GOP health-care bill: House Republican leaders abruptly pull their rewrite of the nationfs health-care law
By Mike DeBonis, Ed O'Keefe and Robert Costa
March 24 at 7:55 PM - The Washington Post
Republican leaders abruptly pulled their overhaul of the nationfs health-care
system from the House floor on Friday, a dramatic defeat for President Trump and
House Speaker Paul D. Ryan that leaves a major campaign promise unfulfilled and
casts doubt on the Republican partyfs ability to govern.
The decision leaves former president Barack Obamafs chief domestic
achievement in place and raises questions about the GOPfs ability to advance
other high-stakes priorities, including tax reform and infrastructure spending.
Ryan (R-Wis.) remains without a signature accomplishment as speaker, and the
defeat undermines Trumpfs 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 blamed Democrats instead. gWe couldnft get one Democratic
vote,h he said.
gI donft blame Paul,h 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 gcame really close
today, but we came up short.h He added: gWefre going to be living with Obamacare
for the foreseeable future.h
gItfs done, DOA,h said Energy and Commerce Committee Chairman Greg Walden
(R-Ore.), who drafted much of the legislation. gThis bill is dead.h
Instead, Republican leaders said, they would wait for the Affordable Care Act
to encounter fatal problems, believing that Democrats will then want to work
with them to make changes.
gAs you know, Ifve 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,h Trump said. gAnd they will come to us, we wonft have to come to
It remains far from certain that Republicans, now in control of the White
House and both houses of Congress, will be able to credibly foist responsibility
for the nationfs health care woes onto Democrats. What is certain is that
Republicans continue to have difficulty turning their campaign promises into
For eight 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.
gSince 2010, every Republican, with the exception of probably a handful, has
campaigned from dog catcher on up that they would do everything they could to
repeal and replace Obamacare,h White House Press Secretary Sean Spicer said
Friday. gTo get in and say youfre going to do something else would not be fair
to the American people.h
But in that time, the party never coalesced around a consensus alternative to
the law, and the scramble to develop one after Trumpfs election revealed some of
the reasons why: 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.
The drama on Capitol Hill unfolded amid new evidence that public opinion was
running against the bill: A Quinnipiac University poll released Thursday found
that U.S. voters disapproved of the legislation 56 to 17 percent, with 26
Signs of trouble across the Republican spectrum were evident by midday
Friday, as lawmakers streamed onto the House floor for a procedural vote .
In one stunning defection, House Appropriations Committee Chairman Rodney
Frelinghuysen (R-N.J.) announced midday that the bill was gunacceptableh and
that changes made late Thursday to placate conservatives graise serious coverage
and cost issues.h
He was joined by rank-and-file members such as Rep. David Joyce (R-Ohio), a
low-key appropriator, and Rep. Barbara Comstock (R-Va.), a longtime Ryan ally
who represents a competitive Northern Virginia congressional district.
But 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 billfs tax incentives and new Medicaid
Most of those demands were rejected, primarily due to the political reality
of holding 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 K. Bannon 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 gives states the option to eliminate some of the mandates,
ten gessential health benefits,h but would leave others in place.
That afternoon, the Freedom Caucus met to reject the deal. Hours later,
Mulvaney came to a closed-door House GOP conference meeting to deliver a final
ultimatum, saying Trump was ready to move on if the bill failed Friday.
Afterward, members lined up at microphones to deliver emotional pleas for party
unity. Some were veiled critiques of the Freedom Caucus, others were less
During the midday procedural vote Friday, Ryan asked Meadows if his group had
changed its stance. They 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 well over a dozen other members had announced their opposition by
Ryan left shortly after for the White House to tell Trump the bill would
Meadows declined to answer questions after the bill was pulled on 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.
gYou know what? I came here to do health care right,h said Rep. Paul Gosar
(R-Ariz.), who was one of six Republicans who voted against the procedural
gA no vote means we save Donald Trump from a Democratic majority in 2019,h
said Rep. Louie Gohmert (R-Tex.), one of Trumpfs most ardent congressional
The defeat has left the remainder of Republican governing agenda in Congress
in tatters. A proposed corporate tax overhaul favored by both Trump and Ryan
depended, in part, on the health care legislation proceeding — creating both
political momentum and fiscal space for dramatic action
Before the bill was pulled Friday, Rep. Bradley Byrne (R-Ala.) called it the
gfirst big vote in the presidency of Donald Trump,h one that would be ga
statement, not just about him and the administration, but about the Republican
Party and where wefre headed.h
gSo much about political power is about perception. And if the perception is
that you canft get your first big initiative done, then that hurts the
perceptions down the road about your ability to get other big things done,h
Trump had personally lobbied 120 lawmakers, either in person or on the phone,
White House press secretary Sean Spicer told reporters on Friday. The president,
he said, had gleft everything on the field.h
The White House did not think that defeat would slow other parts of Trumpfs
agenda including tax reform and immigration reform, Spicer added.
Vice President 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 — including a mid-day huddle with Freedom Caucus members
at the Capitol Hill Club, a GOP social hall next door to the headquarters of the
Republican National Committee.
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.
Rep. Joe Barton (R-Texas), a Freedom Caucus member who said he would have
voted for the bill, rejected the idea that the hard-liners were to blame.
gI thought we were constructive,h he said. gBecause of the sensitivity of the
issue, some of the normal compromise mechanism didnft quite get us there. That
doesnft mean they wonft get us there some time in this Congress.h
At the Capitol, a deflated Ryan said he would confer with fellow Republicans
in the coming days about how to proceed, but he made clear health care would no
longer be a central agenda item.
gMoving from an opposition party to a governing party comes
with growing pains,h he told reporters. gWefre feeling those growing pains
gDoing big things is hard,h he added.
Trump said he had no problem waiting for Democrats to seek cooperation with
Republicans on health care: gI never said I was going to repeal and replace in
the first 61 days.h
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.
Democrats, completely sidelined as Republicans quarreled among themselves,
quickly disputed Trumpfs accusations.
gThe blame falls with President Trump and with the Republicans,h Senate
Minority Leader Charles E. Schumer (D-N.Y.) said in a statement.
gSo much for the art of the deal,h he added.
Kelsey Snell, Sean Sullivan, David Nakamura, David Weigel, John Wagner and
Paul Kane contributed to this report.