House Speaker Paul Ryan doesn't have the votes to pass the American Health Care Act, which is why he postponed the vote on the bill, originally scheduled for Thursday.
This postponement was prudent, and Republicans ought not to vote on Friday either. There is no reason to rush the legislation. There is no imminent deadline, no reason the Senate needs to vote on Obamacare before confirming Neil Gorsuch.
Republicans ought to take their time and write a better bill that, unlike the AHCA, actually repeals Obamacare and institutes real reform of the broken healthcare system.
Needlessly rushing policy has become the ignominious hallmark of the all-Republican government that is now two months old, and the dangers are predictable and clear. Just as the White House rushed through an executive order on border security, without preparing allies or journalists, or consulting appropriate experts, GOP House leadership rushed out a bill without the requisite advance work.
There was no real committee process. The bill was drafted behind closed doors, and party leaders made it clear that no amendments were to be accepted. There was insufficient vetting. They crafted a bill vulnerable to a horrific score from the Congressional Budget Office. And they didn't work enough with conservative groups, journalists or rank-and-file GOP members ahead of time.
After Election Day, Republican leaders did not launch a campaign to make the case for conservative reform of healthcare. There are plenty of economic realities, moral arguments and empirical data points that can argue for a more market-based system. There are countless ways in which the pre-Obamacare set-up can be shown to be not a market-based setup. There's also a smarter way to build a safety net than we have now or had before President Barack Obama.
Republican leaders didn't make these arguments. The campaign to pass this bill has so far been merely a vote-counting exercise in which some members are threatened with the loss of their seats, and others are bought off with promises that their preferred policies will come, and their concerns will be addressed, at some later stage.
That's how President Trump and Ryan ended up in this bind, without enough votes.
Rushing ahead from here would be a mistake.
Jury-rigging a healthcare bill is folly. Ryan changed his tune on Wednesday and reportedly agreed to amend the bill by adding repeal of Obamacare's costly Essential Health Benefits mandate. This addressed conservative objections that the AHCA's "repeal" had left all of Obamacare's regulations, including the EHB mandate, in place.
But Obamacare's other regulations, as of Thursday afternoon, stayed in place. This was necessary to keep centrist Republicans on board.
Does anyone know what this would do to the insurance market? If customers are free to buy slimmed-down plans, but insurers still can't price customers based on their riskiness or exclude pre-existing conditions, this could have dramatic or even chaotic effects on insurance pools. Maybe not, but it's a brand new idea (if it even counts as an "idea") and it's doubtful that White House economists have modeled it.
Mechanistic piecemeal vote-building may have worked to pass spending bills in the earmark era, but it's not appropriate for overhauling a massive, complex, and unique sector of the economy.
As leaders' oscillations over Senate procedure have suggested, Republicans will need to be lawyerly to put their deregulations in bounds for the budget reconciliation process, which is not subject to a filibuster.
The complexity of healthcare and arcana of Senate procedure are why Democrats took their time in 2009.
Thursday, when Ryan wanted the House to pass the bill, was the anniversary of Obamacare's passage. It was, notably, the seventh anniversary, not the eighth. That means that Trump and Ryan could take 364 days to pass this bill, and they would still be on pace.
Take a week. Take a month. Take the time to write a bill that doesn't merely check a box, but that actually reforms healthcare.