Down and out

Ryan: GOP “came re­ally close to­day, but we came up short” Pres­i­dent: “The best thing is to let Oba­macare ex­plode”

The Denver Post - - FRONT PAGE - By Robert Costa, Mike DeBonis and Ed O’Keefe

wash­ing­ton» Repub­li­can lead­ers abruptly pulled their over­haul of the na­tion’s health care sys­tem from the House floor on Fri­day, a dra­matic de­feat for Pres­i­dent Don­ald Trump and House Speaker Paul Ryan that leaves a ma­jor cam­paign prom­ise un­ful­filled and casts doubt on the Repub­li­can Party’s abil­ity to govern.

The de­ci­sion leaves for­mer Pres­i­dent Barack Obama’s chief do­mes­tic achieve­ment in place and raises ques­tions about the GOP’s abil­ity to ad­vance other high-stakes pri­or­i­ties, in­clud­ing tax re­form and in­fra­struc­ture spend­ing. Ryan, R-Wis., re­mains with­out a sig­na­ture ac­com­plish­ment as speaker, and the de­feat un­der­mines Trump’s im­age as a skilled deal­maker will­ing to strike com­pro­mises to push his agenda for­ward.

In an in­ter­view with The Wash­ing­ton Post, Trump de­flected any re­spon­si­bil­ity for the set­back and in­stead blamed Democrats. “We couldn’t get one Demo­cratic vote,” he said.

“I don’t blame Paul,” Trump added, re­fer­ring to Ryan.

Trump said he would not ask Repub­li­can lead­ers to rein­tro­duce the leg­is­la­tion in the com­ing weeks, and con­gres­sional lead­ers made clear that the bill — known as the Amer­i­can Health Care Act — was dead.

Shortly af­ter the de­ci­sion, Ryan told re­porters his party “came re­ally close to­day, but we came up short.” He added: “We’re go­ing to be liv­ing with Oba­macare for the fore­see­able fu­ture.”

“It’s done, DOA,” said En­ergy and Com­merce Com­mit­tee Chair­man Greg Walden, R-Ore., who drafted much of the leg­is­la­tion. “This bill is dead.”

In­stead, Repub­li­can lead­ers said, they would wait for the Af­ford­able Care Act to en­counter fa­tal prob­lems, be­liev­ing that

Democrats will then want to work with them to make changes.

“As you know, I’ve been say­ing for years that the best thing is to let Oba­macare ex­plode and then go make a deal with the Democrats and have one uni­fied deal,” Trump said. “And they will come to us, we won’t have to come to them.”

It re­mains far from cer­tain that Repub­li­cans, in con­trol of the White House and both houses of Congress, will be able to cred­i­bly foist re­spon­si­bil­ity for the na­tion’s health-care woes onto Democrats. What is cer­tain is that Repub­li­cans con­tinue to have dif­fi­culty turn­ing their cam­paign prom­ises into leg­isla­tive ac­tion.

For seven years, GOP can­di­dates have pledged to re­peal the Af­ford­able Care Act — which ex­panded Med­i­caid and cre­ated sub­si­dized, state-based ex­changes to ex­pand health in­sur­ance cov­er­age to 20 mil­lion Amer­i­cans — de­cry­ing the taxes and gov­ern­ment man­dates it en­acted.

“Since 2010, ev­ery Repub­li­can, with the ex­cep­tion of prob­a­bly a hand­ful, has cam­paigned from dog­catcher on up that they would do ev­ery­thing they could to re­peal and re­place Oba­macare,” White House press sec­re­tary Sean Spicer said Fri­day. “To get in and say you’re go­ing to do some­thing else would not be fair to the Amer­i­can peo­ple.”

But in that time, the party never co­a­lesced around a con­sen­sus al­ter­na­tive to the law, and the scram­ble to de­velop one af­ter Trump’s elec­tion re­vealed some of the rea­sons: Repub­li­cans were loath to re­peal popu- lar ACA pro­vi­sions such as a re­quire­ment that in­sur­ers cover those with pre­ex­ist­ing con­di­tions and de­pen­dents up to age 26 but wanted to re­peal the taxes and the in­di­vid­ual man­date to have in­sur­ance that helped make those pro­vi­sions pos­si­ble.

The pol­icy dif­fi­cul­ties were am­pli­fied by an ide­o­log­i­cal cleav­age within the House GOP. Con­ser­va­tive hard-lin­ers chafed that the Ryan-drafted bill left too much of the ACA in place and en­shrined a fed­eral role in health in­sur­ance mar­kets, while mod­er­ates feared that cuts to tax sub­si­dies and Med­i­caid would leave their con­stituents un­cov­ered and their states with gap­ing bud­get gaps.

The drama on Capi­tol Hill un­folded amid new ev­i­dence that pub­lic opin­ion was run­ning against the bill: A Quin­nip­iac Univer­sity poll re­leased Thurs­day found that U.S. vot­ers dis­ap­proved of the leg­is­la­tion 56 per­cent to 17 per­cent, with 26 per­cent un­de­cided.

Signs of trou­ble across the Repub­li­can spec­trum were ev­i­dent by mid­day Fri­day, as law­mak­ers streamed onto the House floor for a pro­ce­dural vote.

In one stun­ning de­fec­tion, House Ap­pro­pri­a­tions Com­mit­tee Chair­man Rod­ney Frel­inghuy­sen, R-N.J., an­nounced mid­day that the bill was “un­ac­cept­able” and that changes made late Thurs­day to pla­cate con­ser­va­tives “raise se­ri­ous cov­er­age and cost is­sues.”

He was joined by rankand-file mem­bers such as Rep. David Joyce, R-Ohio, a low-key ap­pro­pri­a­tor, and Rep. Bar­bara Comstock, R-Va., a long­time Ryan ally who rep­re­sents a com­pet­i­tive North­ern Vir­ginia con­gres­sional district.

But the White House and House lead­ers both saw the key bloc as the House Free­dom Cau­cus, a group of roughly three dozen hard­line con­ser­va­tives who made nu­mer­ous de­mands of the bill since Jan­uary — in­clud­ing a flat re­peal of the ACA, a ma­jor re­work­ing of the GOP bill’s tax in­cen­tives and new Med­i­caid re­stric­tions. Most of those de­mands were re­jected, pri­mar­ily due to the po­lit­i­cal re­al­ity of hold­ing a Repub­li­can ma­jor­ity to­gether in sup­port of the bill.

The Free­dom Cau­cus chair­man, Rep. Mark Mead­ows, R-N.C., be­came a cen­tral player in the ne­go­ti­a­tions, how­ever, and the group kept an open line to the White House — par­tic­u­larly with chief strate­gist Stephen Ban­non and Of­fice of Man­age­ment and Bud­get di­rec­tor Mick Mul­vaney, who had been one of its found­ing mem­bers. The group made a fi­nal de­mand this week: The bill had to elim­i­nate a set of ACA in­sur­ance man­dates that, it ar­gued, were a key fac­tor in driv­ing up pre­mi­ums.

In a Thurs­day morn­ing White House meet­ing, Trump made what would be his fi­nal of­fer: The bill would gives states the op­tion to elim­i­nate some of the man­dates, 10 “es­sen­tial health ben­e­fits,” but would leave oth­ers in place.

That af­ter­noon, the Free­dom Cau­cus met to re­ject the deal. Hours later, Mul­vaney came to a closed­door House GOP con­fer­ence meet­ing to de­liver a fi­nal ul­ti­ma­tum, say­ing Trump was ready to move on if the bill failed Fri­day. Af­ter­ward, mem­bers lined up at mi­cro­phones to de­liver emo­tional pleas for party unity. Some were veiled cri­tiques of the Free­dom Cau­cus; oth­ers were less veiled.

Dur­ing the mid­day pro­ce­dural vote Fri­day, Ryan asked Mead­ows if his group had changed its stance. It had not, Mead­ows told him - mean­ing as many as 20 hard-lin­ers would op­pose the bill. Twenty-two Repub­li­can no votes would sink the bill, and more than a dozen other mem­bers had an­nounced their op­po­si­tion by Fri­day af­ter­noon.

Ryan left shortly af­ter for the White House to tell Trump the bill would fail.

Mead­ows de­clined to an­swer ques­tions af­ter the bill was pulled on Fri­day. But sev­eral Free­dom Cau­cus mem­bers said they would not be cowed by Ryan or even Trump - a fig­ure most of them had en­thu­si­as­ti­cally sup­ported.

“You know what? I came here to do health care right,” said Rep. Paul Gosar, R-Ariz., who was one of six Repub­li­cans who voted against the pro­ce­dural mea­sure.

“A no vote means we save Don­ald Trump from a Demo­cratic ma­jor­ity in 2019,” said Rep. Louie Gohmert, RTexas.

The de­feat has left the re­main­der of the Repub­li­can gov­ern­ing agenda in Congress in tat­ters. A pro­posed cor­po­rate tax over­haul fa­vored by Trump and Ryan de­pended, in part, on the health-care leg­is­la­tion pro­ceed­ing - cre­at­ing both po­lit­i­cal mo­men­tum and fis­cal space for dra­matic ac­tion

Be­fore the bill was pulled Fri­day, Rep. Bradley Byrne, R-Ala., called it the “first big vote in the pres­i­dency of Don­ald Trump,” one that would be “a state­ment, not just about him and the ad­min­is­tra­tion but about the Repub­li­can Party and where we’re headed.”

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