WASHINGTON – Shortly after Republican leaders pulled the vote on their bill to repeal the Affordable Care Act, House Speaker Paul Ryan lamented that “moving from an opposition party to a governing party comes with growing pains and well, we’re feeling those pains today.”
He said the legislative defeat of efforts to fast-track the Republican replacement legislation raised the question: “Are all of us willing to give a little to get something done?”
Neither Ryan nor President Donald Trump, author of “The Art of the Deal,” could cut a bargain with fellow Republicans, based on the premise an imperfect bill’s better than walking away from their promise to repeal Obamacare.
Republican Rep. Austin Scott of Georgia blamed the failure to get sufficient GOP support for the measure on members of the conservative Freedom Caucus who would not yield to pressure from the president.
“Unfortunately,” he said, “(Rep) Mark Meadows (R-N.C.) and a select few members of the Freedom Caucus chose to sabotage legislation that the president and a majority of Republicans in the House wanted to pass that would have eased the burden of increased costs, diminished access to care, and a lower quality of care that resulted from President Obama’s health care law.”
In floor speeches and interviews through the day, proponents like Rep. Lou Barletta, R-Pa., argued that failure would trigger voter anger.
"There will be consequences in the elections because of questions about our ability to govern,” he warned.
Barletta, a conservative lawmaker, had been a hold out until Trump and Ryan agreed to embrace his bill to prevent illegal immigrants from receiving Medicaid subsidies. He urged approval “even if it doesn’t do everything we would want. The alternative leaves Obamacare in place.”
Another late supporter, Rep. Joe Barton, R-Texas, said in a floor speech he decided to back the bill when Republican leaders, in a nod to conservatives, added an amendment removing the requirement insurance policies cover 10 “essential benefits,” including maternity care and mental health. Republicans say they added to the high cost of health insurance.
"We all want to score a touchdown,” said Barton. “Sometimes we take a field goal. But what we don't want to do is take a safety.”
Rep. Larry Buchson, R-Ind., also made the argument that voting against the GOP bill would mean “preserving the Obamacare disaster.”
Rep. Kevin Brady, R-Texas, chairman of the House and Means Committee, which handled many of the bill’s details, played the Trump card as the hour approached for the vote.
“The choice is clear,” he said “Stand with @POTUS or stand with #Obamacare. I stand with @realDonaldTrump.”
Conservative Republicans, in the days leading up to Friday’s showdown, complained the bill left in place federal subsidies in the form of tax credits to reduce the cost of health insurance to lower income earners. Tax credits, they said, only perpetuate a costly entitlement that contribute to the staggering national debt.
Rep. Tom Massie, R-Ky., mockingly described the Republican plan on MSNBC’s Morning Joe show Thursday as “replacing mandates, subsidies and penalties with mandates, subsidies and penalties.”
Massie was one of a few Republicans who said Trump played a role in the defeat by demanding a vote Friday, even though some conservative and moderate GOP lawmakers still had problems with the bill and its short timeline of consideration.
“If Exec branch tells Legislative branch ‘when 2 vote’ ‘how 2 vote’ & ‘what it will b allowed 2 work on if vote fails’ is that a republic?” Massie tweeted.
Republican Rep. Louie Gohmert of Texas, who opposed his party’s health care bill, did not lay failure of its first big legislative test on Trump.
“The president did everything he could,” Gohmert told reporters after the vote’s cancellation. “But it was a bad bill.”
Gohmert criticized leaders for not including conservatives in the initial writing of the bill, adding: “Hopefully we’ll learn a lesson from this.”
Moderates, however, balked that the subsidies were too skimpy. To mollify them, House leaders increased tax credits for older people. But a damaging Congressional Budget Office report analysis of the added subsidies would not lower the projected increase in the number of uninsured – projected at 24 million over a decade.
In an effort to bring upstate New York’s reluctant Republicans aboard, Ryan amended the bill to block New York State from funding its Medicaid program through property tax revenue from rural counties. Republican Rep. Elise Stefanik, who represents rural northeast New York and co-chair of the moderate Tuesday Group, appreciated the gesture but refused to say how she would vote.
“We need to continue working to find solutions we can agree on that will help fix our broken healthcare system,” Stefanik said.
Supporters of the Republican plan lamented not being able to reach a deal. Rep. Todd Rokita, R-Ind., reminded his colleagues that the vote was not to enact the bill into law but rather to send it to the Senate for further consideration there.
“This legislation was not perfect,” said Rokita. “But it was an important step forward in keeping our promise to the American people to repeal Obamacare and replace it with better, conservative health care reforms.
Rep. Keith Rothfus, R-Pennsylvania, who planned to vote for the bill even though he didn’t tip his hand in advance, said: “The Republican plan offered an opportunity to begin the process of moving away from Washington mandates and one-size-fits-all control to the greater flexibility and choice people want.“