The great problem before The Speaker of the House was this: His membership wanted a healthcare bill that was more conservative than what would pass the Senate. His challenge was to reach a compromise.
Which was hard and Paul Ryan doesn’t work hard so he didn’t.
Here’s the thing about the version of AHCA that just passed out of the House. The Senate hates it. The first group of people Paul Ryan wrote off in creating the legislation was Senate Democrats; using the reconciliation process they need only 50 votes and the Vice President to pass it. With 52 GOP Senators, 3 defections kills the bill so its a narrow path to walk.
So what did Paul Ryan put in the bill to sweeten the deal for his folks? Well, for starters, it defunds Planned Parenthood, a non-starter for the two pro-choice Republicans. It also added the much vaunted Upton Amendment, which, and I’m only exaggerating a little, offers peanuts to people with preexisting conditions. That may have been good enough in House, but several Senators have said that the issue needs properly dealt with. It also stripped out help for the opioid crisis—I don’t have a clue why that was popular in the House either—and has given Rob Portman cause to signal no. In fact, the theme from the Senate seems to be, “That’s nice, but, uh, we’re writing our own.”
And a big blow to the bill is coming. When Democrats passed Obamacare, they had every amendment scored by the CBO before voting. While they were accused of not reading the bill (and it was literally true), they carefully weighed and studied each part trying to get it to work. Ryan intentionally rammed this bill through before the CBO could comment on it because it is going to tear the bill to shreds. Most policy experts think the amendments made the bill worse from a deficit standpoint, which will make this even more unattractive in the House, and will increase the number of uninsured people. Pelosi claimed on the floor, and I’m not going to contradict her, that the pitch the GOP made was the Senate would fix that. But then they would send it back to the House—presumably with changes to make it less popular among the very people who narrowly passed it in the first place, thus endangering the coalition that now knew how bad it was.
Let’s review. To make the bill palatable, the Speaker put in several provisions that are DOA in the Senate. He did this without checking with the CBO because he knew that would be bad news. On the off chance the Senate does pick it up—and they say they won’t—any changes to make them accept it endanger the coalition that passed it in the first place.
One arrives at the inescapable conclusion: this is a photo op, proof of life for Ryan’s Speakership. As long as this is rotting in committee, Ryan can tell his caucus that they passed something, that its the dastardly Senate’s fault that nothing happened. And his caucus was stupid enough to go along with it in the first place, so who knows, maybe they will buy it. They got a beer and front page pictures with Trump, after all.
But man, this is a garbage legislative gambit that is already failing.