Despite Rising Dissent, Speaker Ryan Guarantees ‘We Will Have 218 Votes’ To Push Through Bill

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In a humiliating setback, President Donald Trump and GOP leaders pulled their "Obamacare" repeal bill off the House floor Friday after it became clear the measure would fail badly.

It was a stunning defeat for the new president after he had demanded House Republicans vote on the legislation Friday, threatening to leave "Obamacare" in place and move on to other issues if the vote failed. The bill was withdrawn minutes before the vote was to occur.

The president's gamble failed. Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation's health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.

Republicans have spent seven years campaigning against former President Barack Obama's health care law, and cast dozens of votes to repeal it in full or in part. But when they finally got the chance to pass a repeal bill that actually had a chance to get signed, they couldn't pull it off.

U.S. Rep. Jimmy Panetta said, "It is understandable that the AHCA was pulled from a vote on the House Floor by Speaker Paul Ryan not only because of the division in the majority, but because it was a quickly and carelessly crafted bill. I opposed this legislation because if passed, it would have taken health care away from millions, and forced families to pay more for less care."

What happens next is unclear, but the path ahead on other priorities, such as overhauling the tax code, can only grow more daunting.

And Trump is certain to be weakened politically, a big early congressional defeat adding to the continuing inquiries into his presidential campaign's Russia connections and his unfounded wiretapping allegations against Obama.

The development came on the afternoon of a day when the bill, which had been delayed a day earlier, was supposed to come to a vote, come what may. But instead of picking up support as Friday wore on, the bill went the other direction, with some key lawmakers coming out in opposition.

Congressman Rodney Frelinghuysen of New Jersey, chairman of a major committee, Appropriations, said the bill would raise costs unacceptably on his constituents. Rep. Barbara Comstock of Virginia, a key moderate Republican, and GOP Rep. David Joyce of Ohio also announced "no" votes.

The defections raised the possibility that the bill would not only lose on the floor, but lose big.

In the face of that evidence, and despite insistences from White House officials and Ryan that Friday was the day to vote, leadership pulled back from the brink.

The GOP bill would have eliminated the Obama statute's unpopular fines on people who do not obtain coverage and would also have removed the often-generous subsidies for those who purchase insurance.

Republican tax credits would have been based on age, not income like Obama's, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama's Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.

The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.

Democrats were uniformly opposed. "This bill is pure greed, and real people will suffer and die from it," said Rep. Pramila Jayapal of Washington state.

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Some parts of Obamacare working well, problems with others

Once again, "Obamacare" has survived a near-death experience. It won't be the end of the political debate, but House Speaker Paul Ryan acknowledges, "We're going to be living with 'Obamacare' for the foreseeable future."

Ryan pulled the "repeal and replace" bill drafted by House Republican leaders and blessed by President Donald Trump after it failed to muster enough support. It was the latest attempt to undo the Affordable Care Act, which already beat two Supreme Court challenges.

Trump blamed Democrats for the failure and repeated his dire predictions for the Obama-era law. "It's imploding, and soon will explode, and it's not going to be pretty," he said.

While some parts of the law have obvious problems, others are working well and have brought the country's rate of uninsured people to a record low.

The ACA has added coverage in two main ways: a Medicaid expansion to cover more low-income adults, and subsidized private health insurance through online markets such as HealthCare.gov. That's helped push the nation's uninsured rate below 9 percent.

But premiums and other costs are rising faster than expected, and insurers have pulled out of markets in many areas, reducing options for consumers.

A status check on the ACA's major elements, and the outlook for each:

___

MEDICAID

Status: Thirty-one states have expanded Medicaid. The federal-state health program for low-income people now covers about 1 in 5 people in the United States, from newborns to elderly nursing home residents. About half of the expansion states have Republican governors. Gov. John Kasich, R-Ohio, says it has allowed his state to offer "a stable source of care" for the working poor, the drug-addicted, and the mentally ill. Although Medicaid is a notoriously stingy payer, hospitals have strongly supported the expansion as preferable to treating uninsured patients.

Outlook: The Medicaid expansion, which covers about 11 million people, remains in place. Other states may now want to take advantage of its generous federal payment rate for new enrollees. Rising costs are likely to be a problem both for states and the federal government.

Medicaid also will remain as an open-ended entitlement program, with the federal government matching a share of what each state spends on care for beneficiaries. The national average is about 60 percent.

Overhaul efforts will continue, but state governors will take the lead. Expect the federal Health and Human Services department under Secretary Tom Price to be receptive.

___

INDIVIDUAL HEALTH INSURANCE

Status: The health law was meant to expand and stabilize the market for individual health insurance, through which roughly 20 million people get coverage. It's been a roller-coaster ride instead. As sicker, costlier customers came into the market, premiums and deductibles shot up. Consumers eligible for the law's income-related subsidies were cushioned, but millions who still pay their own way are in shock. Former President Bill Clinton, in a candid moment, called it a "crazy system." Aetna CEO Mark Bertolini has pronounced the ACA's health insurance markets in a "death spiral."

Outlook: Unclear, with analysts offering different opinions. The "glass-half-full" view is that this year's premium increases will help stabilize the market, and 2018 probably won't bring another wild ride. The "glass-half-empty" view is that the markets continue to struggle to attract young, healthy customers, and that's going to keep pushing premiums higher, making coverage unattractive.

In the mix is a political wild card. The Trump administration will have to decide whether to continue paying billions in cost-sharing subsidies that help reduce deductibles for more than half of the consumers using markets like HealthCare.gov. The GOP House has challenged the subsidies in court. Insurers say the system would be unworkable without the money.

Finally, no one seems to have an answer for the problems of people who pay the full cost of their individually purchased health insurance policies. They get no help from the government to shield them from rising premiums. And they complain of fewer available low-premium options as a consequence of federal regulation.

Consumers using HealthCare.gov have also found they have fewer choices as some insurers exited the markets. About one-third of counties currently have just one marketplace insurer.

___

COVERAGE PENALTY

Status: As a way to get healthy people into the insurance pool, the ACA imposes tax penalties on uninsured people deemed able to afford coverage. Last year 6.5 million people paid penalties averaging $470, according to the IRS. An additional 12.7 million people claimed exemptions for financial hardship and other reasons. Some young adults in good health decide to pay the fine because they can't squeeze $100 a month for premiums out of their already tight budgets. Experts argue about whether the unpopular requirement has been particularly effective.

Outlook: The penalty remains the law of the land, but the Trump administration isn't likely to make enforcement a priority.

___

OLDER ADULTS

Status: Obama's law limited what insurers could charge their oldest, pre-Medicare customers to no more than three times what they charge young adults.

Outlook: That limitation remains in place for now. Congressional Republicans will keep looking for ways to loosen it, arguing that it would help lower premiums for young adults and help make insurance markets stronger. A budget bill could provide a vehicle for changes.

___

ESSENTIAL HEALTH BENEFITS

Status: The ACA requires insurers to cover "essential benefits," including outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services, and pediatric care, including dental and vision services for kids.

The benefits are considered especially important for women, since birth control and other routine services are now covered as preventive care, at no charge.

Outlook: The ACA's benefits requirement remains in place. Republicans say it drives up costs, but convincing consumers of that will be difficult.

Speaker Ryan falls short in first test of Trump presidency

House Speaker Paul Ryan guaranteed a win on the Republican plan to dismantle Barack Obama's health care law. Instead, he suffered a brutal defeat, cancelling a vote and admitting "we're going to be living with Obamacare for the foreseeable future."

Friday's painful rebuke is an ominous sign for President Donald Trump's agenda, from taxes to infrastructure to the budget. Looming in a few weeks is the need to agree on a bill to keep the government open. After the health care debacle, Trump told Republican leaders he's moving on.

The episode is a danger point for the relationship between Trump and Ryan, who had an awkward pairing during the campaign but worked in tandem on the GOP health measure.

"I like Speaker Ryan," Trump said. "I think Paul really worked hard."

Virtually every congressional Republican won election promising to repeal Obamacare. With a Republican in the White House, passage seemed almost guaranteed.

Ryan was steeped in the details, even at one point replicating for a nationwide cable news audience a detailed PowerPoint presentation he delivered to his members.

Earlier this month, he said flatly, "We'll have 218 (votes) when this thing comes to the floor, I can guarantee you that."

Ryan was thrust into the speaker's chair after the stunning 2015 resignation of John Boehner, R-Ohio, and a failed bid by Majority Leader Kevin McCarthy, R-Calif. At the time, Ryan held his dream job - chairman of the powerful, tax-writing Ways and Means Committee - but took the job as the last viable option to lead a fractured House GOP.

While Ryan eased comfortably into the job, he's not the schmoozer Boehner was, a key skill in delivering like-minded but reluctant lawmakers. He lacked the steel and seasoning of Democratic rival Nancy Pelosi, D-Calif., who delivered Obamacare in the first place - and that took months, not weeks.

Even before the bill went down, Pelosi was piling on, taunting Trump and, by implication, Ryan, for rushing the bill to the floor too early.

"You build your consensus in your caucus, and when you're ready, you set the date to bring it to the floor," Pelosi said. "Rookie's error, Donald Trump. You may be a great negotiator. Rookie's error for bringing this up on a day when clearly you're not ready."

Ryan entered the health care debate without the experience of having ever managed a situation of such magnitude.

"We were a 10-year opposition party where being against things was easy to do," a clearly disappointed Ryan said Friday. "And now, in three months' time, we've tried to go to a governing party, where we have to actually get ... people to agree with each other in how we do things."

During former President Barack Obama's tenure, Ryan had always been able to lean on Democrats to pass legislation Obama would sign.

On health care, however, Ryan could only count on Republicans, inheriting a fractious group that was schooled in opposing Obama, but lacking in the required team spirit to be a functioning, governing party.

It's a far different situation facing Ryan than he witnessed when joining the House in 1999. Then, Speaker Dennis Hastert, R-Ill., and legendary Whip Tom DeLay, R-Texas, ran the House with a five-vote majority, instilling a team spirit that is wholly lacking today. Ryan also lacks the tools available to prior leaders, like hometown earmarks.

"It's sometimes easier to do things with a smaller majority, because you all realize you've got to stick together or you won't get anything done," said Rep. Mike Simpson, R-Idaho. "When you get a bigger majority you have factions. And then the challenge is dealing with the different factions."

Instead, Ryan struggled - and failed - to thread the needle between conservative hardliners in the House Freedom Caucus and moderate lawmakers worried that the GOP measure would harm their constituents - and their political prospects in midterm elections that promise to be bruising for Republicans.

While Trump focused on winning over the Freedom Caucus, Ryan failed to keep more pragmatic lawmakers like Rep. David Young, R-Iowa, in line. When Young announced his opposition, a superPAC affiliated with Ryan, the Congressional Leadership Fund, announced it would pull its support from Young.

To be sure, several factors conspired against Ryan.

Trump sometimes sent mixed signals about how solidly he was behind the effort. The White House is short-handed and its staff is inexperienced in the art of legislating.

And Ryan's vote-counting team failed at basic tasks like keeping lawmakers, including the chairman of the powerful Appropriations Committee, Rodney Frelinghuysen, R-N.J., from issuing public statements promising to oppose the bill.

"We don't browbeat our folks," said Rep. Barry Loudermilk, R-Ga. "That's why it's harder to keep Republicans in line."

Ryan's stature appears secure. And even if Trump and his allies were upset with Ryan, there's no obvious replacement, given the party's short leadership roster.

"I don't think this will impact Speaker Ryan because everyone in our conference, whether you're voting yes or no, does know he put his heart and soul into this," said Rep. Chris Collins, a Trump ally. "I am certainly not blaming Paul Ryan in the least."

"He's highly respected. He worked very hard on this," said Rep. Tim Murphy, R-Pa. "He went in for the right reasons."

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Source : http://www.ksbw.com/article/house-gop-abruptly-pulls-troubled-health-care-bill/9180253

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