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The Journal Gazette

Saturday, March 25, 2017 3:44 am

GOP health care plan dead

Washington Post

WASHINGTON – Republican leaders abruptly pulled their overhaul of the health care system from the House floor 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.

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.

Ryan 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."

Trump said he had no problem waiting for Democrats to seek cooperation with Republicans on health care: "I never said I was going to repeal and replace in the first 61 days."

In fact, Trump said repeatedly as a candidate and before his inauguration that he would work to repeal the ACA on his first day in office.

"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."

No consensus

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.

"To get in and say you’re going to do something else would not be fair to the American people," White House press secretary Sean Spicer said.

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 popular ACA provisions such as a requirement that insurers cover those with pre-existing 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.

In addition, 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.

Freedom Caucus

The White House and House leaders both saw the key bloc as the House Freedom Caucus, a group of roughly three dozen hard-line 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 out of a desire to hold 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 give states the option to eliminate some of the mandates, 10 "essential health benefits," but would leave others in place.

During a midday procedural vote Friday, Ryan asked Meadows whether 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.

Meadows declined to answer questions after the bill was pulled 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.


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."

"So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done," Byrne said.

Trump had personally lobbied 120 lawmakers, either in person or on the phone, Spicer told reporters Friday. The president, he said, had "left everything on the field."

Vice President Mike Pence, White House chief of staff Reince Priebus and Health and Human Services Secretary Tom Price also engaged in last-ditch attempts to win over members Friday.

The heart of the argument made by GOP leaders was that keeping the Affordable Care Act would be a worse outcome than passing a potentially flawed replacement. That worked with some Republicans, but not all.

Ryan said he would confer with fellow Republicans in the coming days about how to proceed.

"Moving from an opposition party to a governing party comes with growing pains," Ryan told reporters. "We’re feeling those growing pains today. Doing big things is hard."