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March 29, 2024

How the health care vote fell apart, step by step

Donald Trump

Pablo Martinez Monsivais / AP

President Donald Trump talks about the health care overhaul bill, Friday, March 24, 2017, in the Oval Office of the White House in Washington.

WASHINGTON — After several days of dramatic back-and-forth between President Donald Trump and Republicans in Congress, House Republicans pulled a bill to repeal and replace the Affordable Care Act, delivering the president a staggering defeat in his first high-profile legislative effort.

That’s quite a turn of events. Let’s break them down.

What happened?

Republican leaders shelved the legislation Friday afternoon — shortly before an expected vote — after House members spent days pushing for concessions on the replacement proposal, called the American Health Care Act. A day before, after the vote was postponed, Trump demanded that a vote be held Friday. But the bill was pulled as it looked as if it would fall shy of the 215 votes needed to pass the House.

Who decided to pull the bill?

Trump and House Speaker Paul Ryan both said it was their decision.

“Ryan says that he advised Trump to pull the bill,” Julie Hirschfeld Davis, a White House correspondent for The New York Times, wrote in a live analysis. “Interesting, because Trump told us that he had directed Ryan to yank it. A lot of blame-shifting going on.”

How did the vote get derailed?

The proposal would have replaced the Affordable Care Act, known as Obamacare, with a system of age-based tax credits to purchase insurance coverage, and its provisions brought a divide between ultraconservative and moderate House Republicans into relief.

This is the gist: The most conservative members of the House didn’t think that the American Health Care Act would go far enough to eradicate Obamacare, and moderates were concerned about an estimate by the nonpartisan Congressional Budget Office that 24 million Americans would be left without insurance.

Republican leaders bent to the will of the House Freedom Caucus, a group of about 30 hard-line members, agreeing to remove several federal mandates for minimum benefits, including mental health services and some maternity care. But this move still didn’t go far enough to appease members of the caucus. And the concessions alienated several moderates.

How has Trump reacted?

By blaming the Democrats.

In a phone call to The New York Times on Friday, Trump noted that no Democrats had pledged to support the bill, and that they would probably seek a deal once “Obamacare explodes” because of rising premiums and declining options. Speaking later to reporters in the Oval Office, he criticized Nancy Pelosi, the House minority leader, and Chuck Schumer, the top Senate Democrat.

“Now they own Obamacare,” he said. “They own it.”

Schumer fired back on Twitter.

“Ultimately the #Trumpcare bill failed because of two traits that have plagued the Trump presidency: incompetence & broken promises,” Schumer wrote.

Trump praised Ryan for working “very, very hard.” He summed up this exercise in legislative failure as a “very interesting experience.”

But this bill was the first major test of Trump’s ability to corral members of Congress to fulfill his campaign promises, and it was a stunning failure. A president who has prided himself on his negotiation skills in the business world learned the limits of his sway in his new office.

What happens next?

The Affordable Care Act stays intact.

“We’re going to be living with Obamacare for the foreseeable future,” Ryan told reporters Friday.

The president seemed to agree. “It’s enough already,” said Trump, who has been president for just over two months. The Republicans will be moving on to tax reform, which Ryan said would be an uphill battle.

In the meantime, Democrats are rejoicing. For now.

How did we get here?

For at least the past year and a half, Trump had talked about quickly repealing and replacing the current health care law. It was a signature campaign promise.

Shortly after taking office, Trump shifted course, warning that it might take until 2018 to make sure it was done correctly.

But in this White House, a lot can change in a month, and Republicans unveiled the first version of their plan four weeks later. What followed was a series of quick changes to try to appease conservative and moderate House Republicans.

On Thursday, Trump sent a message to Republicans: Either vote to replace the Affordable Care Act, or leave it in place.

Clearly, that ultimatum backfired.

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