Republicans pulled out all the stops but ultimately pulled the bill.
After a torturous and unsuccessful effort to satisfy opponents in both wings of the party, full of late-night meetings on both ends of Pennsylvania Avenue and a last-ditch amendment process, House speaker Paul Ryan yanked the American Health Care Act ahead of a scheduled vote Friday afternoon, effectively setting aside a signature issue on which the GOP campaigned for years and watched disintegrate in a matter of days.
“You’ve all heard me say this before: Moving from an opposition party to a governing party comes with growing pains, and, well, we’re feeling those growing pains today,” Ryan told reporters shortly after 4 o’clock, about an hour after the lower chamber’s presiding officer interrupted debate of the bill and declared a recess. In so doing, the matter was declared over.
“Now we’re going to move on with the rest of our agenda, because we have big, ambitious plans to improve people’s lives in this country. We want to secure the border. We want to rebuild our military. We want to get the deficit under control. We want infrastructure, and we want tax reform,” Ryan said.
He still wants Obamacare gone, too, but it “is the law of the land,” he admitted. “It’s going to remain the law of the land until it’s replaced.”
Ryan characterized the reaction among his conference as “let down” and “disappointed.” Multiple congressional sources who spoke to THE WEEKLY STANDARD used stronger terminology. “Indignant,” one said.
“Frustration,” said another. “That’s the single-best word to describe the mood.”
Either one works. Several Republicans are angry that the health care system they’ve spent multiple elections lambasting will remain intact despite finally having the political power to dismantle it. “The House Freedom Caucus just single-handedly saved Obamacare,” Illinois representative Adam Kinzinger barbed after the cancelled vote.
The chairman of that group, Rep. Mark Meadows, was at the center of efforts to beef up the bill. He and his conservative allies—including Senators Ted Cruz, Mike Lee, and Rand Paul—advocated incorporating stronger language to undo the Affordable Care Act’s insurance mandates, despite the ambiguity of whether such an approach would be allowed under congressional budget rules. They never had the opportunity to test it. But Meadows said he remains committed to trying again in the future.
“I promised [my constituents] that I would fight for a full repeal of the Affordable Care Act and a replacement with a market-driven approach that brings down costs and provides more choices for the American people,” he said Friday. “I remain wholeheartedly committed to following through on this promise.”
The AHCA’s backers touted the “market-driven” reforms that existed in it already: a gutting of Obamacare’s individual mandate and premium support subsidies, the elimination of almost all the law’s taxes, and an expansion of max contributions to health savings accounts.
They weren’t enough for a rigid bloc of right-wing opponents to justify supporting the measure. And then there was the separate problem of retaining moderate GOP voters, an increasing number of whom worried that the plan would harm their constituents. Rep. Ileana Ros-Lehtinen of Florida was one such prominent lawmaker.
“Too many of my constituents will be left paying more for coverage and many will be left without coverage at all,” she said. In one example of how the bill tried to appease different factions, it made significant changes to Medicaid’s funding mechanism and rolled back the ACA’s expansion of the program. But it also allowed new enrollees in states that had already taken advantage of the expansion to continue receiving a higher proportion of federal support for a few years, and then maintain that mix of funding long-term. There was a little something for everybody to love. And too much, apparently, for too many to hate.
The path forward for Republicans is uncertain. Ryan said Health and Human Services Secretary Tom Price still had the ability to take regulatory action against some of Obamacare’s provisions, what had been planned as “phase two” of the GOP’s three-pronged repeal and replace strategy. But with the first phase scuttled and the second one hampered, anything the party does for now will necessarily be unambitious. The third phase—non-budget related matters that pertain to Obamacare and are part of the president’s own agenda, such as prescription drugs and interstate insurance competition—is still hypothetical.
Just like one of the biggest political promises of the century, which heads into the foreseeable future unfulfilled.
