Between A Rock And A Hard Right: Repairing "Obamacare" Still Runs Through Ryan

“You have to be willing to lose these jobs, meaning you have to be a political leader, willing to lose an election if you want to do what's right. That's the way the founders envisioned this in the whole first place.”

Paul Ryan spoke those words on 60 Minutes, a week after he was elected by the GOP caucus in 2015 to succeed John Boehner as Speaker of the House. Boehner was truly fed up with the job, particularly the endless wrangling with his party’s most conservative faction, the House Freedom Caucus. Ryan Begrudgingly stepped in.

Some might say that Speaker Ryan was, indeed, willing to “lose his job” over the last month as he crafted and publicly promoted a healthcare bill that neither he nor President Trump would officially put their name on. You could argue that since just 17 percent of Americans were in favor of the legislation, and that the Congressional Budget Office forecast 24 million Americans would lose their coverage under it, that Ryan did fulfill his role as the true believer; willing to roll the dice on a law that was politically high risk.

But another way to view last week’s fiasco is that Ryan and Trump didn’t really have a choice. The GOP didn’t really have a choice. Sure, the bill didn’t need to be as draconian as it was, but after promising “repeal and replace” for so long, Republicans – whether early in the Trump administration or down the road – would have to present a “conservative” policy solution to address the weaker parts of the Affordable Care Act. They would at least have to keep their word in some fashion. They would at least have to try.

The fact that the proposed American Health Care Act was so universally disliked – opponents included House Democrats, moderate House Republicans, members of the House Freedom Caucus, GOP and Democratic Senators, and the majority of American voters – was being interpreted over the weekend by many progressives as a larger ideological victory. But it hasn’t just been Democrats. Even before the vote was scheduled, Senator John Cassidy (R-LA), himself a physician, explained that forcing so many people to lose their insurance only moves the costs back to taxpayers. Cassidy concluded:

“There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care. If you want to be fiscally responsible, then coverage is better than no coverage.”

Certainly not all Republicans are acknowledging a policy shift as clearly as Cassidy is, but as soon as the president withdrew the House vote, a chorus of Republicans started conceding that politically they couldn’t do this alone anymore. Rep. Charlie Dent (R-PA), who’d had the arm put on him by Trump, actually sounded relieved on CNN:

"If we're going to have a durable, sustainable healthcare reform in this country, it must be done on a bipartisan basis…We could find areas of agreement to improve this system."

Senator Lindsey Graham made it even clearer in a Saturday town hall meeting:

"Let me tell ya about healthcare. I don't think one party's gonna be able to fix this by themselves... I think the president should reach out to Democrats. I should reach out to Democrats. We should say, let's take a shot at doing this together, cuz it ain't workin' doin' this by ourselves.”

A new bipartisan approach even seemed fine by the president, to the extent we are still able to assign meaning to his words. Right after his first grand public legislative failure, he blamed just about everybody. But he also said:

“I know some of the Democrats, and they're good people. I honestly believe the Democrats will come to us and say, look: let's get together and get a great health care bill or a plan that's really great for the people of our country. And I think that's going to happen.”

The president has no ideological core. Nor does he have interest in the details. He wants to “win.” Full stop. And now that he’s lost, he’s realizing he’ll likely need to recalibrate to win next time.

It’s a nearly unanimous opinion in Congress that the Affordable Care Act needs corrections and improvements. Even Senator Bernard Sanders (I-VT) bemoans the fact that premiums and deductibles that are too high. And while speculation abounds regarding whether Democrats will come to the table, Sanders said Sunday that they should where they can:

“President Trump, let’s work together. Let’s end the absurdity of Americans paying by far the highest prices in the world for prescription drugs. Let us do, among other things, a public option…Let’s talk about lowering the age of Medicare eligibility from 65 to 55. Let’s deal with the greed of the pharmaceutical industry. Those are areas that we can work together on.”

While moderate Republicans might not agree with all of that, many of them are at least now willing to deal. And we know the president is, too. But what about Speaker Ryan? The darling of the GOP for years when it came to conservative policy, he now finds himself right where Boehner was: needing Democrats.

After pulling the vote off the floor, Ryan did own up to the failure like a man. He acknowledged that being the opposition party for years was easy; that governing is difficult. Hardly profound. Yet true. But Ryan wasn’t emphasizing bipartisanship.

In 2013, when a bipartisan comprehensive immigration bill passed 68-32 in the Senate, Speaker Boehner wouldn’t allow it to come to a House vote. Not because it couldn’t pass, but because it didn’t meet the GOP’s arbitrary “Hastert Rule” – dictating that the majority of the majority had to be on board.

The road to repairing Obamacare still runs through Ryan. If the president negotiates with Congress and secures a majority of House support on legislation, will Ryan accede to Trump’s wishes even if they’re antithetical to the principles he’s promoted for over two decades? Will he be willing to move to the ideological center on healthcare? On tax reform? On rebuilding the country’s infrastructure? He’ll need to be truly willing, in his own words, to “lose an election if you want to do what’s right.” The irony is that instead of the policy conservatism that’s guided his entire career, ultimately Ryan’s test of leadership may be centered upon centrism.

Michael Golden is the author of “Unlock Congress: Reform the Rules — Restore the System” and is a Senior Fellow at the Adlai Stevenson Center on Democracy