Todd Johnson / March 27, 2017

Who’s to Blame for the GOP’s Health Care Debacle?

Ryan, Trump and others failed Friday, but that cannot be the end of the effort.

The Grand Old Party’s failure Friday to even hold a vote on the American Health Care Act (AHCA) was a shock to veteran political observers and Republican voters alike. This weekend, many of the party faithful began to contemplate what went wrong and who should be held accountable. Blame is one thing; what to do next is another. To take that next step, though, we need to know how we got here.

Considering the size of the mess, there is a lot of culpability to go around. Some point to President Donald Trump, saying that his low approval ratings, along with his neglect of any guiding framework about health care policy in general, caused the efforts to collapse. His cajoling, threats and ultimatum failed.

Reason’s Peter Suderman argues, “This is the danger of a president who is so disinterested in policy particulars, especially when, like Trump, he expects to maintain a central role in the process. Trump’s character — his personal style and his habits of mind — prevent him from effectively negotiating complex legislation. And in this case, it meant that even with control of the White House and both chambers of Congress, Republicans couldn’t put together an Obamacare repeal bill that could pass, or was worth passing. It’s a problem that is likely to continue to haunt conservative policy goals for as long as Trump is president.”

And just as we warned Friday, Trump blames conservatives.

Others also blame the recalcitrant Freedom Caucus (which would gladly take credit for defeating a bad bill) and “moderate” Republicans, who often times have seemed more interested in starting an internecine war with one another than in passing comprehensive legislation.

But let’s take a look at the sizeable role House Speaker Paul Ryan played in this debacle. Ryan was not only the public face of the effort to pass the AHCA but also served as the primary architect of the plan and, in his role as speaker, he controlled the legislative calendar. Throughout key times in the process, Ryan made questionable judgments about his own caucus and the bill itself, and in the end, it was his failure to lead that brought about catastrophic results.

The Federalist’s Ben Domenech asserts, “Yes, AHCA failure is a failure for the president, but it’s much more a failure for House leadership and Paul Ryan. They had seven years to prepare for this moment, and they failed to do so sufficiently.” Not just that, he marvels, “How do you end up with, after seven years, a bill opposed by every major conservative, elderly, and doctors groups?” Indeed, the GOP bill had almost no public support.

Now, some may feel this criticism of Speaker Ryan is unwarranted and that the seeds of dysfunction in the Republican Party were planted many years ago. It is true that the party of Lincoln has had its share of infighting over the last decade, most recently when Ryan’s predecessor, Congressman John Boehner, resigned from the speaker post in 2015. However, when the 45-year-old Ryan took the gavel becoming the youngest speaker since the 19th century, he was a 17-year veteran of Congress so he had full knowledge of the atmospherics on Capitol Hill and that he was going to be dealing with an unruly and divided House GOP conference.

That’s why it’s surprising that Ryan didn’t seem to take the concerns of the Freedom Caucus and the centrist portions of his party more seriously over the last year. His initial misstep was the release of “A Better Way” back in June 2016. He hoped that the document would serve as a uniting policy document for the Republican Party. While the portions focused on tax reform and national security were embraced by many conservatives, the same could not be said for the health care section. It wasn’t clear on how ObamaCare would be repealed or how the proposed solutions would be funded. It also seemed to be a continuation of the Republican message that ObamaCare was so bad that any proposal would be better. It was a disappointing first step for a leader who had spent the previous six years criticizing the Affordable Care Act.

Ryan’s next major gaffe was the poorly constructed bill he showcased in early March. The initial legislation was panned for different reasons by members of his party and, of course, Democrats. It wasn’t just politicians in the nation’s capital who had real issues with his work. It was Republican governors, think tanks, and the Congressional Budget Office. All of these distinct groups had significant concerns over the proposed legislation, ranging from the number of people who would be without health insurance to cuts in Medicare spending.

Ryan and Trump initially tried to stem criticism of the initial bill by saying that the criticisms were unwarranted but they soon realized that their antagonists’ messaging was gaining traction and that they would have to react. On March 20, House Republicans modified their original bill but it did little to assuage the fears of their opponents. The new CBO numbers showed that Ryan’s revised plan would only cut the federal deficit by $150 billion (instead of twice that much) and still not provide coverage to 24 million Americans. In the end, those changes didn’t swing undecided Republican voters — at least not toward the bill.

Still, while many critics are already starting to produce requiems for Paul Ryan and the Republican Party, those assessments are premature at best. However, going forward, Ryan must learn from his grievous miscalculations and do a better job of leading his fractured party.

Ryan now says, “We’re going to be living with ObamaCare for the foreseeable future.” And Trump has promised to just move onto issues he actually cares about, while dismissively saying, “[T]he best thing we can do politically speaking is let ObamaCare explode.”

The effort to repeal and replace ObamaCare cannot end with this defeat. Conservatives shouldn’t lament this bill, but we also shouldn’t let our elected representatives give up. Too much has been given over the last seven years to achieve this goal to let this be the end.

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