(Sarah Parnass/The Washington Post)

Thursday was supposed to be a glorious anniversary for President Trump and the Republicans. Seven years after President Barack Obama signed the Affordable Care Act, Republicans were poised to take the first concrete step toward repealing and replacing that law. Instead, Thursday produced an embarrassing setback that left the way forward far from certain.

Legislative sausage-making is never pretty, but what has been happening all week with the signature legislative priority of the GOP seems beyond the norms. Faced with possible defeat on the floor, House Republican leaders postponed a scheduled vote until Friday, hoping that another day of negotiations could produce what seven years of talking have failed to produce, which is a consensus bill that all factions of the party can support.

The difficulties Republicans are confronting are entirely of their own making. For seven years, Republican politicians have made one overriding bargain with their conservative constituency, which was that they would repeal Obamacare as their first order of business if they ever had the power to do so. Now that they have the power, they still haven’t found a way to make good on that promise.


The other reality that has become clearer as Republicans have struggled to turn a campaign promise into a satisfactory piece of legislation is that, even if they eventually put a bill on Trump’s desk, they still could be buying themselves political problems in the months and years ahead. That is perhaps a second-order problem right now, given the goal of getting something through the House. But as Obama and the Democrats learned, changing the health-care system is fraught, no matter which direction the changes go.

Failure to live up to the pledge to, at the very least, significantly scale back Obamacare is obviously the worst of all possible outcomes. Such a defeat would put the lie to the claim that the Republicans, now with full control of the executive and legislative branches, were ready to govern as a conservative party. Failure also would undermine the idea of the president as the dealmaker in chief, for he has thrown himself into the battle with notable energy and determination, putting his own prestige on the line.

Republicans have postponed votes on critical legislation before, bedeviled by opposition from the hardcore conservative faction. They’ve overcome those setbacks and could do so with health care. The president and Republican leaders are far from conceding defeat and will redouble efforts to cobble together the necessary votes in the House.

But at a minimum, Trump’s reputation as the closer in chief has taken a hit — and on the first big test of his presidency. The greater damage has been to the reputation of House Speaker Paul D. Ryan (R-Wis.) as the savvy intellectual godfather of a new conservative agenda around which his party could rally. This legislation, if eventually passed, may come to be known as Trumpcare, but for now it can more fairly be called Ryancare.

Until House leaders decided to postpone a vote, Thursday had been yet another frantic day of attempted dealmaking, as first hard-line conservatives and then more moderate conservatives trooped from Capitol Hill to the White House and back. The negotiations came on top of deals cut Tuesday night to woo conservative holdouts, which came after House leaders had made other changes on Monday night, which all came after Ryan had failed to find the legislative sweet spot with his initial plan.

The effort to strike a delicate balance was designed with a single purpose in mind, which was not necessarily to produce a truly better bill. The real purpose, as everyone knew, was to produce something — anything — that would allow passage, even if by the slimmest of margins, of the House bill with the hope that the Senate could then find a way to fix any remaining problems and eventually produce a winning formula.

How health care amendments appease GOP moderates and hard-liners

The rallying cry at this point has been a call to arms to keep a promise. There was no Plan B, White House press secretary Sean Spicer had said when asked what would happen if they didn’t have the numbers in the House ahead of Thursday’s scheduled vote. This was do or die, Trump had told lawmakers. That blew up Thursday afternoon. It still is do or die, however, but with the stakes higher now that Republican leaders have called a timeout.

Hardly anyone knows what is in the current bill, or what could be in it after further negotiations. Concessions to conservatives have brought defections among some moderates. Rep. Mark Meadows, (R-N.C.), the leader of the House Freedom Caucus, told reporters Thursday afternoon that there were still 30 to 40 Republicans not committed to supporting the bill. Republicans can afford to lose only 21 or 22 of them, depending on how many Democrats are present to vote.

Passage in the House — hardly a certainty — would provide the president and congressional Republicans with a partial, if enormously welcome, victory. But that’s merely the first hurdle. The bill already was in trouble in the Senate, and House action could produce fresh substantive and parliamentary challenges for Senate Majority Leader Mitch McConnell (R-Ky.) to overcome. And, of course, the bill now under consideration is only part one of three parts of the overall GOP plan. So Republicans are far from the finish line.

The haste with which Republicans have been moving has outpaced the ability of the Congressional Budget Office to evaluate the bill. CBO’s first analysis produced mixed headlines for the GOP: tens of millions more without health insurance; higher premiums over the next few years but slightly lower premiums than under current law a decade from now; and a $337 billion reduction in the deficit over the next 10 years.

An updated analysis released Thursday said deficit reduction would be $150 billion with no significant change in the number who would be without insurance. Those numbers do not reflect where the bill stood as of Thursday and probably will change with additional negotiations in the House and almost-certain amendments in the Senate.

A Quinnipiac University poll released Thursday showed that the Republican plan starts out in a deep hole. Just 17 percent of Americans say they approve of the GOP bill, compared with 56 percent who say they disapprove. The remaining 26 percent say they are undecided.

The lowest approval level for the Affordable Care Act in any Washington Post-ABC News poll was 39 percent, with the highest disapproval 57 percent. The worst net negative recorded in those polls was minus-17 points. The Quinnipiac survey puts the net negative for the Republican plan at more than double that number, or minus-39 points.

Obama administration officials long claimed that, once their bill was approved and implemented, support would rise significantly. That didn’t happen, and Democrats were battered in the 2010 and 2014 midterm elections. Republicans must be thinking about 2018 as they evaluate current public opinion.

“A promise that looked like a political winner when they started talking about it seven years ago is now beginning to look like a massive political headache,” said William Galston of the Brookings Institution.

Headache or not, Thursday’s setback or not, Republicans are now left with unpalatable choices. Fail, and suffer the consequences. Succeed, and hope the public eventually buys in. This is hardly the script that Trump and Republicans imagined when they came to power in January.