Ryan is the perfect symbol of the establishment Republican because he always has to make matters unnecessarily difficult for everyone.
Everything would go so much easier for every member of the GOP hierarchy, from the most indifferent Republican voter up to the most plugged in donor, if the establishment would simply cooperate occasionally with Conservatives.
And yet they always take the hard route by insisting on fighting their rightwing with many times more tenacity than they do, if they do, against Democrats. We see this wrongheaded mindset of theirs emerge again in the repeal process.
For his sake only, Ryan has a compelling enough self-interest in appeasing Conservatives to get something respectable passed: If Ryan fails he isn’t nearly feared enough by his Caucus compared to how, for example, they once feared Tom Delay to survive a setback on repeal. But Ryan continues on, smiling obliviously like the idiot he is, jeopardizing his legislation by refusing to compromise with Conservatives.
Perhaps Trump wants him to lose a few of the initial House votes to discredit Ryan and prepare the way for a different Speaker. If this is the goal desired by Trump there is no more certain way to reach it than by handing the initiative to Paul Ryan.
I give the House Leadership’s repeal bill a C- on policy and a D- on strategy.
Its reform of Medicaid is its best feature. The bill’s expansion of Health Saving Accounts is, if not flawless, acceptable. The tax credits are undesirable but not a deal killer.
The bill’s glaring fault is its failure to repeal Obamacare’s regulations. Without elimination of those regulations the other aspects of the bill will not have a free enough insurance market to be successful in. Dealing with regulations is absent because the House “leadership” stupidly assumed from the start they could not get then past procedural objections to their inclusion from the Senate Parliamentarian.
First, it is not clear the Parliamentarian would strike down all of the regulation reforms if it were explained that the regulations are germane to reconciliation rules because the House bill repeals Obamacare’s taxes and its regulations were designed so they could not function without those taxes. There is a decent chance the Parliamentarian could be brought around to this thinking. But we will not likely find out if the House doesn’t try.
Secondly, if the Parliamentarian does rule (wrongly) against their relevance the Parliamentarian can simply be overruled by Vice President Pence or Majority Leader McConnell.
Any repeal bill the House sends to the Senate should include as much regulatory rollback (including permitting selling medical insurance across state lines) as possible in order to increase the odds that at least some of the those rollbacks survive the Senate.
On the flipside, the fewer regulations are repealed in this first attempt at dismantling Obamacare the less likely it is they will be repealed in future votes when the vote hurdle in the Senate rises to 60.
House and Senate Conservatives could best position Ryan to be blamed by Trump for any vote failures by doing a runaround Ryan through directly offering Trump a set of specific amendments to the bill that, if Trump approves, would then guarantee their support for the full House legislation.
If Ryan includes their proposals they will be in a strong position to ultimately repeal more than 75% of Obamacare instead of the current bill which, arguably, repeals only ~30% of it.
If Ryan does not Trump will be able to ask why Ryan preferred the legislation fail instead of seeking a compromise Trump approved of.