Trump and Ryan together own the defeat of this health-care bill. Both had pledged to deliver on a seven-year GOP promise to undo the Affordable Care Act. Ryan struggled to win over his conference, but it was the do-or-die ultimatum that Trump delivered to House Republicans that forced the speaker to try to hold a vote before he knew he could win.
“I will not sugarcoat this: This is a disappointing day for us,” Ryan told reporters Friday. “But it is not the end of the story.”
According to Bloomberg, neither Ryan nor Trump could ultimately win over rebellious party conservatives or moderates unnerved about the bill’s potential effects.
Trump told reporters in the Oval Office that the GOP was perhaps 10 votes short. “We’ll end up with a truly great health-care bill after the Obamacare mess explodes,” he said.
Ryan said the party will need some time to regroup. “Now, we’re going to move on with the rest of our agenda,” he said. “We will proceed with tax reform.”
Hospital Stocks Surge
Hospital stocks surged on the news of the cancellation, with the BI North America Hospitals Competitive Peer Group up 5.4 percent at the close in New York. Centene Corp., an insurer that focuses on Medicaid plans, rose 5.2 percent to $68.73. Hospitals and insurers like Centene would have been hurt by the GOP bill, which would cut millions of people from health insurance and roll back an expansion of the Medicaid program for the poor.
Lawmakers sounded ready to turn their attention to other issues.
House Ways and Means Chairman Kevin Brady of Texas said in a statement that Republicans on his panel "are moving full speed ahead with President Trump on the first pro-growth tax reform in a generation."
“I think that this is a learning lesson and we’ve made this shift from an opposition party to a governing party, and I hope that we do learn from this experience and that we are able to not make the perfect the enemy of the good,” said Andy Barr, a Kentucky Republican. “Because this is not a game.”
But the episode demonstrated that the Republicans’ long-awaited unified control of Congress and the White House doesn’t translate easily into unity of purpose.
In public, Trump praised Ryan’s work and Ryan thanked Trump for his efforts. Behind the scenes, though, the president’s aides blame Ryan for the bill’s embarrassing defeat, which stymied a top Republican goal, a senior administration official said.
Learn to Govern
Senate Judiciary Chairman Chuck Grassley of Iowa wrote on Twitter that one lesson from the episode was that "major social policy change in US must be bipartisan."
Representative Steve Womack said Republicans need to get back to basics about what it means to govern.
"We have moderates and we have ultra-conservative people in the conference. We have to re-educate ourselves in mathematics and basic arithmetic," Womack said. "We have to learn that we’re not just the party of no. We have to learn how to govern."
He called it "a loss for leadership."
It also leaves the health care issue in limbo in Washington.
Law of the Land
“Obamacare is the law of the land. It’s going to remain the law of the land until it’s replaced,” Ryan said. “We’re going to be living with Obamacare for the foreseeable future.”’
Democrats said they were ready to talk about how to improve Obamacare.
"It is now abundantly clear to every member of Congress that the only option for progress going forward is bipartisan legislation to improve the Affordable Care Act. That’s what the American people want. It’s time to govern," said John Yarmuth of Kentucky, the top Democrat on the House Budget Committee.
Trump himself waded into the legislative weeds to fight for the bill, meeting with scores of lawmakers and traveling to Capitol Hill on Tuesday to address the full House Republican conference. The president "left everything on the field," according to spokesman Sean Spicer.
‘Some Divisiveness’
Top Trump aides told House Republicans Thursday night that the president had run out of patience: he wanted a vote Friday, win or lose, even if that meant leaving Obamacare in place.
Trump and Ryan repeatedly called Obamacare a "disaster" that was collapsing under its own weight. But in 2015, the proportion of the U.S. population without insurance fell to a record low -- about 10.5 percent of Americans younger than 65, down from 18.2 percent in 2010.
The Republican proposal aimed to pull hundreds of billions of dollars out of the health system by winding down Obamacare’s expansion of Medicaid and limiting its subsidies, thereby threatening revenue for hospitals, doctors and insurance companies.
Conservatives wanted a more complete repeal, while moderates were taken aback when the nonpartisan Congressional Budget Office said the GOP plan would leave 24 million fewer Americans with health insurance by 2026.