As it became clear that the Republican plan to repeal and replace the Affordable Care Act was bound to fail in the House of Representatives on Friday, the crucial question became: What comes next? About half an hour after his office announced that the scheduled vote on the American Health Care Act had been cancelled, House Speaker Paul Ryan gave his answer: Nothing.
In the end, there really was no Plan B. After Ryan and President Trump decided Friday afternoon to take the embarrassing step of pulling the bill from the floor rather than risk what was shaping up to be an even more embarrassing defeat as the list of Republican “No” votes grew longer and longer, Ryan offered no path forward.
“We are going to be living with Obamacare for the foreseeable future,” Ryan admitted in a press conference at the Capitol. He insisted that the House Republicans had come very close to passing the replacement legislation, but were unable to overcome solid Democratic resistance combined with defections from both the right wing of their own party and from more moderate members who were against concessions made in an effort to appease the right wing.
Ryan characterized the conflict within the party as “growing pains” that members who have spent 10 years in the opposition are experiencing as they transition to governing.
When a reporter asked Ryan if he would change his focus from attempting to completely eliminate the ACA to working with Democrats to try to improve the bill, he suggested that any effort to do so would be pointless because, he said, the bill is too “fundamentally flawed” to fix. He repeated his assertion that the system is in a “death spiral” -- a claim that is disputed by the Congressional Budget Office, which believes health insurance markets will be mostly stable under the existing law.
In a statement from the Oval Office, President Trump also suggested that the next step for Republicans would be to turn to other priorities such as tax reform, and to simply wait for what he described as the inevitable collapse of the health insurance system. However, he went a step further than Ryan, expressing a willingness to work with Democrats on a bipartisan effort to craft new health care legislation.
“The best thing we could do, politically speaking, is let Obamacare explode,” Trump said. “It is exploding right now ... It’s going to have a very bad year.”
He added, “What would be really good, if the Democrats, when it explodes, they got together with us and got a real health care bill.” Referring to the Democrats, he said “when they all get civilized and get together,” Republicans will be “open to it.”
Trump also insisted that the bill had been within a few votes of passage and appeared to blame Democrats for failing to offer any support. He did not explain why a bill crafted with no input from Democrats and aimed at gutting the last Democratic president’s signature domestic achievement ought to have attracted that party’s support.
Republicans streaming out of a conference meeting shortly before Ryan spoke appeared angry and defeated. They also appeared no more sure of a way forward than their leaders.
“The bill is dead,” said Rep. Greg Walden, chair of the House Energy and Commerce Committee, which had voted to approve the original version of the AHCA.
Asked what members would do now, Rep. Lou Barletta of Pennsylvania said simply, “We go home.”