WASHINGTON — After a mad March sprint, the House stalled in its pursuit of a replacement for the Affordable Care Act, throwing into doubt whether the Trump administration and GOP Congress can deliver on their first major legislative goal.
With a vote set to occur Friday afternoon, Republican leaders instead decided to pull the bill from the floor amid widespread reports that they did not have the votes to pass it. House Speaker Paul Ryan met with President Trump, who had wanted a vote Friday, shortly before that decision was made.
Speaking to reporters Friday afternoon, Ryan said: “We came really close today, but we came up short.”
“Now we’re going to move on with the rest of our agenda,” he added, saying House leaders would pursue issues including tax reform.
It was a remarkable rebuke for Trump and House leaders, who had tried to rush the bill to the floor the same month it was publicly released and before an official analysis of the final version was issued by the Congressional Budget Office.
Trump on Thursday gave reticent House members an ultimatum: pass this bill or Obamacare stays. But ultimately, that tactic failed to persuade skeptical members of his party.
Republicans have for years sworn to undo the ACA. Many people on and off Capitol Hill believe they can’t so easily give up on that promise. But Ryan suggested Friday there were no immediate plans to advance another plan.
“Obamacare is the law of the land,” Ryan said. “We’re going to be living with it for the foreseeable future.”
Republicans streaming out of a conference meeting gave no clear indication of where the party would head next on health care either.
Some lawmakers expect Health and Human Services Secretary Tom Price to take regulatory actions to address problems Republicans see in the law. But there seemed to be a general sense that Congress would have to come back to the issue, at some point.
“If you look at this health care problem, it’s not going away,” said Congressman Bradley Byrne of Alabama. “At some point, we’re going to have to come back to this. Whether we do it incrementally, whether we do it in a grand bill, I don’t think you can say.”
Trump, speaking after the vote was pulled, simultaneously blamed Democrats for that failure while also signaling he might be open to working with them in the future.
Democrats “own it,” Trump said of Obamacare, speaking to reporters in the Oval Office shortly after the vote.
He said he would be open to working with Democratic leaders on a replacement bill in the future.
“Obamacare, unfortunately, will explode,” he added, saying premiums were going to skyrocket over the next year.
Some Republicans in Congress, such as Congressman Mike Coffman of Colorado, said they believed that might be the path forward, especially on reforms to the individual insurance market.
“I think ingredients are there, the environment is there, for a bipartisan solution,” he said. “As that part of the Affordable Care Act continues to collapse, I believe that a bipartisan effort will emerge to get that part fixed.”
In the end, opposition from the most conservative and more moderate members of the Republican conference doomed the bill.
The former group believed that the legislation, the American Health Care Act, didn’t repeal enough of Obamacare’s mandates or satisfactorily reduce health care costs. The latter bloc feared what the bill, projected to lead to 24 million more uninsured over the next decade, would mean for their constituents.
The bill was an ambitious attempt to roll back parts of Obamacare, keep its most popular elements, and overhaul the entire Medicaid system. However, it found little love beyond the Republican establishment.
Outside groups — from hospitals to doctors to patient advocates — were almost uniformly against it. They argued that it would lead to fewer people, particularly older, sicker, and poorer Americans, having access to health care. It was a dramatic swing from Obamacare, which eventually earned the support of most of the health care lobbying and advocacy groups.
The bill also faced political rebellion on Capitol Hill, from each end of the Republican conference.
House leaders and the White House tried to win over conservatives with some concessions, such as rolling back the ACA’s requirement for what services health plans must cover.
But it seemed every olive branch to the right hardened the resolve among moderates, who feared what undoing the law’s Medicaid expansion and transition to age-based, rather than income-based, tax subsidies would mean for their districts.
Outside analyses repeatedly found that the bill would lead to more uninsured and could raise premiums significantly for many older Americans who do not yet qualify for Medicare, for poorer people, and for Americans in rural areas that benefitted from Obamacare’s more generous financial assistance.
The softening of requirements for what services health plans must cover — shifting those decisions to the states — was also politically perilous. Obamacare for the first time required all health plans in the individual and small-group market to cover mental health and addiction services. Democrats were already drawing attention to the consequences of making that change amid the opioid crisis killing 30,000 Americans annually.
But those concerns are moot, at least for now.