House Speaker Paul D. Ryan said Wednesday that his health-care proposal must change to pass the House, marking a significant retreat from his earlier position that the carefully crafted legislation would fail if substantially altered.
Ryan acknowledged that changes would be made two days after an analysis issued by the Congressional Budget Office prompted a fresh round of criticism of his proposal. Among the report’s projections was that 14 million fewer Americans would be insured after one year under the Republican plan.
Speaking after a private meeting of GOP lawmakers, Ryan said that leaders would “incorporate feedback” from the rank-and-file in response to the CBO findings. He did not repeat his previous comments calling support for the bill a “binary choice” for Republican lawmakers.
In other words, they do not have the votes, contrary to what the House leaders have been saying, and the CBO report was a stunning blow, contrary to Ryan’s happy talk. (“Ryan aides played down his remarks, saying that the speaker had long acknowledged further changes were possible as the bill moved through a multistep legislative process.”) It’s not clear what will happen in the Budget Committee on Thursday if the bill is under revision and re-negotiation. Any changes, of course, would need to be scored, prompting further delay.
This breakdown comes as no surprise to us, given how swiftly opposition to the bill was spreading. The setback represents a stunning defeat for Ryan’s strategy, which aimed to rush the bill through before opposition formed. Obviously fearing he’d be blamed for the mess, he clumsily emphasized repeatedly throughout the day that this was the White House’s bill as well, drafted together. But did the president understand what was in it? (Did he see that it did not adhere to his campaign and post-inauguration promises, e.g., cover “everybody”?).
The collapse reveals several uncomfortable truths for Republicans.
First, you cannot govern with a president who has no idea about the specifics of controversial legislation he is backing. He cannot simply say it is “wonderful” and expect people to fall in line. That is the difference between campaigning when one is selling a candidate (or trying to destroy an opponent) and when one has to find a concrete solution to satisfy many different interests. In this case, the particulars of the bill bore very little resemblance to President Trump’s grandiose promises, whether he realized it or not. His base still wants that magical (costs less, covers more, provides better care) formula. The legislative roadblock they have hit reminds us that neither Ryan nor Trump have LBJ-like powers to drive legislation home.
Second, the Freedom Caucus will now be energized to fight against anything less than a complete repeal. More moderate Republicans are unlikely to go along with that, however, because even the milder version of GOP legislation was unacceptable. Even if House moderates did go along, the reconciliation rules in the Senate would not permit repeal of the entire bill (remember Ryan’s prongs No. 2 and No. 3?). What hard-liners want can’t pass the Senate, and might not even make it out of the Senate. They can try, however — and more important, stop just about anything else.
Third, Republicans have been playing a shell game for too long. On the one hand, they say Obamacare is awful and they want to repeal it in its entirety. On the other, they want to go back to pre-Obamacare health care, which very few people in the country want. Returning to the pre-Obamacare system would not solve all (any of?) the problems they promise to address — people with preexisting conditions, high deductibles, spiking premium costs, etc.
Sen. Ted Cruz (R-Tex.) typified the contradictions on the right. He declared on Tuesday, “The test of success will be a year from now, two years from now, three years from now: Is health care more affordable? … We need to fix the problems and, in particular, we need real reform that drives down the cost of premiums so that health care is more affordable.” Total repeal of Obamacare doesn’t get you there. Before Obamacare, health-care premiums were rising at a faster rate than they are now, and those with preexisting conditions could not get coverage. So what’s the alternative if you don’t like Obamacare or the American Health Care Act? You can understand why Republicans, at least for now, are stuck.
Until Republicans figure out what — other than AHCA and the Affordable Care Act — they want and how they are going to pass it (realistically needing 60 votes in the Senate for significant parts of it), they will not be able to move forward. And, frankly, without accomplishing health-care reform, it’s hard to see how the rest of the GOP-Trump agenda will get through.