The uncertain future of the Republican proposal to repeal and replace Obamacare is threatening to complicate President Trump’s working relationship with House Speaker Paul Ryan.
The White House and House Republican leaders are projecting a united front on the American Health Care Act. They are cooperating to line up votes for legislation under intense fire from all quarters of the GOP and saying only nice things about one another for public consumption.
But privately, there has been sniping.
Some senior White House aides are blaming Ryan for last week’s rocky rollout of the AHCA and the headwinds it is facing in Congress because of dissatisfaction with key provisions of the bill.
Meanwhile, some Republican congressional insiders are criticizing Trump for his lukewarm embrace of a bill crafted with the administration’s input as he hopes to satisfy his liberal inclinations to provide “insurance for everybody.”
These simmering tensions could boil over in public if health care reform fails, setting back the significant progress Trump and Ryan have made toward building a rapport that was virtually nonexistent during the 2016 campaign.
That could put the populist president and conservative speaker at odds in the months ahead, undermining their ability to work together and reach consensus on tax reform and the rest of their ambitious agendas.
“Healthcare reform, regardless of the outcome, will be a defining moment of Trump and the Republican-controlled Congress,” said Brad Smith, a veteran Republican operative and former House GOP leadership aide.
House Republicans unveiled the AHCA on the evening of March 6, ostensibly to satisfy internal rules that the bill be made available to members of Congress and the public to view at least two calendar days before it begins to move through committee.
The next morning, few Republicans were on television or radio selling the legislation. By the end of the first 24 hours of the AHCA’s release, the president and top administration officials had said very little in support of the bill. Rather, its Republican critics dominated cable news and talk radio.
Some White House aides are pointing fingers at Ryan for this public relations fail, according to a conservative opponent of the legislation who attended a negotiating session with Trump and administration officials.
“They said he really botched the rollout,” this conservative operative said, on condition of anonymity in order to speak candidly. “The president didn’t say that, but several of his aides said that. But he didn’t correct them, either.”
A White House spokesman downplayed tensions, saying Trump is satisfied with Ryan’s effort and focused on getting a deal done.
“There is no unhappiness. The White House is focused on repealing and replacing Obamacare and giving the American people healthcare that will work for them,” the spokesman said.
“Their personal relationship and rapport is as good as ever,” added Brendan Buck, Ryan’s chief spokesman. “They talk almost every day, sometimes multiple times a day. As far as these things go, they’re in a great place.”
Congressional Republicans are pleased with Trump’s private involvement in the process.
The president has been meeting almost daily with supporters and opponents of the AHCA, soliciting proposals and counterproposals in an effort to forge consensus among competing factions. Vice President Mike Pence and Health and Human Services Secretary Tom Price also are holding negotiating sessions.
Trump has indicated that he’s willing to throw the full weight of his bully pulpit behind the bill. The White House has told Republican leaders the president is prepared to hit the road to sell the AHCA to the public, and employ his full array of media skills to convince GOP opponents to get on board.
That could include threatening to support primary challengers who run against Republicans who vote against the AHCA in 2018.
But so far, other than a few supportive Twitter posts and comments, Trump has kept a measured public distance from the legislation. Congressional Republicans who support the AHCA — and they are still a majority — are starting to get antsy.
They believe that the time has come for Trump to make it abundantly clear to his party that this is his bill, and that voting against it is equivalent to voting against him. Allowing Ryan to be the chief public face of the health care bill is a recipe for failure.
“He’s got to get involved now,” a senior Republican House aide said.
For conservative critics of the bill, Ryan is a convenient scapegoat. It’s why they’ve taken to calling the AHCA “Ryancare” rather than “Trumpcare” (Democrats are referring to by the latter nickname.).
They need Trump to support conservative changes to the bill that might go against his own inclinations to provide expansive coverage. Conservatives also need the president to be on their side on this and legislation that will arise in the future.
Their claims that Ryan’s leadership is jeopardizing passage of the AHCA, and that he is responsible for the precariousness of Trump’s first major legislative effort as president, is adding to the tension between the two camps.
“I think President Trump remains open to change. I think the House leadership has dug their heels in,” Sen. Rand Paul, R-Ky., a vocal critic of the AHCA, told reporters. “I think Paul Ryan’s selling [Trump] a bill of goods, that he didn’t explain to the president, that the grassroots doesn’t want what Paul Ryan’s selling.”
