Through controversy and contradiction, Speaker Paul Ryan proved Thursday that the boisterous House can produce a Republican governing majority. The question now is whether—like the Democrats of the late 2000s—that majority’s products will endanger the majority itself.
After weeks of tweaking their health care bill with pet amendments and twisting arms to get last-minute votes, House Republicans celebrated their legislative victory with a rally at the White House. Notably absent among the smiles and back-patting were several centrist Republicans who, begrudgingly, voted for the bill.
Therein lies the contradiction of the American Health Care Act: On the one hand, it is a much-needed legislative victory for President Trump, Ryan, and the House leadership team. Leaders played the Rocky theme song to pump their members up during their morning meeting and in the afternoon, Ryan got a standing ovation from his members on the House floor just before the vote.
“When you’ve got a group as unruly and independent as our conference is, it’s tough to lead. But I think he’s done a great job,” Rep. Richard Hudson said of Ryan. “I think we’re getting there.”
On the other hand, it is a bill that even some members who voted for it privately concede is deeply flawed and was passed through a flawed process. Furthermore, it may never pass the Senate, and even if it does, it will almost certainly look very little like the bill voted on in the House. As if to illustrate its unpopularity in some segments of the Republican Conference, throughout the week, some members ducked reporters so they wouldn’t have to make their position on the bill public until the critical last minute.
"Some members of House leadership are concerned the repeal/replace process, lack of regular order, and an extremely tight vote could imperil the majority built by the NRCC over the past few elections," said a GOP lobbyist.
Democrats viewed the vote as a political gift. As the House voted, they jeered their endangered Republican colleagues with bellows of, “Na na na na, hey hey hey, goodbye.” House Minority Leader Nancy Pelosi, during the last minutes of debate on the bill, picked up on the political dynamic and spoke directly to those moderate Republicans.
“You vote for this bill, you have walked the plank from moderate to radical,” she told them. “And you're walking the plank for what? A bill that will not be accepted by the United States Senate. … But you have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.”
Still, Republicans recognized that the stain of doing nothing would have been just as deep, with the anger coming from their own base, not the other side of the aisle. Members noted that to not vote on the bill, or for the bill to fail, would have been an abdication of a key promise of nearly every Republican campaign for the past seven years: to roll back Obamacare.
“People made promises they wanted to be able to keep,” House Majority Leader Kevin McCarthy told reporters after the bill passed. “It’s one thing to act in a majority when we don’t have the presidency, it’s another way to act collectively … to be able to find compromise.”
Still, contradictorily, to keep their promise, they had to break others. Republicans had to embrace policy elements, like the goal of near-universal coverage, that are not traditional planks of Republican orthodoxy. To pass the bill, they employed procedural and negotiating tactics they repeatedly decried when Democrats held the gavels.
To achieve their goal and prove the GOP majority is not ineffectual, almost every segment of the Republican conference made compromises. Conservatives in the House Freedom Caucus took the unusual step of supporting what they agreed was a half-measure that does not fully repeal Obamacare.
The group’s chairman, Rep. Mark Meadows, said part of that decision stemmed from understanding that Republican members in the Northeast have a much different task than those like him representing constituents in the South.
“The epiphany is that this is a critical piece of legislation that we’ve been making campaign promises on for seven years and if I can’t deliver here, I need to go home,” Meadows said. “It’s real easy to be unified when your vote doesn’t matter and you’re in the minority. It’s much more difficult to be unified when you’re in the majority.”
Moderate Republicans who supported the bill did so knowing that if a bill like this became law, they could not ensure that constituents with preexisting conditions or those covered by Medicaid expansion would ultimately be able to keep or afford insurance. And on top of that, they could ultimately lose their seats for the vote.
Rep. Tom Cole said that for those members, the calculation was similar to what some Democrats went through when voting for Obamacare seven years ago.
“We run the same risk. If we do something, then we’ll be judged on the quality of what we do,” Cole said. “Nobody’s going to say, ‘Oh you got it done, that’s wonderful!’ If it doesn’t make their life better, let alone if it makes their life worse, then we will pay a price. We will lose the majority.”