Why the Republicans' Bizarre and Failed Efforts to Repeal Obamacare Is a Major Defeat for Trump and the GOP

President Donald Trump and House Speaker Paul Ryan have stunningly failed their first major legislative test, as a bill to repeal Obamacare and defund Medicaid was pulled from House debate just before voting was to begin. A chorus of “No” erupted before its live video link went dead.

Ryan’s effort to repeal the Affordable Care Act and gut Medicaid was a risky gamble. It showed that the right-wing ideology of ending government programs under the guise of cutting spending and spreading personal freedom was more fantasy than reality, especially when the GOP faced undermining millions of lives.

Even though Republicans have been pledging to dismantle Obamacare for years, Ryan’s bill arrogantly went beyond Trump’s oft-repeated campaign pledge to repeal and replace the ACA by tying it to the first major defunding of Medicaid, an anti-poverty program that has served tens of millions for half a century. Across the country, tens of thousands of people attended rallies protesting the proposed healthcare cuts and unexpectedly deluged town meetings convened by Republicans in their home districts.

At a press conference after the bill was pulled, Ryan darkly predicted Obamacare would collapse under its own weight yet the government’s role in providing health coverage is here to stay. "Obamacare is the law of the land. It’s gonna remain the law of the land until it’s replaced," he said. "We did not have quite the votes to replace this law.”

What Really Happened?

It will become clear in coming days what prevented Ryan from gaining the votes needed for passage. Many news reports blamed the so-called House Freedom Caucus, whose several dozen members are notoriously inflexible and refused to budge despite numerous concessions from Ryan. While Trump threatened that anyone voting against the bill wouldn’t be re-elected in 2018, the libertarian Koch brothers countered they would set aside millions to defend members voting no, claiming Ryan’s bill didn’t go far enough.

A more intriguing narrative emerged a few hours later. More moderate Republicans had deserted Ryan and Trump, facing—as Democrats reminded them during the floor debate—tens of thousands of their constituents who would lose coverage, with polling finding that only 17 percent of Americans supported Ryan’s plan. 

“Some of the highest-profile opposition to the bill came from the 30 or so right-wing members of the House who make up the Freedom Caucus,” wrote the New Yorker’s Benjamin Wallace-Wells. “But by midday Friday—when the chair of the House Appropriations Committee announced his opposition to the bill—it seemed that the larger pool of opponents might come from the Party’s moderate wing. At lunchtime, the conservative Congressman Louie Gohmert, who was firmly against the bill, tweeted, a little gleefully, ‘Leadership hiding likely more NON-Freedom Caucus No votes than Freedom Caucus No votes.’"

While a Republican blame game has ensued in the capital, with conservatives decrying Ryan and Trump, millions of Americans who want to see health safety nets expanded and legislative reforms that cut their healthcare costs without losing coverage are undoubtedly breathing easier.

What Republicans will learn from this episode is worth watching. Ryan said the House GOP still has to learn how to govern after years as an opposition party. Other Republicans who have criticized the rise of right-wing extremism in the party, from rabid talk radio to websites trafficking in conspiracies, said the ardent right-wingers need to get over “self-inflicted blind spots” and realize that most of America isn’t like them.

“In March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage,” David Frum, a speechwriter for George W. Bush, wrote in the Atlantic. “That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to ‘choose’ to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.”

Frum’s comment is a remarkable indictment of how out of touch Ryan, Trump and the Freedom Caucus are. But he ends his essay with a plea that may fall on deaf ears: “I would urge that those conservatives and Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.”

The Negotiator-in-Chief Fails

The House action is also a major defeat for Trump, underscoring the fact that he lacks the experience and clout to lead his party to enact major legislation. White House Press Secretary Sean Spicer said Trump had personally lobbied 120 members of Congress and “left everything on the field” in negotiations.

Outsourcing the details to Ryan, who could not bring the GOP factions together, on top of Trump’s disinterest in policy details, is undoubtedly another reason why the repeal failed. Spicer said there were no plans to revive the repeal, although Trump later said he would be willing to try again once Democrats realize how problem-plagued Obamacare is.

It’s breathtaking to consider what Trump left “on the field” that the House nearly adopted. Although it did not completely erase Obamacare, Ryan’s bill was a trillion-dollar hollowing out of federal health programs. The bill did not revoke the ACA's ban on lifetime insurance coverage caps or allow insurers to decline coverage for pre-existing conditions, but it posed devastating blows to medical safety nets for the poor, working class, middle class and elderly.

The bill brought to the floor Friday would cause an estimated 24 million Americans to lose coverage in a decade with half of those losses next year alone, all while cutting Obamacare’s income taxes on the rich and medical industries, and ending minimum coverage requirements for insurers.

The decision to pull the bill came after nearly four hours of debate, in which most Republicans and Democrats stuck to party line positions heard in recent days. Few specified what could be done to bring down costs while ensuring the public gets the care they need. Both sides talked past each other, with few Democrats addressing Republican criticisms that had merit, and vice-versa.

That kind of legislative process, in which a new major program like Obamacare is fine-tuned by successive Congresses to respond to changing economic or societal trends, was not in evidence. What Trump and Ryan do next remains to be seen.

But as of midday Friday, the Republicans have failed to deliver in their first major legislative test and that has left millions across America breathing easier.