On March 24, Speaker of the House Paul Ryan (R-WI) pulled the American Health Care Act (AHCA) for a second time as it became clear that the Affordable Care Act (ACA) repeal bill did not have sufficient Republican support to pass. (See WICs article, "ACA Repeal Vote Postponed, Rescheduled Amid Republican Dissent," March 24, 2017.) In a statement to the press, Ryan said, "Moving from an opposition party to a governing party comes with growing pains...We came really close today but we came up short." He also acknowledged that the ACA is the "law of the land" for the "foreseeable future", and will remain so until it is repealed. A number of factors went into the bill's failure to pass, including dismally-low public approval (measured on Thursday as being only 17%), deep fissures between House Republicans, and what was seen as tepid support from the President in the initial stages.
As Friday progressed, it became clear that if the AHCA was put up for a vote, it would fall well short of votes needed. President Trump convened a meeting with Republican members of the conservative Freedom Caucus on Friday morning to make a final pitch to garner support. Members were unmoved, saying that the AHCA did not go far enough to repeal the ACA, and that even with last-minute amendments, did not sufficiently alter what was viewed as the creation of a new entitlement in the form of new tax credits. As the changes moved the bill further right, more moderate Republicans also dropped support. The professed "no" votes increased, signaling that failure of the bill was inevitable. Rather than forcing a vote that would defeat the bill, Ryan and Trump agreed to pull the bill Friday afternoon.
President Trump was not critical of Speaker Ryan in the moments following the bill's failure, instead saying that the lack of Democratic support was to blame. (No Democrats supported the AHCA). Trump said, "With no Democrat support we couldn't quite get there." He also said that if Democrats "got together with us and got a real health care bill, I'd be totally open to it...I think the losers are [House Minority Leader] Nancy Pelosi and [Senate Minority Leader] Chuck Schumer, because now they own Obamacare." Democrats were vocally critical of Republicans throughout the 17-day lifecycle of the legislation, repeatedly blasting Republicans for not inviting a bipartisan process. Fellow Republicans were critical of the lack of transparency during the process, including Senator Rand Paul (R-KY) who attracted press attention by attempting to view a draft version of the bill that was under guard in the basement of the Capitol.
President Trump, Speaker Ryan, and other members of the Republican party have indicated they will move on from health reform, and that the next major policy initiative on deck will be tax reform. Though many disability, aging, and Medicaid advocates are relieved that the significant restructuring of the Medicaid system that was included in the AHCA has been given a temporary reprieve, there is still great concern that similar proposals to impose block grants or per capita caps will emerge as a way to offset the costs that will inevitably come with any tax reform package. For now, all eyes turn back to the House, which will need to coalesce around budget legislation, increase the debt ceiling, and ensure that the government does not shut down when the funding included in the current continuing resolution expires.