WEAK MEDICINE!

It Sure Looks Like Paul Ryan Wants Ryancare To Fail

Caught between a repeal rock and a replace hard place, the Speaker sure looks like he wants to say he fought the good fight and lost, while passing off the blame.

03.08.17 8:02 PM ET

So it seems clear—not just to me, but to most other journalists and health wonks I’ve communicated with over the last two days—that Paul Ryan has introduced a bill that he doesn’t want to pass.

This seems crazy on its face. Destroying Obama has been the core aim of conservatism for the better part of a decade. The Tea Party movement sprang to life opposing it, during those ferocious town halls of 2009. Congress voted who knows how many times to repeal it. Repeal was the one pledge every single Republican candidate made, from Donald Trump on down to poor Jim Gilmore. And I’m sure if you asked your average Limbaugh fan or InfoWars devotee “what’s the one thing the Republicans should do above all else?”, the answer would surely be repeal Obamacare.

And yet, Ryan and the House Republicans have put forward a bill that everyone has attacked from all sides, and astonishingly, they did so without laying the very basic groundwork you lay before putting something like this out there. The tip-off to me came Tuesday around noon, when Heritage Action, the political arm of the Heritage Foundation, issued a tweet condemning the bill. If Ryan didn’t even bother to grease this with Heritage, he’s just not being serious.

But you will ask me: How could he want it to fail? He’ll have millions of furious conservatives on his hands. He’ll look weak to your average voter. And most of all he’ll look weak to Trump and Steve Bannon, who are not big fans to begin with and are presumed to want him out of the way (he’s too “liberal” for Bannon, you see).

And I will say to you: I don’t have a great answer to your question. The Occam’s Razor answer is that maybe Ryan has calculated, in light of Obamacare’s surprising robust poll numbers, that getting rid of it would be worse than keeping it, because getting rid of it would give the opposition a cause. It would create millions of angry voters who’d march to the polls in 2018 to vote against the Republicans. Remember, the Democrats need only 24 or so seats to flip the House—hardly an insurmountable number if the incumbent president has an approval rating in the low 40s, as Trump does now. If the Democrats take the House, Ryan is finished of course, and Trump is probably finished too. Not only will he pass no legislation, but the subpoenas will be flying off to everyone from Bannon to the White House janitors. The devil’s deal that Ryan and so many Republicans made—we’ll let Trump be crazy Trump as long as he lets us dismember the welfare state—will be moot. Dead.

So maybe it’s in Ryan’s interest to introduce a bill that he knows will fail provided he can blame the right people. He knew his hard-right flank would hate this bill. So, the thinking may be, make some changes to accommodate them, knowing that those changes will make Senate passage a virtual impossibility, because Democrats—yes, all of them, even Joe Manchin—will be united in opposition, and three or four Republicans may join them (Susan Collins, Dean Heller, Jeff Flake, Lisa Murkowski). This will enable Ryan to say hey, I tried, I moved to assuage concerns on the right, but the Democrats and the soft Republicans in the Senate, and the evil “liberal” special interests like the American Medical Association, killed it.

That’s legislative logic. Losing but being able to blame somebody else? There are worse places to be.

But still. Losing is losing. And losing something like this reverberates, maybe for a long time. Remember when the Clintons lost on health care in 1994? It took the Democrats 16 years to regroup on the issue. When will Republicans try again to repeal Obamacare? Probably not for a while.

And what future Congress is going to freeze the Medicaid expansion? This, by the way, was another tip-off to me that this bill was a totally unserious play. Why does it call for ending the Medicaid subsidies in 2020—a presidential election year? Does Ryan really think that Congress is going to yank subsidies away from millions of people in a presidential election year?! When, he might be thinking, he could be seeking the presidency himself? (That is, Trump is a disaster, he’s been impeached or indicted or something, and it’s Mike Pence versus all comers; not an insane scenario.) 

If repeal fails now, the Medicaid expansion is probably here to stay, and it will probably expand to more states as Republican governors run up the white flag. If anything, governors will pressure Congress to keep the federal financial commitment as high as possible (it was 100 percent originally and is scheduled to fall to 90 percent by 2020).

And if repeal fails, what’s that going to tell us about tax reform and Ryan’s beloved Medicare “reform”? I could maybe see something minor still happening on tax reform, because there are probably eight Senate Democrats (the number the Republicans need to break a filibuster) who support lowering the corporate tax rate and a couple other things, but there will likely be no huge tax cuts for the rich. And there’s no way Ryan will move Medicare to the private market.

So he loses, and loses big, if repeal fails. But he risks losing even bigger if it passes—he risks losing his majority and his job. Barack Obama and the Democrats spent eight years feeling the wrath of citizens who were terrified that the Democrats were taking away their health care, and the Republicans did much to exploit that fear. Now it’s their turn to feel that same heat. Couldn’t happen to a nicer bunch.