After meeting with Trump just moments before the AHCA was scheduled to be voted on by the House of Representatives, Paul Ryan's sad thumbs-up indicated a not-so-bright future for the health care bill. And sure enough, House Republicans went ahead and pulled the vote just a bit later, knowing that it wouldn't garner enough votes from the GOP, let alone Democrats.
For Ryan, both Thursday and Friday must have been pretty stressful days. The Trumpcare vote was initially scheduled for Thursday, canceled because he knew it would flop on the House Floor, and rescheduled for Friday. Every hour surely mattered in his last-minute effort to recruit unconvinced Republicans. But according to CNN's vote count, at least 27 Republicans were still planning on voting against it. The bill could only afford to lose the support of 22 House Republicans. By the looks of it, Ryan is pretty upset.
And it's possible Ryan could have had more time to persuade his fellow Party members if Trump hadn't insisted on a vote by Friday or had asked director of the Office of Management and Budget Mick Mulvaney to announce an ultimatum. If the House didn't vote on it by Friday, Trump said, Republicans could keep Obamacare and the president would focus his efforts elsewhere. But the controversy within the GOP began long before that Thursday evening announcement.
A group of far-right conservative representatives who call themselves the House Freedom Caucus were in negotiations with Trump and Vice President Mike Pence on Wednesday. In the group's opinion, the AHCA preserved too many Obamacare-era regulations. In the meeting, Trump reportedly agreed to take away health insurance requirements for maternity care, mental health, and wellness visits, among other benefits that the original version of the AHCA had included. Still, other more moderate Republicans were concerned for entirely different reasons. For example, Florida Representative Ileana Ros-Lehtinen, a Republican, explained on her website why she planned to vote no:
I will vote no on this bill because it does not provide adequate solutions for the working poor, disabled, and elderly in South Florida. Too many of my constituents will be left paying more for coverage and many will be left without coverage at all. The cuts and changes to Medicaid will make it more difficult to effectively care for uninsured patients as well as individuals with high costs of coverage due to special needs or chronic diseases.
Though Ryan ultimately failed to secure enough votes, White House Press Secretary Sean Spicer had reassuring words for him during a press brief on Friday:
I think the speaker has done everything he can. He's worked really closely with the president. I think at the end of the day, you know I said this yesterday, you can't force people to vote.
Though Ryan's probably still down in the dumps about this one, those who weren't in favor of the AHCA can take a breath... until, at least, the GOP writes up a new health care bill.
