the 2018 election as possible.”

Heading into the climactic week, Ryan’s team had been whipping votes on the expectation that fulfilling a six-year-
stale campaign pledge – and pressure from Trump – would be enough. Vote yes, they pleaded with centrists, and the Senate can make it better. To conservative holdouts in the House Freedom Caucus, they promised there would be more phases of legislation and regulatory changes to come. 

Neither side was fully convinced Ryan satisfied their concerns. And then came Trump, who told lawmakers time was up and the vote had to happen immediately.

On Friday, as moderate votes melted away after last-minute concessions hacked out for conservatives, the real-world consequences of the hastily crafted bill helped sink it. Some of the very Americans who gave Republicans their majority – older, lower income, often in rural areas who are unprofitable to insure – stood to lose the most if Trump signed the bill.

‘Currently unacceptable’

“Unfortunately, the legislation before the House today is currently unacceptable,” Rodney Frelinghuysen, the chairman of the powerful Appropriations Committee announced Friday morning, likely sealing the bill’s fate. “It would place significant new costs and barriers to care on my constituents in New Jersey.”

Ryan’s bill was derived from the broad 37-page “Better Way” policy paper published by House Republicans in June of last year. But the bill itself remained a secret until March 7. In the days before Ryan released the draft, Republican Senator Rand Paul and Democrats were combing Capitol Hill, reporters in tow, to find the secret reading room where a handful of Republicans were allowed to read the actual text.

When the criticisms started pouring in, Ryan defended his bill as the strongest measure that could be written to fit within the budget reconciliation process, which would allow Republicans to bypass a filibuster by Senate Democrats. He rebuffed efforts to make significant changes to the measure, at least until Trump began negotiating directly with conservative holdouts.

Ryan said many of the bill’s critics just didn’t understand the constraints of the process.

‘A little wonky’

“It gets a little wonky, it’s a little detailed, it kind of confuses people,” Ryan said on Fox Business Network on March 15.

“You just went through it very clearly,” Maria Bartiromo, the host, said. “You say it’s confusing, it’s not. Our audience understands where you are and why you had to do it the way you did it.”

Ryan plans to use the next reconciliation bill for tax overhaul, so it too can be pushed through Congress without support from Democrats.

In the collapse of Ryan’s health-care measure lies an important lesson for the speaker: details and salesmanship matter, to fellow Republican lawmakers, the conservative groups that support them and constituents, who jammed the Capitol’s phone lines with complaints about the health-care bill.

The canceled vote also laid bare the stubborn fissures that continue to plague the Republican party. The far-right Freedom Caucus group of roughly 40 members proved they have the power – and the will – to defeat leadership’s agenda.

For now, Republican lawmakers still praise Ryan for his leadership. Despite rumblings from right-wing media, there is currently no overt movement to unseat Ryan as House speaker.

“Paul Ryan, he’s a very good man, he’s an eloquent speaker,” said Representative Mo Brooks of Alabama, one of the most stubborn opponents of the health-care plan. “I like the job he is doing. And I want him to stay as speaker of the House.”

Some cracks

Still, some cracks were beginning to show as the bitterness of falling short of repealing and replacing Obamacare began to sink in.

“House is supposed to be a deliberative body where outcomes are discovered, not dictated,” Justin Amash, another Freedom Caucus member, said on Twitter. “Compromise & consensus cannot be centrally planned.”

Congressional Republicans will continue struggling to reconcile their conservative principles with Trump’s more generous campaign promises. How does one write health-care policy, for example, that shrinks spending and the role of government with no cuts to entitlement programs like Medicare.

“The speaker is a human being,” said Joe Barton, a Republican from Texas. “He’s not superman.” By Anna Edgerton, Bloomberg