Inside the Demise of the Republican Health Care Bill
More than 30 minutes into a meeting White House and House leadership officials wanted — needed — to be a breakthrough, it was time for everyone to put their cards on the table.
For White House budget director Mick Mulvaney and House Speaker Paul Ryan, the members of the House Freedom Caucus sitting beside and around them at the long table at the center of the conference room adjoining Ryan’s Capitol Hill office had spent enough time talking. A deal was on the table — one the White House and House leaders never planned to give in on — and this was the time to see how many of the conservative, and proudly intransigent, members it would bring aboard.
Mulvaney pointed to a member and asked where he stood, according to multiple sources inside the room. His request was met with demurral. Confused, Ryan tried again. Then Rep. Raul Labrador of Idaho spoke up: The Freedom Caucus is unified and Rep. Mark Meadows, the caucus chair, speaks for the group. Mulvaney and Ryan turned to Meadows. The group was indeed unified, Meadows told them. And they were still a no.
It was a gut punch moment for White House and leadership officials who’d knowingly risked the bill’s fate by offering a compromise to the group, but were convinced it would be enough to start quickly picking off members, one-by-one.
Steve Bannon, President Donald Trump’s chief strategist, was furious and confronted the group. There would be no more negotiating, he said.
But Thursday night, as the men who could make or break the Obamacare repeal effort stared back at one another across the table, the realization was hitting many involved: There would be no deal.
The GOP’s long-awaited Obamacare repeal bill, the first big push of the new Republican era, was doomed.
This story relies on accounts from more than two dozen administration officials, congressional staffers and Republicans close to the health care process. It recounts the chaotic period of brinkmanship, improvisation and disappointment that unfolded as the Republican Party — yet again, but for the first time with its newly minted Republican President — turned against itself.
The debacle raises a very real question as Republicans pledge to move onto other equally ambitious Trump agenda items — like tax reform, an even heavier lift than Obamacare. Can Republicans actually govern?
At the White House, top Trump aides seemed stunned at the position they’d wound up in.
“Seven years and this is what we get,” one senior administration official said. “Really incredible.”
Privately, Trump’s team seethed. In their view, the President had ventured far out on a limb. He’d pushed to change the provision to force all health insurers to cover crucial services like maternity care, mental health and prescription drugs. He’d guaranteed other promises in writing.
In the West Wing, there was still determination to force a vote the following day. But optimism? That was in short supply.
Less than 24 hours later, the issue Trump pledged to take care of “on Day 1” imploded upon itself.
It was an epic failure for a young administration still feeling its way around through the byzantine bureaucratic maze that is Washington and a stunning defeat for a speaker who made his name as the wonk-prince of the GOP.
Speaking from the Oval Office on Friday, the President was careful to lay the blame on Democrats, whom he had neither engaged with nor expected to support the GOP’s attempt to unspool their legacy legislation. But Trump also seemed clear-eyed about the surprises the process served up, which likely weren’t news to anyone but him.
“We learned a lot about loyalty,” Trump said. “We learned a lot about some very arcane rules in obviously both the Senate and in the House. So, it’s been certainly, for me, it’s been a very interesting experience.”
Know when to walk away
Friday dawned with Republicans digesting Trump’s ultimatum, unveiled by Mulvaney on Capitol Hill Thursday night. The President — who campaigned daily on repealing Obamacare — was threatening to leave them saddled with the law if they did not vote for his replacement plan.
As the sun was just rising over the White House on the crisp morning, a weary Mulvaney walked slowly up the north driveway toward the West Wing. He had just finished a tough round of television interviews, where he put on a brave face about the fate of the bill.
But away from the cameras, he paused for a moment and said bluntly what he telegraphed privately the night before: “If it fails today, we’re moving on.”
It was the decision of a boardroom titan who believes you have to know when to walk away to seal a deal. It turns out those bluffs don’t always pay off outside the board room.
The Freedom Caucus was standing firm — insisting the Trump-Ryan plan was effectively Obamacare lite — a new entitlement, simply swapping the Affordable Care Act’s subsidies for tax credits. The White House and House leadership had inched their way in offering to repeal a key insurance mandate, but they wanted more — a repeal of Obamacare’s entire insurance regulation infrastructure.
Arrayed against them were the moderates of the Tuesday Group, who feared that the American Health Care Act represented a wrecking ball to their hopes of retaining their seats in less conservative territory during the midterm elections in 2018.
Despite a raucous and, according to several people in the room, deeply emotional closed-door conference meeting the night before, by mid-morning on Friday, Ryan knew there was no way forward, several sources involved in the process recounted.
The speaker approached Meadows on the floor at 10:30 a.m., nodding to the proclamation the night before the Meadows was the sole spokesman for the Freedom Caucus. He asked him point blank — were he and his group still a “no?”
Meadows’ answer would doom the bill.
Journey to the White House
Ryan decided it was time to head to the White House to deliver the bad news to Trump.
His dash down Pennsylvania Avenue was immediately interpreted by lawmakers and reporters as a sign that the game was up.
But Trump’s spokesman, Sean Spicer, was putting on a brave face, chastening reporters for being so downbeat about the bill’s prospects.
“You guys are so negative!” Spicer said. He appeared to be trying to boost his own spirits as much as anyone’s during a particularly melancholy defense of the GOP health care bill’s prospects in the White House Briefing Room.
At that very moment, a few hundred feet away, Ryan was telling Trump the painful truth.
Over lunch of grilled chicken, Brussels sprouts and twice-baked potatoes — Ryan got to the point: The ultimatum hadn’t worked.
Moderates — burned by the concessions to conservatives — continued to fall away, and they were actually getting further from the 215 votes they would’ve needed for passage.
The President did not have the votes and Ryan wanted Trump to agree to pull the bill from the floor.
Until that point, Trump had bought into the theory from his aides that it was time to smoke out disloyal members with a vote. The President wanted to know who would truly be on his side in the future.
But Ryan countered, forcefully, that it was bad strategy. The Freedom Caucus had been the cause of much heartburn for the House speaker, but forging ahead with a vote would expose the moderates — the very members the GOP needs to keep its majority.
Freedom Caucus members wouldn’t be punished politically for the vote. Most come from very safe districts. In fact, most — if not all — had run ahead of Trump in November in those districts.
The members from swing districts would take the biggest hit.
Trump said he saw Ryan’s point, but there was one more meeting he wanted to wait on. Vice President Mike Pence and Health and Human Services Secretary Tom Price were on their way to talk with the Freedom Caucus one more time. Perhaps there would be a breakthrough.
Beyond that, some Trump aides still believed a gamble on the House floor was worth the risk. Publicly, the White House continued to press for a vote, convinced that Republicans would balk at lining up with Democrats to effectively give Obamacare a lifeline.
“It wasn’t so much about shaming members who would vote ‘No’ so much as daring them to do so,” one senior administration official said.
Ryan was adamant the bill could not pass. But Pence, Bannon and Mulvaney were eager to force a vote.
The vice president — whose political radar was honed by years in the House — was particularly convinced that if members were forced into a binary choice, the bill would pass.
“The idea was to call their bluff,” the senior administration official said.
But House leaders and their top aides knew plainly that it was a gross misreading of the temperature on Capitol Hill. It was already too late.
Tempers had been ratcheted to a breaking point by a week of draining internal GOP combat. Sentiment was boiling against the conservatives whom were making Ryan’s life as much of a misery as they had for his predecessor, John Boehner.
“I’ve never seen it as bad as this. People are very angry, and now you have a White House and President who are also very angry,” one leadership aide said.
Ryan — who, along with his trip to the White House, spoke with Trump by phone three times on the bill’s final day — knew there was no chance.
At 3 p.m. on Friday, Ryan made the case once more: The votes weren’t there. Taking the vote to the floor would prove to be a damaging loss.
Even with some of Trump’s most trusted aides still itching for a vote, Ryan broke through to the President. Trump gave Ryan the green light to pull the bill.
Republicans got the news after they were called from the floor for a conference meeting. They filed out quietly afterward, with glum faces. Most just walked by reporters, headed for Friday night flights back to their districts, where they would have to explain their failure to deliver on the most fundamental, oft-repeated promise in successive elections.
There was not much that Ryan could say.
“I will not sugarcoat this, this is a disappointing day for us. Doing big things is hard. All of us. All of us, myself included, we will need time to reflect on how we got to this moment, what we could have done to do it better,” he told reporters.
Then Ryan reached for an explanation that might just leave open the possibility that the Obamacare drama may be a learning experience for his troops.
“We were a 10-year opposition party, where being against things was easy to do. You just had to be against it,” Ryan told reporters.
“And now in three months’ time we tried to go to a governing party where we actually had to get 216 people to agree with each other on how we do things, and we weren’t just quite there today,” he said.
He left the most relevant question to his caucus unanswered.
“Are we willing to say ‘yes’ to the good, the very good, even if it’s not the perfect?” he said.
One key player in the drama is staying in town.
As Trump settled in for a rare weekend in Washington, his aides were going over just what happened and asking themselves how they could have prevailed.
They fumed at the Freedom Caucus Republicans who made it impossible for a GOP speaker to govern effectively. One senior official said the West Wing may have underestimated “how deep the animosity is in the Republican conference.”
But publicly Trump offered only kind words for Ryan — “He worked very, very hard” — and held his fire on the Freedom Caucus. The President, in a rare show of discipline speaking briefly with reporters from the White House afterward, ventured only so far as to say, “I’m disappointed because we could have had it. So I’m disappointed. I’m a little surprised, to be honest with you.”
The political impact of Friday’s House GOP meltdown is clear.
Trump will almost certainly wrap up his First 100 Days in office next month without a significant legislative achievement.
If Trump’s ego was bruised, his aides aren’t letting on.
“He’s doing great,” Spicer, Trump’s spokesman, insisted late Friday afternoon. He insisted the President firmly believed he’d done all he could to ensure the health care bill passed.
By all accounts, the President endured long meetings with both sides of the Republican divide, using his signature style to try to woo even the most reluctant participants. But even as the White House and Republican leaders repeatedly played up Trump’s engagement, there was often a suspicion — voiced quietly but repeatedly by senior congressional aides involved in the process and at times by many of the rank-and-file lawmakers themselves — that he was not all in.
The President’s lobbying efforts sounded impressive: Face-to-face meetings with more than 120 members of Congress. For good measure, private phone calls with many of them.
But in many of those meetings, details were an afterthought, according to multiple people present.
“Staff was for details, Trump was for closing,” said one senior congressional aide. When it came to details, Trump “didn’t know, didn’t care, or both.”
He didn’t answer their specific questions about the bill, according to three members of Congress who attended the meetings. He didn’t offer any arguments for why they should support the legislation other than to give him his first legislative victory.
Trump repeatedly focused instead on the politics of the broader situation, the people said. In the Oval Office, he quizzed the Republicans about the margin of victory in their districts last fall. His victory, not theirs.
“He did very little to say why we should vote ‘yes,’ ” one Republican member of Congress said, speaking on condition of anonymity to avoid alienating the White House. “He kept talking about his damn election.”
In the end, the man dubbed “the ultimate closer” could not close the deal.
Trump swept into office with soaring crowds and big rallies. But for the biggest legislative fight of his young presidency, he barely mentioned health care as he made only two trips outside Washington to sell the bill. Repealing Obamacare often came off more as a slogan rather than a driving policy proposition. And the legislation Trump was touting, which would’ve insured 24 million fewer Americans over the next decade, bore little resemblance to his campaign trail promises.
His advisers once telegraphed a robust travel schedule, taking his case directly to the heart of Freedom Caucus districts. That never happened.
As a result, there was no one to reassure people concerned about losing coverage — like Jessi Bohon, the Tennessee high school teacher who confronted Rep. Diane Black in a February encounter that went viral on social media, as Bohon defended the individual mandate that requires people to buy insurance under Obamacare.
“As a Christian, my whole philosophy in life is to pull up the unfortunate, so the individual mandate — that’s what it does, the healthy people pull up the sick,” Bohon had said. “We are effectively punishing our sickest people.”
The lawmakers who would be called upon to cast tough votes on a bill no one really liked were coming face-to-face with the fury of public opinion in a way Trump and his advisers never really experienced.
Instead, he visited only urban areas of Nashville and Louisville, where his true believers packed the arena. Yet he railed against health care as though he was still on the campaign trail a year ago, rather than the man now driving the agenda.
“This is our long-awaited chance to finally get rid of Obamacare,” Trump said Monday at Freedom Hall in Louisville, where supporters cheered his arrival. “We’re gonna do it. What’s the alternative? The alternative is what you have. The worst. It’s a big lie.”
Four days later, one of the biggest Republican promises of a decade was dead. The party’s new President, unable to deliver.
The morning after, with his epic failure spread across the pages of newspapers and television screens, the President set off for his golf course in the Virginia countryside.
But unlike failed deals from his old world of business, he can’t walk away from these Republican partners. How they regroup will answer the question of whether his presidency can rebound.