President Trump and the GOP Humbled by Health Care Failure

The decision to cancel a vote to repeal major chunks of the Affordable Care Act was a humbling moment for President Trump and House Speaker Paul Ryan.

Their failure to repeal the law on Friday came on the heels of an intra-party revolt between conservatives and moderates, laying bare deep divisions in the GOP despite its control of Washington. Republicans seized the White House and both chambers of Congress on the core promise of repealing the controversial healthcare law, and proved unable to deliver.

“We were very, very close,” said Trump said in the Oval Office, expressing dismay that conservative members of his party bucked the bill. He claimed he was 10 to 15 votes short, although in an earlier interview with the Washington Post he said the number was five to 12.

For Ryan, a policy wonk who made repealing Obamacare his top priority, it was the starkest failure of his leadership ability. For Trump it was a an even more sobering moment. He has built his political identity on his deal-making prowess, and the defeat of his inaugural legislative priority cast his entire agenda into doubt.

“Being against things is easy to do: You just have to be against it,” Ryan said in a rebuke of his own members.

Republican officials on both ends of Pennsylvania Avenue were quick to blame the House Freedom Caucus, the conservative bloc of about three-dozen lawmakers whom Trump and House leadership courted for weeks but who ultimately refused to get behind the legislation. White House officials and Ryan offered amendment after amendment designed to win the group over, “but they couldn’t get to yes,” said one Administration official.

“There is a bloc of ‘no’ votes that we had that is why this didn’t pass,” said Ryan. “Some of the members of that caucus were voting with us, but not enough were.”

Some of those inducements to the conservatives alienated the moderates within the Republican conference, but officials appeared less inclined to blame them for the defeat.

The failure on Friday was not for lack of trying on the President’s part. Trump called members personally, invited them to the White House, granted concessions and used all the negotiating tactics he laid out in his book The Art of the Deal.

White House spokesman Sean Spicer said Trump “left everything on the field” in pushing for the vote. At a press briefing earlier in the afternoon, he highlighted how “how detail-oriented, how personal it was” for Trump. He added the president worked the phones until late in the night all week, and that his aides reached out over and again to wavering members.

But the man who once said “I alone can fix it” ultimately fell short. “At some point you can only do so much,” Spicer said. “At the end of the day, this isn’t a dictatorship.”

Despite promising for seven years to repeal former Obama’s signature achievement, Republican leaders now face a painful reality: Obamacare, the largest expansion of government entitlements in a generation, is here to stay.

Speaking to reporters after the vote, Trump expressed surprise that the Freedom Caucus wouldn’t get on board the vote.

“I’m disappointed, because we could have had it,” Trump said of the group. “I’m surprised.”

Republican lawmakers who had hoped to pass the bill blamed the Freedom Caucus for bringing down the effort.

“Quite frankly, if the Freedom Caucus had voted for this bill, which gave them 90% of what they wanted, it would have passed,” said Republican Rep. Phil Roe of Tennessee.

Trump and Ryan were searching frantically for the votes to pass the bill right up until the decision to pull it. The GOP whip team sought on Friday morning to convince members in the halls of the Capitol building, and Administration officials such as Health and Human Services Secretary Tom Price personally called lawmakers to try to sway them. Still, it was clear Republicans did not have the 216 votes in their own party to pass the bill by the time of a procedural vote shortly before noon.

At midday, Ryan traveled to the White House to brief Trump on the bad news: Despite all their efforts, House leadership and White House aides were still many votes short. Trump indicated he wanted to move forward with the vote, and the White House announced that it would take place Friday afternoon.

But two hours later, with no forward progress, Ryan recommended again to Trump that Republicans pull the vote. The president relented, sparing Republican lawmakers from a taking a politically painful vote on a GOP health care bill that polls show is deeply unpopular.

To moderates, the bill was draconian, cutting off the poor from access to health care — according to an estimate by the nonpartisan Congressional Budget Office, the bill would have caused 24 million people to lose insurance in the next decade.

For conservatives, it left too much of Obamacare’s regulations in place and did not go far enough in reducing the deficit and lowering premiums. Indeed, the CBO forecast that premiums would drop only 10 to 15%, after rising sharply through 2020.

The defeat suggests a trying future for the Republican legislative agenda. It further strains the credibility of Trump and Ryan’s relationship and their ability to whip votes and reinforces the power of the conservative House Freedom Caucus, which played an instrumental role in destroying the bill. Trump and Ryan indicated they hope to proceed to tax reform — a task that will grow more difficult by the loss of more than $150 billion in budgetary savings that would have been included in the health care bill.

For a Republican Party used to being in the opposition, it was a calamitous result for its first test at governing.

“Moving from an opposition party to a governing party comes with growing pains,” Ryan told reporters Friday, trying to put a positive spin on the unmitigated legislative disaster. “And we’re feeling those growing pains today.”