“Obamacare is the law of the land,” House Speaker Paul Ryan announced last week after pulling his replacement bill from consideration shortly before it was set to be voted on in the House of Representatives. Speaker Ryan has been an outspoken critic of the ACA,  citing issues with premium hikes and implementation of the law. Ever since the Affordable Care Act was signed into law seven years ago, Republicans have focused tremendous efforts into building a repeal and replace plan.   On March 6, he released that replacement, the American Health Care Act (AHCA), also dubbed “Trumpcare” or “Ryancare,” which had already been partially leaked in late February. The bill would eliminate several key aspects of Obamacare, but keep popular provisions such as children being able to stay on their parents’ insurance plans until the age of 26. It faced immediate opposition from House Democrats and surprising resistance from factions of the Republican party, including the prominent hard-line conservative House Freedom Caucus. 

The Freedom Caucus was vocally against any replacement of Affordable Care Act and called for a complete repeal. As soon as the new bill was leaked, Rep. Mark Meadows, Chairman of the Freedom Caucus, said he could not support it without severe changes. “A new Republican president signs a new entitlement and a new tax increase as his first major piece of legislation? I don’t know how you support that — do you?” Along with the rest of his caucus, Meadows took great issue with the tax credits outlined in the bill. President Trump specifically targeted Rep. Meadows in meetings with the Freedom Caucus, hoping to sway him to vote yes, but he and the rest of the caucus were adamant in their dissent. 

President Trump, who had repeatedly promised to abolish President Obama’s signature healthcare bill, at first seemed hesitant to throw his wholehearted support to the replacement, and barely mentioned it in his rallies the week leading to the vote. White House Press Secretary Sean Spicer affirmed that Mr. Trump was fully committed to passing the new legislation and was confident it would pass. 

However, the American Health Care Act was an unpopular bill among American citizens. A Quinnipiac poll found that a mere 17% of constituents approve of the bill, and that even among registered Republicans, support did not crack 50%. Across the country, angry citizens took to town halls to voice their displeasure with the new bill on the floor and with the idea of replacing Obamacare, which has grown increasingly popular in the past month. Districts won by Hillary Clinton in the presidential election were even more vocal, which caused many moderates to rethink their support of the AHCA. Then came the Congressional Budget Office’s estimate stating that 24 million people would lose health care by 2026. The CBO calculations made some Republicans reevaluate their stance since many of their own constituents directly benefitted from the ACA and would likely lose coverage under its replacement.  This largely explains why some moderate Republicans were wary to vote in a way that could hurt their constituents on this issue. 

Getting this bill passed would be difficult considering Democrats were in staunch opposition and would likely vote unanimously against it.  That meant passing the bill depended on the strong support of the moderate Republicans and at least some members of the Freedom Caucus which were both hesitant to vote yes on the bill from the start. As the day of the vote, March 23rd,  approached it became clearer that the AHCA’s chance of passing was in jeopardy.  Republican leadership was at least 11 votes away from passing their bill which forced them to try to save the bill before it hit the House floor.  There were frantic meetings with Freedom Caucus members led by Speaker Ryan in an attempt to scrap health care requirements that alienated several members of the group.  President Trump stepped into the fray, holding meetings with Freedom Caucus members. However, these attempts were not enough, so  Mr. Ryan postponed the vote until the next day. 

President Trump ruled out any more delays, saying that the upcoming vote was the last chance Republicans had to repeal the Affordable Care Act. With more concessions being made to the Freedom Caucus, the new bill hemorrhaged support from the moderate right. The next morning, it was clear that if the bill came to a vote, it would fail. With almost no coalition left, Speaker Ryan pulled the bill from the floor, finally conceding defeat. Junior Hannah Saunders thought this was a large defeat for the Republican party and the President. “After all the chaos surrounding the travel ban, the Trump administration finally had an opportunity to get it right this time when helping to shape legislation to replace Obamacare.” Though healthcare is a critical issue, the party failed in its chance to put forth new legislation that would please the different factions within the party.  Junior Charles D’Ambra said he understood why the bill was so disliked by the GOP, “It was just an alteration of Obamacare,” he explained. 

At his press conference, a visibly disappointed Speaker Ryan admitted this was a painful defeat. “We were a 10-year opposition party, where being against things was easy to do. You just had to be against it. And now in three months’ time we tried to go to a governing party where we actually had to get 216 people to agree with each other on how we do things, and we weren’t just quite there today. We will get there, but we weren’t there today.” Hopefully, he said, the party will rally together on the next issue they plan to tackle: tax reform. However, there is no indication that the massive grassroots movement that arose to defeat the American Health Care Act will die out in the face of slashing business tax cuts, so this will be another fight taking place on the House floor soon.  There is also some mixed messaging coming out of Republican leadership.  While they said tax reform is the next thing on the agenda and they were done with the ACA, they seemed to have a change of heart later in the week saying that they will still try to repeal and replace Obamacare with a new bill. 

Due to the failings of the AHCA, the President suffered a severe blow to his deal-maker image, and his popularity dropped to an all-time low of 36% approval. The Democrats saw their health care bill survive another major test and are using the momentum to try and block the confirmation of Judge Neil Gorsuch to the Supreme Court. Clearly, the AHCA’s problems will have a profound impact on the overall agenda in Washington and will continue to create ongoing drama on Capitol Hill in the near future. 

Sources: TIME, Business Insider, The New York Times, CNN, Congressional Budget Office, The Daily Beast, Quinnipiac University, Think Progress, Gallup, Reuters, NBC News

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