After pulling his wildly unpopular American Health Care Act, House Speaker Paul Ryan tried to put a brave face on a stinging defeat. At a press conference on Friday afternoon, Ryan argued that this was nothing more than a minor speed bump and that Republicans would have no trouble making progress on their other agenda items. Ryan thanked President Trump profusely for all his help, despite the fact that Trump’s lack of enthusiasm for the legislation that’s come to be known as “Ryancare” undoubtedly emboldened its opponents within the House GOP. Again and again, Ryan said that “this is how governing works when you’re in the majority,” insisting he did everything he possibly could to reach a consensus. He was the grown-up who wanted to get things done. As for those who refused to get in line—the members of the caucus he couldn’t quite bring himself to name? If the Freedom Caucus had thrown its support behind the AHCA, Ryan suggested, everything would’ve turned out differently.
The demise of the American Health Care Act wasn’t inevitable. Contra Ryan’s implication on Friday, the blame for the failure of the AHCA doesn’t belong to the House Freedom Caucus, a collection of 30 or so GOP lawmakers who’ve defined themselves as the keepers of the Tea Party flame. It belongs to Ryan himself.
As far as Ryan and his allies are concerned, the HFC is a gang of reckless rebels who’ve jeopardized Republicans’ best chance to undo Obamacare and to establish a better, more sustainable health system. And it’s not hard to see why Ryan wants to lay all the blame for the AHCA debacle at the feet of the House’s hard-liners. There is no question that the HFC has tended toward unreasonableness, most notably when the caucus very nearly forced the federal government to breach the debt ceiling—a prospect that terrified a large majority of House Republicans and the country at large. Over the past few weeks, however, the HFC has actually acted quite reasonably. When Mark Meadows, the chairman of the Freedom Caucus, told reporters on Thursday night that he was “desperately trying to get to ‘Yes,’ ” he was telling the truth. Ryan and the rest of the House GOP leadership have been trying and failing to strong-arm the HFC and other Republicans into swallowing shabbily crafted legislation that no one really understands. As strange as it might seem, it is the Freedom Caucus that has been fighting for a more deliberative, thoughtful approach that might yield a more coherent set of reforms.
How exactly did we get here? In October 2015, shortly after members of the HFC forced then-Speaker John Boehner into an early retirement, Ryan managed to win over the Freedom Caucus by promising to honor the “Hastert Rule,” in which legislation would move forward only if it commanded the support of a majority of the members of the majority party. Ryan also vowed to open up the legislative process so the House Republican leadership would have less power while committees and individual members would have more. At the time, these promises didn’t count for much. As long as Barack Obama was in the White House, there was only so much Republicans could accomplish on their own. To get anything done at all, the House GOP had to cut deals with President Obama and Senate Democrats, and the HFC ensured that Ryan couldn’t make any concessions that would anger conservatives.
When Donald Trump was elected president and Republicans won a razor-thin majority in the Senate, it was only natural that the Freedom Caucus expected a seat at the table. That’s not what happened. If the HFC had one non-negotiable demand, it was that Obamacare would be repealed root and branch, or at least as thoroughly as possible under the rules of budget reconciliation. The idea was that Republicans would repeal Obamacare first and then worry about replacing it later, a strategy known as “repeal and delay” or “repeal and start over.” Inevitably, many moderate Republicans had cold feet about repeal and delay, recognizing that it would likely lead to a meltdown of the individual insurance market. President Trump expressed doubts about the strategy as well, which sent Ryan scrambling to cobble together a reconciliation bill that would endeavor to replace Obamacare.
What Ryan failed to appreciate is that his mad dash to draft a replacement would end up alienating Freedom Caucus members who wanted to play an active role in shaping it. Repeal and delay was compelling to those on the Republican right who wanted to have a more open, inclusive process in which all elements of the GOP would take part in crafting successful legislation. Did it make sense to believe you could repeal Obamacare and then take your sweet time with a slow-moving, deliberative process designed to reconcile the seemingly irreconcilable positions of moderate Republicans and the members of the HFC? Maybe not. But Ryan didn’t really make that case. Instead, he pivoted right back to the highly centralized, secretive process that drove the Freedom Caucus crazy in the first place.
The result has been disastrous, and predictably so. To Ryan and his allies, it is obvious that you’d need refundable tax credits to ensure that people can afford insurance coverage in the individual market. He’s probably right. Yet he hadn’t laid the groundwork necessary to bring members of the Freedom Caucus—most of whom are deeply suspicious of the idea of creating new refundable tax credits (“a new entitlement program”)—along with him. Rather than consult with HFC members, he assumed that he could leverage Trump’s popularity in their districts to beat them into submission. To be a bit less charitable, you could say Ryan expected the Freedom Caucus to be as craven in the face of Trump as he’s been himself.
As it turns out, the Freedom Caucus has—with a handful of exceptions, such as the die-hard libertarians Justin Amash and Thomas Massie—been willing to go along with a tax credit if it’s the only way forward. They have said, however, that a concession on tax credits should be contingent on rolling back more of Obamacare’s regulations, to get closer to their goal of moving the American health care system in a more free-market direction. Conservatives have long seen Obamacare’s regulations as the biggest problem with the law, so it’s no wonder the Freedom Caucus wants to undo them. Ryan has steadfastly refused to budge on making big regulatory changes, on the grounds that you couldn’t get that done under the rules of budget reconciliation. Well, lo and behold, the Senate parliamentarian has made it clear that there really is scope to make sweeping regulatory changes under reconciliation rules. That news infuriated HFC members, and it sent Ryan scrambling to see if he could push through some last-minute changes to his bill, which got uglier and uglier by the hour.
So what happens now? It’s hard to say. One possibility is that Republicans will drop health care altogether and focus on pushing through other more popular measures. The GOP could also start from scratch to craft a health reform bill that would satisfy moderates and right-wingers alike. Hard as it might be to believe, the fact that the HFC was willing to budge on tax credits is very significant, and it could be a sign of things to come. It’s just not clear that Ryan is the man who can make a health care deal happen.