House Speaker Paul Ryan, who has invested nearly all his political capital into repealing and replacing President Barack Obama's signature health law, finds his fate suddenly tied this month to whether he can deliver on the Republican Party's promise to send a bill with GOP-centric health solutions to President Donald Trump's desk.
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Paul Ryan is under heavy fire as he faces the first big test of his relationship with Trump
House Speaker Paul Ryan has invested a lot of political capital into the passing of the American Health Care Act.
Paul Ryan
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"You can't underscore how important this is to the speaker," said Republican strategist and president of the Potomac Strategy Group. "From a policy standpoint, it's becoming more closely identified as his rather than the president's."
Ryan's mission, however, will not be easy. His proposal has already faced a number of setbacks, from Democrats and Republicans alike.
Democrats remain staunchly opposed to repealing Obamacare, while some Republicans, like members of the House Freedom Caucus and Kentucky Sen. Rand Paul, don't think Ryan's legislation goes far enough to advocate for free-market solutions.
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The plan, as has been laid out, consists of three "phases," the first of which is an initial budget reconciliation bill that requires 50 Senate votes if passed through the House. The GOP holds 52 seats, making every vote critical.
But the political forecast only seems to be growing darker for Ryan.
On Monday, a report from the nonpartisan Congressional Budget Office said the plan would lead to roughly 24 million fewer Americans being insured over the next decade.
And although Trump has backed the plan, reliably pro-Trump outlet Breitbart, which helped launch Steve Bannon into his role at the White House, has established itself as the bill's top critic on the right.
This week, the far-right website released a tape of Ryan telling House Republicans in October that he would not defend Trump after years-old audio of Trump making lewd comments about women was released. The comments from Ryan had been reported on at length in October, but audio had never been published.
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Another Trump-ally, Chris Ruddy, the CEO of Newsmax, wrote online that Trump should instead focus on a proposal that expands Medicaid and Medicare, rather than the AHCA.
"I think the degree of difficulty in what they're trying to do is off the charts, given the constituencies, given the procedural challenges, and given the kind of state of play of the country politically," Mackowiak said.
added that this is a "big year" for Ryan and "a big part of why he was willing to be speaker."
"Look, Ryan didn't want to be speaker, he was very reluctant about doing this in the first place," . "He was able because he had a lot of leverage, to structure the position in a way where he could do the things he wanted to do and have other members do the things he didn't want to do."
The bill is a part of the three planks to which Ryan has dedicated much of his political career: healthcare, tax reform, and entitlement reform. As Mackowiak put it, he's been thinking about those items "seriously" for the better part of two decades.
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"Now he has a chance, a real opportunity to have major achievements in those areas," explained. "So I do think he has a lot riding on this. I also think if this were to go down one way or the other, it would imperil his ability to have achievements on the other issues he cares about."
Kurt Bardella, formerly a senior adviser and spokesman for the Republican-led House Oversight Committee, told Business Insider in an email he thinks Ryan "has foolishly put himself in a lose-lose situation."
While Mackowiak said the criticisms of the bill are overblown, adding that all three phases need to be in place before the legislation can be truly judged, Bardella said if "TrumpCare" passes at Ryan's push, the speaker "will have shilled for one of the worst pieces of legislation EVER at the expense of his majority."
"If it fails, Bannon-Breitbart are already laying the groundwork [for Ryan] to be the fall guy, and his position as speaker will come under attack," said.
"Had Paul Ryan stood by his actual principles vs. becoming one of Trump's lapdogs, he would have at least retained his own moral high ground and had a platform to lead the GOP for many years to come. Instead, the minute Trump became president, he, like so many in the GOP, rolled over and are on the wrong side of 24 million Americans who are about to lose their health care coverage."
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Another top Republican strategist said he thinks the biggest problem with the rollout so far has been the Ryan team's explaining of the legislative process, saying that they're "frustrated" by the current debate because it's been mostly discounted that the bill will in all likelihood face some major changes in the Senate if it arrives there.
"So the House and Speaker Ryan in turn are taking way more arrows than they need be right now," the strategist said. [This is] the first step of many. They need to start explaining that better to people. It's not a final bill."
If they don't explain that aspect better, the strategist said, House Republicans — and chiefly Ryan — will "get saddled with every negative outcome." But, even as Breitbart slams Ryan with persistence, the strategist said he didn't see a political threat to the speaker.
"There were some stumbles out of the gate," the person said. "The speaker has done a pretty admirable job pulling it together and making the best case. He's out there alone right now, but he can handle it."
And, for the GOP, it's not just Ryan who has a lot on the line.
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"All Republicans have a lot riding on this," Mackowiak said. "Whether they realize that or not."
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