The Five Biggest Losers in the Health Bill Debacle

Blame game commences after GOP effort to repeal-replace Obamacare ends in disaster

Faced with the obvious reality that their plan to replace Obamacare would fail, Republican leaders in the House of Representatives pulled the plug on the American Health Care Act on Friday.

It’s hard to overstate what a colossal political debacle that is for a party that has campaigned for seven years on a promise to repeal the Affordable Care Act. And unlike Thursday, when House Speaker Paul Ryan (R-Wis.) delayed a vote for just one day, Friday’s failure leaves Obamacare in place for the foreseeable future.

“I will not sugarcoat this. This is a disappointing day.”

“I will not sugarcoat this,” Ryan told reporters. “This is a disappointing day.”

Speaking at the White House, President Donald Trump tried to shift blame to Democrats.

“We were very close,” he said. “It was a very, very tight margin. We had no Democrat support … So it’s a very difficult thing to do.”

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Trump and Ryan said they would move on to tax reform, infrastructure spending, and border security.

“Let Obamacare explode. It is exploding right now,” Trump said. “Many states have big problems. Almost all states have big problems.”

Here are the five biggest losers:

Trump. The president by all accounts did not play a large role in crafting the bill, which would have replaced Obamacare’s income-based subsidies with tax credits based on age and made changes to Medicaid.

Still, the president pushed hard for its passage. He traveled the country trying to drum up support for the bill, and personally talked to 120 members of the House. Press secretary Sean Spicer said earlier in the day that the president “left nothing on the field” in lobbying for the bill.

Not only that, but Trump routinely mentioned Obamacare on the campaign trail and pledged again to repeal it in his inaugural address.

Failing even to get a vote in the House, where the Republican majority is substantial, is painful. What’s more, it likely will tarnish his image as the ultimate dealmaker.

Ryan. Failure to pass the bill reflects, perhaps, most directly on Ryan. He is speaker, in large measure, because his predecessor failed to keep the party’s various factions in line. After years of enmity, former Speaker John Boehner (R-Ohio) finally had enough and walked away in 2015.

Ryan, after playing hard to get, took office with high hopes that he would more deftly manage the caucus. Popular among his colleagues, he has invested time in meeting regularly with members of different ideological stripes.

But still, he could not rescue the American Health Care Act.

In the biggest test of his leadership, Friday’s outcome is a big, fat failure.

House Freedom Caucus. Some will praise members of the House conservative group for standing on principle. But a failure to rally around repeal will only reinforce its reputation for intransigence and a lack of realism.

Trump refused Friday to criticized the Freedom Caucus, but he did allow, “I’m a little surprise, to be honest with you.”

He also said, “We learned a lot about loyalty.”

It remains to be seen if those words will translate into action, but Trump had in recent weeks suggested primary challenges for holdout representatives.

Tuesday Group Republicans. For all the focus on House conservatives, it appears that the moderate Tuesday Group Republicans played an even bigger role in killing the bill.

More noteworthy than the fact that moderates bailed are the reasons they gave — that it would reduce the number of people on Medicaid and shrink the number of services guaranteed by Obamacare. It should have come as no surprise to any of those Republicans that those features were part of the Affordable Care Act.

None of those Republicans voted for that law, and all of them voted in 2015 to repeal the law — without even a replacement.

The position of moderate Republicans now will invite suspicion about just how committed to smaller government the party of small government really is.

Health Insurance Customers Not Protected by Subsidies. Failure to pass a bill leaves Obamacare in place. And even Democrats acknowledge it has shortcomings.

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More than 1,000 counties and five states now have only one insurance provider — and some counties soon will be left without any insurer on the government-run health exchanges. Average premiums rose by 25 percent last year.

“The worst is yet to come with Obamacare,” Ryan said at his news conference.

People in the individual market who make too much money to qualify for subsidies will get hit hard by future rate hikes. People who get insurance through their employers also will feel the pain, indirectly, because many firms will pass on premium increases without reforms that lower the price of health care.

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