A new dynamic may be emerging in the House: A right and left flank within the GOP willing to buck leadership

Paul Kane, reporting for the Washington Post:

President Trump and House Speaker Paul D. Ryan made it a binary choice: You’re either for their health-care legislation or you’re for “Obamacare.”

From Reps. Trent Franks (R-Ariz.) to Rodney Frelinghuysen (R-N.J.), spanning the party’s ideological spectrum, the answer came back Friday: No, it’s much more complex. It was filled with several different options and possible routes ahead, and dozens of Republicans agreed with their sentiment.

That left Republicans well short of the votes they needed to fulfill a seven-year promise to destroy the 2010 Affordable Care Act once they were fully in charge, delivering a stinging defeat to both Ryan and Trump.

It also suggested a new dynamic in which both the right and left flanks of the Republican conference are emboldened to challenge leadership. And that could make each future negotiation more difficult as the issue matrix gets more complicated and the pockets of internal GOP resistance continue to grow, not shrink, in the new era of Trump’s Republican-controlled Washington.

Some parts of these botched negotiations looked a lot like the recent past. Franks and his House Freedom Caucus cronies played the role of obstructionists who will buck party leaders no matter if it’s John A. Boehner, Ryan’s predecessor, or now Trump, as well. These ideologues gobbled up tons of attention, resulting in much care from Trump, Vice President Pence and top West Wing advisers.

By lunchtime Friday, Franks still would not commit to publicly supporting the bill — even though he admitted it was far better than current law. “Of course it is, yeah, it’s a lot better than Obamacare, of course it is. There’s not even any comparison,” Franks said a few hours before the legislation went down in flames.

Franks remained upset that conservative proposals were left out of the bill because they would have violated Senate budget rules, meaning that the proposal to replace the ACA was nowhere near to his liking.

“That still is like putting dirt in ice cream,” he said.

Other parts of the negotiation, however, were new and quite different from the previous six years of Republican control of the House. Nothing capped this off more than the stunning announcement Friday morning from Frelinghuysen, just three months into his hold on the coveted Appropriations Committee gavel, that bucked leadership.

“Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents,” he said in a statement.

A 22-year veteran whose family traces its establishment lineage to the Continental Congress, Frelinghuysen won his chairmanship uncontested with the blessing of Ryan and the leadership team. He’s not someone who rocks the boat — he supported impeachment articles against President Bill Clinton — but his pronouncement Friday sent a jolt through the Capitol.

He also joined a long list of influential centrists who rejected the proposal on policy grounds, not out of fear politically. Frelinghuysen has received more than 60 percent of the vote in all but one election.

If anyone should back Ryan — he’s a new committee chairman, he’s safe back home — it would have been Frelinghuysen. Instead, he sent a message to a few dozen other Republicans who have more troubling districts that they, too, should break from the president and the speaker.

More here.

Donald, This I Will Tell You

Maureen Dowd, writing in the New York Times:

Dear Donald,

We’ve known each other a long time, so I think I can be blunt.

You know how you said at campaign rallies that you did not like being identified as a politician?

Don’t worry. No one will ever mistake you for a politician.

After this past week, they won’t even mistake you for a top-notch negotiator.

I was born here. The first image in my memory bank is the Capitol, all lit up at night. And my primary observation about Washington is this: Unless you’re careful, you end up turning into what you started out scorning.

And you, Donald, are getting a reputation as a sucker. And worse, a sucker who is a tool of the D.C. establishment.

Your whole campaign was mocking your rivals and the D.C. elite, jawing about how Americans had turned into losers, with our bad deals and open borders and the Obamacare “disaster.”

And you were going to fly in on your gilded plane and fix all that in a snap.

You mused that a good role model would be Ronald Reagan. As you saw it, Reagan was a big, good-looking guy with a famous pompadour; he had also been a Democrat and an entertainer. But Reagan had one key quality that you don’t have: He knew what he didn’t know.

You both resembled Macy’s Thanksgiving Day balloons, floating above the nitty-gritty and focusing on a few big thoughts. But President Reagan was confident enough to accept that he needed experts below, deftly maneuvering the strings.

You’re just careering around on your own, crashing into buildings and losing altitude, growling at the cameras and spewing nasty conspiracy theories, instead of offering a sunny smile, bipartisanship, optimism and professionalism.

You promised to get the best people around you in the White House, the best of the best. In fact, “best” is one of your favorite words.

Instead, you dragged that motley skeleton crew into the White House and let them create a feuding, leaking, belligerent, conspiratorial, sycophantic atmosphere. Instead of a smooth, classy operator like James Baker, you have a Manichaean anarchist in Steve Bannon.

You knew the Republicans were full of hot air. They haven’t had to pass anything in a long time, and they have no aptitude for governing. To paraphrase an old Barney Frank line, asking the Republicans to govern is like asking Frank to judge the Miss America contest — “If your heart’s not in it, you don’t do a very good job.”

You knew that Paul Ryan’s vaunted reputation as a policy wonk was fake news. Republicans have been running on repealing and replacing Obamacare for years and they never even bothered to come up with a valid alternative.

And neither did you, despite all your promises to replace Obamacare with “something terrific” because you wanted everyone to be covered.

Instead, you sold the D.O.A. bill the Irish undertaker gave you as though it were a luxury condo, ignoring the fact that it was a cruel flimflam, a huge tax cut for the rich disguised as a health care bill. You were so concerned with the “win” that you forgot your “forgotten” Americans, the older, poorer people in rural areas who would be hurt by the bill.

As The Times’s chief Washington correspondent Carl Hulse put it, the G.O.P. falls into clover with a lock on the White House and both houses of Congress, and what’s the first thing it does? Slip on a banana peel. Incompetence Inc.

“They tried to sweeten the deal at the end by offering a more expensive bill with fewer health benefits, but alas, it wasn’t enough!” former Obama speechwriter Jon Favreau slyly tweeted.

Despite the best efforts of Bannon to act as though the whole fiasco was a clever way to bury Ryan — a man he disdains as “the embodiment of the ‘globalist-corporatist’ Republican elite,” as Gabriel Sherman put it in New York magazine — it won’t work.

And you can jump on the phone with The Times’s Maggie Haberman and The Washington Post’s Robert Costa — ignoring that you’ve labeled them the “fake media” — and act like you’re in control. You can say that people should have waited for “Phase 2” and “Phase 3” — whatever they would have been — and that Obamacare is going to explode and that the Democrats are going to get the blame. But it doesn’t work that way. You own it now.

More here.

Republicans Land a Punch on Health Care, to Their Own Face

Jennifer Steinhauer, reporting for the New York Times:

At the end of the long day, the alliance of conservative ideologues who once shut down the government over President Barack Obama’s health care law could not find the will to repeal it.

Since the Tea Party wave of 2010 that swept House Republicans into power, a raucous, intransigent and loosely aligned group of lawmakers known as the Freedom Caucus — most from heavily Republican districts — has often landed a punch to its own party’s face.

Friday’s defeat of the Republican leadership’s bill to repeal the Affordable Care Act was a return to form, handing an immense defeat to President Trump and embarrassing Speaker Paul D. Ryan in his own House. It also challenged the veracity of their long-held claims that a Republican president was all they needed to get big things accomplished.

The most important question for Republicans now is whether the members of the Freedom Caucus will find themselves newly emboldened in ways that may bring the new president more defeats — or whether Mr. Ryan will do what former Speaker John A. Boehner could not, and find a way to shred their influence for good.

“If you are defined by your opposition to leadership, it’s hard to be part of a governing coalition,” said Alex Conant, a onetime aide to Senator Marco Rubio, the Florida Republican who was once a Tea Party star. “Their opposition to Trump’s health care bill should surprise nobody who’s paid attention for the last six years. Even the world’s best negotiator can’t make a deal with someone who never compromises.”

But the Freedom Caucus has never been about compromise. In 2011, it picked a huge, costly fight over Planned Parenthood. In 2013, it orchestrated a government shutdown over funding for the health care law. Then, in its most striking move, it deposed Mr. Boehner in 2015. The common thread: It has continuously been an adversary of legislation itself.

But after years of opposing power — both in the White House, which was occupied by a Democrat, and in the leadership of their own party — the conservatives were offered a chance to negotiate directly with the president and his budget director, a former Freedom Caucus member, over the bill to replace the Affordable Care Act. The members pushed and pushed Mr. Trump to the far right edges of policy, just as they have done for years on other bills. But they still could not get to “yes,” and therefore became part owners of the expansive health law they were trying to undo.

“They made the perfect the enemy of the good,” said Representative Roger Marshall, Republican of Kansas. “I don’t know how they can go back home and tell people they voted to keep Obamacare, voted to keep funding Planned Parenthood.”

Indeed, members of the Freedom Caucus — which is supported by outside conservative groups — have often claimed the mantle of pure conservatism, but their tactics have been seen by many in their party as uniformly counterproductive.

Time after time, they undermined Republican leaders’ efforts to secure wins for the conservative cause by overreaching and demanding the impossible.

They have anointed Representative Mark Meadows of North Carolina as their leader and principal spokesman. But they occasionally get help from three senators sympathetic to their cause: Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah.

At critical times, House conservatives have forced their party to make deals with Representative Nancy Pelosi of California, the Democratic leader — an idea anathema to most Republicans, who would seethe.

This time, by negotiating with Mr. Trump on the complex issue of health care, a measure whose complexity he did not seem to fully grasp, they moved an already contentious bill further and further to the right, eliminating too many benefits to keep moderate and other conservative members on board. Even Mr. Trump was said to be taken aback by their attempts to remove things Republicans have long promised to keep, like health insurance benefits for children up to 26 years old.

More here.

Trump’s First Legislative Effort Fails as G.O.P. Pulls Bill to Repeal Obamacare

Via The New York Times:

House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday afternoon in a humiliating defeat for President Trump on the first legislative showdown of his presidency.

Paul D. Ryan, the House speaker, rushed to the White House shortly after noon to tell Mr. Trump he did not have the votes for a repeal bill that had been promised for seven years — since the day President Barack Obama signed his landmark health care act into law.

Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums. The president said he did not fault Mr. Ryan and said that he was pleased to move past his first legislative fight. He maintained that he was merely going along with the House bill.

But the effort to win passage was hardly kept secret. Vice President Mike Pence and Tom Price, the health secretary, rushed to Capitol Hill for a late appeal to House conservatives, but their pleas fell on deaf ears.

“You can’t pretend and say this is a win for us,” said Representative Mark Walker, Republican of North Carolina, who conceded it was a “good moment” for Democrats.

“Probably that champagne that wasn’t popped back in November may be utilized this evening,” he said.

At 3:30 p.m., Mr. Ryan called Republicans into a closed-door meeting to deliver the news that the bill would be pulled, with no plans to try again. The meeting lasted five minutes.

“We’re going to go home and spend time with our families and time with our constituents, and one day I hope we can eventually repeal,” said Representative Chuck Fleischmann, Republican of Tennessee.

The Republican bill would have replaced the Affordable Care Act, known informally as Obamacare, which mandated that almost everyone have health insurance, with a system of age-based tax credits to purchase health insurance plans.

But it never won over conservatives who wanted a far more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance.

With the House’s most hard-line conservatives holding fast against it, the bill’s support collapsed Friday after more rank-and-file Republicans came out in opposition, including Representatives Rodney Frelinghuysen of New Jersey, the soft-spoken chairman of the House Appropriations Committee, and Barbara Comstock of Virginia, whose suburban Washington district went handily for the Democrat nominee, Hillary Clinton, in November.

“Seven years after enactment of Obamacare, I wanted to support legislation that made positive changes to rescue health care in America,” Mr. Frelinghuysen wrote in a statement. “Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey.”

In the end, Republican leaders doomed the bill by agreeing to eliminate federal standards for the minimum benefits that must be provided by certain health insurance policies.

“This provision is so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret capitol lair last night,” said Representative Jim McGovern, Democrat of Massachusetts. “This backroom deal will kill the requirement for insurance companies to offer essential health benefits such as emergency services, maternity care, mental health care, substance addiction treatment, pediatric services, prescription drugs and many other basic essential services.”

Defeat of the bill could be a catalyst if it forces Republicans and Democrats to work together to improve the Affordable Care Act, which virtually every member of Congress believes needs repair. Democrats have been saying for weeks that they want to work with Republicans on such changes, but first, they said, Republicans had to abandon their drive to repeal the law.

Much more here.

‘We just pulled it,’ Trump says of health bill

Via The Washington Post:

House Republican leaders abruptly pulled a Republican rewrite of the nation’s health-care system from consideration on Friday, a dramatic acknowledgment that they are so far unable to repeal the Affordable Care Act.

“We just pulled it,” President Trump told the Washington Post in a telephone interview.

The decision came a day after Trump delivered an ultimatum to lawmakers — and represented multiple failures for the new president and House Speaker Paul D. Ryan (R-Wis.).

The decision means the Affordable Care Act remains in place, at least for now, and a major GOP campaign promise goes unfulfilled. It also casts doubt on the GOP’s ability to govern and to advance other high-stakes agenda items, including tax reform and infrastructure spending. Ryan is still without a signature achievement as speaker — and the defeat undermines Trump’s image as a skilled dealmaker willing to strike compromises to push his agenda forward.

“I don’t blame Paul,” Trump said, referring to Ryan.

Rep. Bradley Byrne (R-Ala.), who planned to vote for the legislation, said that Friday would have been the “first big vote in the presidency of Donald Trump. I think it’s a statement, not just about him and the administration, but about the Republican Party and where we’re headed.”

“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said in an interview before the decision.

The decision came hours after Ryan visited the White House to warn Trump that despite days of intense negotiations and sales pitches to skeptical members, the legislation lacked the votes to pass.

Trump had personally lobbied 120 lawmakers, either in person or on the phone, White House press secretary Sean Spicer reminded reporters on Friday. The president had “left everything on the field,” Spicer said.

Spicer said that no matter what happens, the White House did not think that defeat would slow other parts of Trump’s agenda including tax reform and immigration reform.

Vice President Pence, White House Chief of Staff Reince Priebus and Health and Human Services Secretary Tom Price also made a last-ditch attempt to win over members of the hard-line House Freedom Caucus, huddling with them at midday at the Capitol Hill Club, a GOP social hall next door to the headquarters of the Republican National Committee. All three exited the meeting quickly without taking questions.

In one stunning defection Friday, House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced at midday that the health care bill is “currently unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.”

Another moderate, Rep. David Joyce (R-Ohio) — who had met with Trump on Wednesday night — said he would vote against the bill. So did Rep. Barbara Comstock (R-Va.), a longtime Ryan friend and ally who represents a competitive Northern Virginia congressional district.

Rep. Paul Gosar (R-Ariz.), a Freedom Caucus member, was one of six Republicans who voted against a procedural resolution bringing the bill to the floor on Friday morning.

“You know what? I came here to do health care right,” said Gosar, a dentist. “This is one chance we that can get one-sixth of our GDP done right. It starts with here.”

At the heart of the argument made by GOP leaders to skeptical members: Keeping the Affordable Care Act is a worse outcome than passing a potentially flawed replacement.

“You want to score a touchdown, but sometimes, on the fourth down, you kick a field goal,” said Rep. Joe Barton (R-Tex.), the longest-serving member of Congress in the Freedom Caucus. “The choice is yes or no. I’m not going to vote no and keep Obamacare. That’d be a stupid damn vote.”

At the White House on Friday morning, Trump projected confidence as he answered shouted questions following an announcement of a presidential permit for the Keystone XL pipeline, a revived project that the president said would create jobs.

Asked by a reporter what he would do if the bill fails, Trump — seated at his Oval Office desk — shrugged and said: “We’ll see what happens.”

Trump also said he didn’t feel the process had been rushed and that Ryan should remain as speaker if the bill fails.

On Twitter, Trump said that “After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!”

With 237 House Republicans, party leaders can afford only 21 or 22 defections, depending on how many Democrats are present on Friday. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation. An unsuccessful vote could also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.

No matter what happens in the House, the ultimate fate of the legislation hinges on the Senate, where new uncertainty emerged about the timing of a vote despite earlier guidance that Senate Majority Leader Mitch McConnell (R-Ky.) planned to push for a vote next week.

The Congressional Budget Office warned senators on Friday that recalculating the rewritten House bill could take a week or more to produce, said several officials familiar with the discussions, who were not authorized to speak publicly about the matter.

That was expected to upend McConnell’s plan to finish their work and send the legislation to the White House for Trump’s signature before a two-week Easter recess, according to three people briefed on the matter.

Senate budget rules require that party leaders provide an official estimate of how much the legislation would cost and how it would change the deficit before scheduling a vote.

McConnell’s aides didn’t immediately return requests for comment.

Republicans have a 52-to-48 advantage in the Senate, but at least a dozen Republicans are on the fence about the legislation, because many of them want to maintain some of the current law’s more generous spending components.

When formal debate on the bill began on Friday morning, top leaders used a procedural vote to gauge last-minute support. House Majority Whip Steve Scalise (R-La.) was seen conferring with Rep. Christopher Smith (R-N.J.), a key holdout. House Ways and Means Committee Chairman Kevin Brady (R-Tex.) sat in the row behind them cajoling Rep. Patrick Meehan (R-Pa.), another moderate who has yet to announce what he plans to do.

Rep. Mark Meadows (R-N.C.), who chairs the Freedom Caucus, did not respond to requests for comment on Friday about his plans.

Rep. Ken Buck (R-Colo), a caucus member who said before the election that minor losses in the House Republican ranks would increase conservative clout, said he remained undecided.

“I’m examining life experiences,” he said. Asked to explain what he meant, he said he was joking.

Rep. Peter King (R-N.Y.), a moderate who had expressed qualms as recently as Tuesday, when he was singled out by Trump inside a private meeting of House Republicans, said he had all but decided to vote for the bill.

“I’m not one they should worry about,” he said.

More here.

A postponed health-care vote, a big GOP embarrassment and no good options ahead

Dan Balz, reporting for the Washington Post:

Thursday was supposed to be a glorious anniversary for President Trump and the Republicans. Seven years after President Barack Obama signed the Affordable Care Act, Republicans were poised to take the first concrete step toward repealing and replacing that law. Instead, Thursday produced an embarrassing setback that left the way forward far from certain.

Legislative sausage-making is never pretty, but what has been happening all week with the signature legislative priority of the GOP seems beyond the norms. Faced with possible defeat on the floor, House Republican leaders postponed a scheduled vote until Friday, hoping that another day of negotiations could produce what seven years of talking have failed to produce, which is a consensus bill that all factions of the party can support.

The difficulties Republicans are confronting are entirely of their own making. For seven years, Republican politicians have made one overriding bargain with their conservative constituency, which was that they would repeal Obamacare as their first order of business if they ever had the power to do so. Now that they have the power, they still haven’t found a way to make good on that promise.

The other reality that has become clearer as Republicans have struggled to turn a campaign promise into a satisfactory piece of legislation is that, even if they eventually put a bill on Trump’s desk, they still could be buying themselves political problems in the months and years ahead. That is perhaps a second-order problem right now, given the goal of getting something through the House. But as Obama and the Democrats learned, changing the health-care system is fraught, no matter which direction the changes go.

Failure to live up to the pledge to, at the very least, significantly scale back Obamacare is obviously the worst of all possible outcomes. Such a defeat would put the lie to the claim that the Republicans, now with full control of the executive and legislative branches, were ready to govern as a conservative party. Failure also would undermine the idea of the president as the dealmaker in chief, for he has thrown himself into the battle with notable energy and determination, putting his own prestige on the line.

Republicans have postponed votes on critical legislation before, bedeviled by opposition from the hardcore conservative faction. They’ve overcome those setbacks and could do so with health care. The president and Republican leaders are far from conceding defeat and will redouble efforts to cobble together the necessary votes in the House.

But at a minimum, Trump’s reputation as the closer in chief has taken a hit — and on the first big test of his presidency. The greater damage has been to the reputation of House Speaker Paul D. Ryan (R-Wis.) as the savvy intellectual godfather of a new conservative agenda around which his party could rally. This legislation, if eventually passed, may come to be known as Trumpcare, but for now it can more fairly be called Ryancare.

More here.

Healthcare quote of the day

I don’t know whether [Trump] will ultimately succeed or fail [on healthcare], but I will tell you that President Trump is so transactional, who knows what transactions he will be willing to make to pass this.

So far he’s acting like a rookie. It’s really been amateur hour. He seems to think that a charm offensive or a threat will work — that saying “I can do this for you” or “I can do this against you” will work. That’s not the way it works. You have to build real consensus, and you have to gain a real knowledge of the policy — and the president hasn’t done either of those things.

Nancy Pelosi, quoted in the New York Times.

As Trump takes ownership of GOP health bill, support for it drops

Greg Sargent, reporting for the Washington Post:


The fate of the GOP health plan appears to hang in the balance, with GOP leaders still struggling to find the votes to pass it in the House. There is widespread disagreement both about the bill and its prospects for passage. But one thing appears to be widely agreed upon: President Trump has now “taken ownership” of this bill.

Yet Trump’s ownership of the GOP plan is not having the desired effect. It doesn’t appear to be moving many Republicans — indeed, GOP critics of it appear to be hardening in their opposition — and a new poll out this morning finds that support for it is dropping.

Trump’s ownership of the bill is being widely praised by some Republicans. “He’s all in,” gushed Sen. Roger Wicker (R-Miss.). “It was the right thing for the president to take ownership of it,” enthused Rep. Patrick McHenry (R-N.C.). Meanwhile, other Republicans report that Trump has made an aggressive pitch to them for the bill, arguing that they will face a voter backlash in 2018 if they don’t deliver on their promise to repeal and replace the Affordable Care Act.

But NBC News reports that House Republicans are moving away from the bill:

Yesterday morning, we wrote that 17 House Republicans opposed or leaned strongly against the GOP health-care plan that’s scheduled for a vote Thursday. Then President Trump visited Capitol Hill and appeared to threaten GOP lawmakers …

After that visit, the number of Republicans opposing or leaning strongly against the legislation grew to 27, per NBC News’ count — when Trump and GOP leaders can’t afford more than 21 defections.

As the NBC First Read crew observes, it’s “clear that Trump’s arm-twisting hasn’t paid dividends — at least not yet.”

Meanwhile, a new Politico/Morning Consult poll finds that support for the bill has dropped six points among American voters nationwide, and more voters approve of Obamacare than of the GOP replacement:

Since the Congressional Budget Office released its cost estimate of the Obamacare alternative last week, showing steep coverage losses, the legislation’s approval rating has dipped six points, from 46 percent to 40 percent. Obamacare’s approval rating, on the other hand, sits at 46 percent, as it did in February.

Meanwhile, disapproval of the GOP bill has ticked up two points, for a total net swing against the bill of eight points. What’s more, the new Morning Consult poll shows that only 1 in 5 voters thinks it will decrease their health-care costs, while a plurality of 39 percent think they will increase. And note this:

Fifty-three percent of voters said they were less likely to support the legislation when taking into account the CBO estimate that it would lead to 24 million fewer people having health insurance in the next decade. And 59 percent of voters, including almost half of Republicans (49 percent), said they were less likely to support the bill because the CBO projects it could increase average premiums by 15 to 20 percent in its first two years after becoming law.

Majorities tilt against the legislation when told it would result in millions without coverage and would drive up costs, as the Congressional Budget Office has concluded.

More here.

How the GOP Crackup Happens

Rich Lowry, reporting for Politico:

Less than two weeks after the unveiling of the GOP Obamacare replacement, the party is already staring into the abyss.

The bill has had the worst rollout of any major piece of legislation in memory, and failure is very much an option. If the proposal falters, it will be a political debacle that could poison President Trump’s relationship with Congress for the duration.

That relationship is awkward and tenuous. It is an uneasy accommodation between a GOP Congress that would find a more natural partner in a President Rubio, Cruz or Bush, and a President Trump who would, presumably, be happier to work with Speaker Dave Brat — the populist congressman from Virginia — than with Speaker Paul Ryan.

This is a product of how the Republican sweep of 2016 was won on separate tracks. Trump tore up many Republican orthodoxies and went out and found a different way to unlock the electoral map, winning in the industrial Midwest. Congressional Republicans more or less stuck with the usual script, kept Trump at arm’s length, and held their majorities in the House and the Senate.

As a result, there is no significant Trumpist wing in Congress. The faction most favorable to him, the House Freedom Caucus, is made up of ideological conservatives whose philosophy is at odds with Trump’s economic populism, even if they are drawn to his anti-establishmentarianism.

And there was no off-the-shelf Trump legislation that Congress could begin on immediately. In the campaign, Trump identified a constituency and a message, but the agenda was often symbolic (Mexico will pay for the wall) or nebulous (negotiating better trade deals).

* * *

Even more than most politicians, Trump has no interest in owning failure. The explanation of the president and his supporters won’t be that he backed a flawed strategy and bill in the House and paid the price. It will be that he was stabbed in the back. He went along with a GOP establishment politics that doesn’t understand or care about Trump voters, and he can never make that mistake again.

There’s almost no question that Trump would win any blame game. He would have the larger megaphone, the more intense supporters and much sharper elbows. He could instantly define Paul Ryan as a creature of the Washington swamp and decide to triangulate away from the GOP Congress rather than work with it.

This would mean Trump would be a president not without a party necessarily, but without a Congress. It would make major legislative accomplishments impossible, although if Obamacare repeal and replace fails, that might be the reality regardless.

More here.

The GOP masterminds behind Obamacare’s ‘death spiral’

Dana Milbank, reporting for the Washington Post:

House Speaker Paul D. Ryan (R-Wis.) says Obamacare is in a “death spiral,” and he should know: He’s the one who cut the power to Obamacare’s engines and pointed its nose downward.

President Trump says, ObamaCare is imploding and will only get worse,” and he should know: He’s the one who placed the explosives under Obamacare’s foundation.

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), co-author of the GOP health-care bill, says of Obamacare: “We’ve arrived at the scene of a pretty big wreck.” And he, too, should know: He’s the one who dumped oil and tire spikes on the road.

This is some prodigious cynicism, even by Washington standards. In the past couple of months, the Trump administration and the new GOP Congress have done all they could to undermine Obamacare, and now that their efforts are beginning to succeed they’re claiming Obamacare is collapsing under its own weight.

The Affordable Care Act may or may not be in the death spiral Republicans have long craved, but it has definitely deteriorated since the Trump administration and the new GOP Congress assumed power. And no wonder: They sabotaged it.

They withdrew TV and online advertising encouraging people to sign up for coverage during the crucial period before the deadline. The White House issued an executive order and took other actions that strongly implied it would no longer enforce the “individual mandate” requiring people to sign up for coverage. And the constant promises of imminent repeal have spooked both insurers and individuals from participating.

Trump and congressional allies have, in short, created a self-fulfilling expectation of collapse. “What’s happened since the Trump administration took power is tremendous uncertainty about the future of the ACA,” said Larry Levitt of the Kaiser Family Foundation, which conducts health-care research but takes no position on the law. “For people who were on the fence about participating, the future uncertainty pushes them over. Many insurers, meanwhile, were willing to suffer short-term losses with the promise of future profits, but if the ACA’s future is uncertain there’s little reason to stick around.”

* * *

Now opponents of the law are using the wreckage they created to justify their own plan, which the nonpartisan Congressional Budget Office projects would cause 24 million more people to go without coverage than would have under Obamacare. It would dramatically cut coverage for poor and middle-class Americans, increase costs sharply for older Americans and give hundreds of billions in tax breaks to the wealthy and corporate interests. There would actually be more people without health insurance under the GOP plan than there were before Obamacare.

Confronted with the task of selling this cruel plan to the public, the administration and its allies are doing what they’ve done before: attempting to deny reality. They’re seeking to discredit the CBO, perhaps hoping people won’t recall that Republicans picked the man who runs it: Keith Hall, a conservative former George W. Bush administration economist .

Worse, they’re perpetuating the canard that Obamacare was collapsing on its own, leaving them no choice but to repeal it. Walden argued that “if we don’t intercede now, fewer will have access to insurance — period.” Ryan said the “law is collapsing” and asked: “Are we going to stay with Obamacare and ride out the status quo?” And Trump floated a fallback plan: pass nothing, let Obamacare fail and blame Democrats for it.

More here.

Trump loyalists sound alarm over ‘RyanCare,’ endangering health bill

Robert Costa and Philip Rucker, reporting for The Washington Post:

A simmering rebellion of conservative populists loyal to President Trump is further endangering the GOP health-care push, with a chorus of influential voices suspicious of the proposal warning the president to abandon it.

From headlines at Breitbart to chatter on Fox News Channel and right-wing talk radio, as well as among friends who have Trump’s ear, the message has been blunt: The plan being advanced by congressional Republican leaders is deeply flawed — and, at worst, a political trap.

Trump’s allies worry that he is jeopardizing his presidency by promoting the bill spearheaded by House Speaker Paul D. Ryan (Wis.), arguing that it would fracture Trump’s coalition of working- and middle-class voters, many of them older and subsisting on federal aid.

Vice President Pence and administration officials scrambled Tuesday to salvage the plan amid widespread dissatisfaction in both the Senate and House over the Congressional Budget Office’s estimate that 24 million fewer people would be insured in a decade under the Ryan proposal, titled the American Health Care Act.

Trump — who has not yet fully used the bully pulpit of the presidency to rally support for the plan — spoke privately with Ryan on Tuesday afternoon. They discussed the various factions, the opinions of several key lawmakers and developing a closing strategy, according to two people with knowledge of the call.

Trump loyalists warned that the president was at risk of violating some of his biggest campaign promises — such as providing broad health coverage for all Americans and preserving Medicaid and other entitlement programs — in service to an ideological project championed for years by Ryan and other establishment Republicans.

“Trump figures things out pretty quickly, and I think he’s figuring out this situation, how the House Republicans did him a disservice,” said Christopher Ruddy, a longtime Trump friend. “President Trump is a big-picture, pragmatic Republican, and unfortunately the Ryan Republican plan doesn’t capture his worldview.”

Ruddy, the chief executive of Newsmax Media, published a column Tuesday urging Trump to “ditch” the current bill.

Inside the White House, senior officials said they are taking note of the mounting opposition. “You can’t be so blind that you’re not seeing the outside noise,” said one adviser, who spoke on the condition of anonymity because the adviser was not authorized to speak publicly.

A second adviser, who also requested anonymity to speak candidly, said, “We take their views seriously and we’re listening, but we do appreciate when those concerns are shared privately and with a smaller megaphone.”

Much more here.

The Republican health-care plan’s top critics? Republicans.

Dana Milbank, writing in The Washington Post:

President Trump, long at the forefront of intellectual discovery, last week came up with a major finding: Health-care reform is hard. “Unbelievably complex,” in fact.

“Nobody knew that health care could be so complicated,” the president said.

Actually, we all knew. That’s why Republicans’ successor plan to Obamacare, “repeal and replace,” became repeal and delay. That’s why House Republicans kept their draft legislation under guard in a secret, GOP-only “reading room” in the Capitol, so copies wouldn’t leak. That’s why they decided to push the legislation through committees this week only a couple of days after introducing it — and before waiting for the Congressional Budget Office to say how much the legislation would cost taxpayers and how many people would lose health insurance.

Apparently they have to pass the bill so we can find out what’s in it.

And now that Republican leaders in the House have finally revealed their plan, the magic formula turns out to be . . . a cheap knockoff of Obamacare: covering fewer people, charging them more and giving a tax cut to the rich.

Democrats, predictably, panned it because it’s a cheap knockoff of Obamacare, and they prefer the original over imitators. The bigger problem for GOP leaders is that conservatives also panned it because, well, it’s a cheap knockoff of Obamacare.

Outside the Capitol Tuesday afternoon, conservative legislators lined up to denounce the bill.

“A step in the wrong direction,” said Sen. Mike Lee (R-Utah).

Rep. Louie Gohmert (R-Texas) likened the “flawed bill” to “horse excrement.”

“Let’s not lower the bar on what we believe simply because a Republican is in the White House,” said Rep. Mark Sanford (R-S.C.).

Rep. Thomas Garrett (R-Va.) complained that the bill was drafted “in a cloak of secrecy” and blessed a “new entitlement.”

“Obviously,” deduced Rep. Mark Meadows (R-N.C.), “we have some serious concerns.”

The sales effort so far has been wanting. Rep. Jason Chaffetz (R-Utah), defending the legislation on CNN on Tuesday, suggested that Americans, “rather than getting that new iPhone that they just love and they want to spend hundreds of dollars on that, maybe they should invest in their own health care.”

Much more here.

Backlash grows against House GOP proposal to replace Obamacare

Mike DeBonis, Robert Costa, and David Weigel, reporting in The Washington Post:

Lawmakers prepared Wednesday for a marathon day sifting through a Republican proposal to revise the Affordable Care Act, which has met with widespread resistance from conservatives in and out of Congress, moderates in the Senate and key industry stakeholders since House GOP leaders released it on Monday.

The most imminent and serious threat to the plan crafted by House Speaker Paul D. Ryan (R-Wis.) was the growing backlash from conservative lawmakers and powerful outside groups who argue that the draft is nothing more than “Obamacare Lite,” a disparaging reference to the former president’s signature 2010 domestic achievement.

The lawmakers do not represent a majority of Republicans in either chamber of Congress, but there could be enough of them to scuttle any health-care bill they oppose — and several said Tuesday they intend to use that leverage to force major changes to the measures. Their efforts could begin Wednesday morning, when the House Ways and Means and ­Energy and Commerce panels begin taking up the legislation.

President Trump said at a meeting with House Republicans on Tuesday afternoon that he would work with them to secure passage of their plan.

According to several attendees, Trump made clear that he wants the House bill to be approved and land on his desk largely intact. He pledged to become personally involved in persuading skeptical lawmakers and warned that failing to pass the legislation would result in trouble at the ballot box for Republicans who pledged to repeal and replace Obamacare.

“The president said very clearly . . . this is the bill he wants on his desk, and he wants to get this done quickly,” said Rep. Patrick T. McHenry (R-N.C.), the House GOP chief deputy whip, who attended the meeting. “The president is paying attention to what people are saying and doing, where they’re saying it and doing it. He is highly aware and has a highly attuned ear to what is happening in the press and has a real understanding of the challenges in order to get this bill on his desk.”

As if to prove it, Trump targeted Sen. Rand Paul (R-Ky.) — who has emerged as the bill’s chief skeptic — with a tweet Tuesday evening: “I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!”

* * *

Following late-afternoon votes Tuesday, several Republican senators privately groused that they felt rushed by their GOP colleagues in the House and by Trump, who they said does not fully grasp the Senate’s slower pace or its concerns.

The senators also expressed skepticism that key White House officials with deep ties to Congress’s conservative wing would eventually be able to lock up the votes for the current plan. Instead, they said there is confusion over who is managing the process and which administration figures, if any, have power to sway Trump on the issue.

One Republican senator, who spoke on the condition of anonymity because negotiations are ongoing, said several senators are asking their leadership to “take it easy” in terms of the timeline, allowing space to debate and analyze the proposal with a “clear understanding of the costs involved.” “If that takes months or a year, so be it,” the senator said.

A second GOP senator said the party was making a “mistake” in its rollout by taking “too much ownership” of health care after years in which Democrats were identified with Obamacare.

More here.

Republicans in Washington Are in Control, but Not in Agreement

Carl Hulse, reporting in the New York Times:

Six weeks into unified government, Republican leaders are back to where they were in the Obama years — under fire from conservatives for giving too much ground on major policy issues.

In particular, the party push to undo the health care law while avoiding major disruptions in coverage — a priority reinforced on Tuesday by President Trump in his prime-time address — is encountering major resistance from the right. The determined opposition has thrown the party’s repeal effort into confusion and created uncertainty over what to eliminate and how to pay for any alternative.

Three Republican senators this week said they would vote only for a straightforward repeal of the law despite reluctance to do so on the part of several colleagues worried about cutting off health insurance to their constituents. With Senate Republicans holding only a 52-seat majority, those three alone — Senators Rand Paul of Kentucky, Ted Cruz of Texas and Mike Lee of Utah — could doom a Republican measure opposed by all Democrats. House conservatives are also lining up against emerging repeal-and-replace proposals in numbers that could deny House Republicans the needed votes to deliver on a top priority.

“We are a force to be reckoned with,” declared Mr. Paul, who has orchestrated the coordinated resistance with the ultraconservative House factions.

Conservatives are also showing some unease at sudden indications from Mr. Trump that he might be willing to embrace an immigration overhaul that could lead to legal status for millions of undocumented immigrants. And quick rejection by Republican leaders of many of Mr. Trump’s proposed budget cuts as unachievable is not likely to go down well either.

It wasn’t supposed to be this way with Republicans in control of Congress and the White House for the first time since 2006. They were certain they would now have the muscle to carry out their agenda. But just as Mr. Trump has discovered that revising the health law is “unbelievably complex,” Republicans are finding that being in charge doesn’t mean being on the same page — or even reading the same book.

The developing situation is reminiscent of the challenges faced by John A. Boehner, the former speaker, when he tried to corral recalcitrant conservatives to vote for compromise spending and immigration packages. His inability to do so helped break up a major spending deal, caused a government shutdown and ultimately ended up with the conservatives forcing him out.

Despite his retirement, Mr. Boehner might have helped fuel this latest revolt. Representative Jim Jordan, an Ohio Republican and leader of House conservatives who clashed repeatedly with Mr. Boehner, noted caustically on Tuesday that the former speaker is now predicting that Republicans won’t be able to kill the law, and Mr. Jordan seemed eager to prove him wrong.

“This is what we told the voters we were going to do,” he said of the straightforward repeal effort.

Conservatives have become increasingly alarmed at discussion of what they deride as “Obamacare Lite” — efforts to keep some of the provisions in place and “repair” the health law rather than kill it outright. They complain that an approach backed by some House health policy writers would impose new taxes on employer-provided health insurance and interfere in a part of the marketplace that is working. And they don’t favor a tax credit plan that Mr. Trump endorsed in his speech. They back the more market-driven approach that Republicans approved in 2015.

But that legislation was crafted when President Obama was in office and was certain to veto any repeal — giving Republicans what amounted to a free shot at the law. Now they and their constituents would have to live with the replacement, and lawmakers fear a potential backlash if it goes awry. Many Republicans may have complained that the crowds at angry town hall meetings over the recent recess were organized by political opponents, but that doesn’t mean Republicans aren’t paying attention to them.

More here.

As Donald Trump said, who can believe how complicated healthcare is?

Trump touts spending plan, but promise to leave entitlements alone puts GOP in a quandary

Abby Phillip and Kelsey Snell, writing in The Washington Post:

President Trump is preparing a budget that would fulfill some of his top campaign promises by boosting military spending while cutting domestic programs.

But his reluctance to embrace cuts to entitlement programs could lead to sharp tensions with Republicans in Congress who have long argued that Medicare and Social Security must be overhauled to ensure the government’s fiscal health.

The White House on Monday announced the first details of the president’s spending plan, highlighting a $54 billion increase in defense spending and equal cuts to domestic programs, such as the Environmental Protection Agency, and foreign aid.

“We are going to do more with less and make the government lean and accountable to the people,” Trump told reporters at the White House on Monday morning. “We can do so much more with the money we spend.”

White House officials skirted questions about whether the budget would include proposals to slow the growth of Social Security, Medicare and Medicaid — the largest drivers of federal spending. But Republican lawmakers, including House Speaker Paul D. Ryan (Wis.), have for years argued that spending increases must be accompanied by significant changes to entitlements.

White House press secretary Sean Spicer insisted Monday that the president intends to keep his campaign promise to preserve the programs, but avoided commenting on whether there is any wiggle room, such as protecting current beneficiaries while implementing future changes.

“Let me get back to you on the specifics,” Spicer told reporters.

Republicans have long advocated significantly changing the programs to address the nation’s debt, which is now nearly $20 trillion.

Independent budget analysts said policy proposals the administration has released would do little to fix the growing red ink.

“This is a president who loves to talk about easy choices and pretty much runs away from any hard choices when it comes to the budget,” said Maya MacGuineas, president of the nonpartisan Committee for a Responsible Federal Budget. “This president has pointed out that our national debt is an important metric of this country’s health, but he has not put forward a plan for how to deal with it.”

Monday’s announcement was the first indication of spending priorities by the new administration, with the president set to arrive on Capitol Hill on Tuesday to address a joint session of Congress.

In his speech, Trump is expected to outline an optimistic vision for the country, touting his intent to replace the Affordable Care Act, implement policies to help working parents and address national security concerns, including rebuilding the U.S. military.

Ryan and other Republican leaders have avoided weighing in on the specifics of the budget, saying they are waiting to see all the details that will be released in the coming weeks, while speaking positively of the president’s overall agenda.

But Ryan has long advocated changing entitlement programs, arguing that their finances are in a perilous state.

“Medicare and Social Security are going bankrupt,” he said in October 2012, during a vice presidential debate when he was Republican presidential nominee Mitt Romney’s running mate. “These are indisputable facts.”

White House Budget Director Mick Mulvaney in many ways embodies the fiscal quandary Republicans face under Trump. As a conservative member of Congress from South Carolina, he fashioned himself a deficit hawk who opposed big increases in defense funding and advocated cutting spending for Medicare, Medicaid, Social Security and other entitlement programs. Now he is overseeing Trump’s effort to greatly increase defense spending while offering no plan to address entitlements.

On Monday, he avoided answering specific questions about the upcoming budget, noting that the first part will be finalized by mid-March with more details set to arrive in May.

Speaking to reporters at the White House, Mulvaney emphasized that the military and domestic spending priorities outlined Monday are intended to send a clear signal that Trump is seeking to fulfill his campaign promises.

“We are taking his words and turning them into policies and dollars,” Mulvaney said. “A full budget will contain the entire spectrum of what the president has proposed.”

More here.