Ryan and his GOP colleagues failed to build a coalition for replacement legislation known as the American Health Care Act and effectively abandoned a key campaign promise made to voters in the 2016 election.
The messy fight over the bill — waged among Republicans who control both Congress and the White House — was an embarrassing failure for the party, which has pledged for seven years to eliminate one of President Barack Obama’s signature achievements.
“Moving from an opposition party to a governing party comes with growing pains,” Ryan said in a Friday afternoon press conference. “Well, we’re feeling those pains today.”
Despite around-the-clock arm-twisting and open threats from Republican President Donald Trump, the bill saw roughly 40 Republican detractors, from hardline Tea Party conservatives to more moderate members.
While Ryan acknowledged defeat Friday, the White House remained on the offensive, blaming Democrats for refusing to work across the aisle.
On Friday, White House Press Secretary Sean Spicer pushed back on suggestions that Trump’s dealmaking efforts were unsuccessful, contending that he had called more than 120 lawmakers and “left everything on the field.”
While Republicans didn’t rule out a renewed push for health care reform sometime in the future, the devastating failure of the GOP bill this week has led many members of Congress, as well as the president himself, to throw in the towel for the rest of the 115th congressional session.
“We’re going to be living with Obamacare for the foreseeable future,” Ryan said Friday. “I don’t know how long it’s gonna take us to replace it.”
“We’re going to move on with the rest of our agenda,” Ryan added.
Chaos and confusion permeated Washington this week as Republican leaders scrambled to tweak the bill and attempted to garner votes.
While Ryan had desperately worked to keep his bill clean, he allowed a series of amendments favored by hard-line conservatives to be tacked onto the legislation this week in hopes it would increase the likelihood of passage.
Members of the conservative House Freedom Caucus said Ryan’s initial proposal retained too many of the protections and regulations mandated in the Affordable Care Act, also known as Obamacare.
The amendments would have repealed the individual and employer mandates for coverage, and would also have rolled back a series of taxes that help pay for coverage offered in the ACA. The proposed taxes to be eliminated include ones on wealthy individuals, insurance companies and medical devices.
The federal mandate that insurance plans must cover 10 so-called essential benefits, like mental health and drug addiction treatment as well as maternity care, were also removed in the Trumpcare proposal. Instead, states would be able to set their own regulations over required coverage. Vermont has mandated a comprehensive set of required health care benefits for residents, including maternity and preventative care.
Tax credits for covering out-of pocket co-payments would have also been eliminated under the finalized Republican plan.
The formula for a separate tax subsidy to help pay for premiums and deductible was altered in the Republican proposal. Obamacare created income-based subsidies that took into account the local cost of insurance in every state and for every age. The Republican plan offers consumers subsidies which are less generous and are calculated based on age. The credits would increase based on inflation.
The massive Medicaid expansion would have sunset in fiscal year 2020, under Trumpcare. The elimination of the program would have cost the state of Vermont up to $200 million.
The Republican bill would have allowed states to institute work requirements for some Medicaid recipients and would have also given states expanded spending flexibility with federal Medicaid money.
Cory Gustafson, commissioner of the Department of Vermont Health Access, said that while work requirements are being examined in some states, “this is not a conversation we are having.”
The final version also included a few amendments aimed at wooing moderate Republicans, including a $100 billion increase in federal aid for maternity and elderly care. An amendment supported by moderates would have also changed the funding formula for Medicaid. Instead of covering a percentage of costs, Medicaid recipients would receive a fixed amount that would change based on medical inflation.
Republicans may take a piecemeal approach to health care reform in the future, aiming to pass sections of the Trumpcare plan that are more palatable to the conference, though it’s unclear what would be prioritized.
“This is a setback, no two ways about it,” Ryan said Friday. “But it’s not the end of the story.”
Democrats are now looking to offer legislation aimed at fixing Obamacare in the hopes that some Republicans would come on board. On Friday, Trump signaled a willingness to work with Democratic leaders.
“If they got together with us and get a real health care bill, I’d be totally open to it,” Trump said, later adding, “whenever they’re ready, we’re ready.”
Democrats want to stabilize markets in so-called risk corridors. The ACA, as passed, set up a three-year subsidy program to help health insurance companies offset the cost of setting up new markets across the country.
The startup costs were much more expensive than imagined, and the subsidy program was gutted in 2015 by Republicans in Congress, led by Sen. Marco Rubio, R-Fla. The elimination of federal supports has weakened insurance markets and left insurance companies reeling.
In the wake of defeat, U.S. Sen. Patrick Leahy, D-Vt., urged Republicans to reach out to Democrats and “actually let all of the people’s elected representatives take part in forging actual solutions for improving health care and the ability of all Americans to have solid, practical, good-quality and affordable health insurance.”
U.S. Sen Bernie Sanders, I-Vt., called the defeat of the plan “a major victory for the working families of this country and for the hundreds of thousands who attended rallies and town hall meetings in opposition to this bill.”
“What the defeat of this bill shows is that the American people will not accept legislation that provides huge tax breaks to billionaires while 24 million people are kicked off their health insurance, massive cuts are made to Medicaid and Planned Parenthood and premiums for senior citizens are dramatically increased,” Sanders said. “Our job is to improve the Affordable Care Act, not repeal it. Our job is to guarantee health care to all people as a right, not a privilege.”
U.S. Rep. Peter Welch, D-Vt., said in an interview that Democrats should redouble efforts at health care reform.
“My view is we need to maintain our goal for an effective Medicare for all health insurance system,” Welch said. “I don’t want to spend my time defending the status quo of Obamacare — there’s a lot of good things in it. But there’s still too many people uninsured, our healthcare is too expensive and we should be looking to improve it.”