(KTVU and AP) House Speaker Paul Ryan and President Trump pulled the GOP's American Health Care Act, minutes before a House vote, as it became clear they did not have enough Republican votes needed to pass it. The AHCA was intended to be their first legislative victory and fulfillment of a campaign promise to overturn and replace the Obama-era Affordable Care Act.
It was an admission of defeat, that seven years and a Republican-controlled Congress and White House were not enough Friday to pass the Republican's health care bill.
"I will not sugar-coat this. This is a disappointing day for us," said House Speaker Paul Ryan, a Wisconsin Republican, "Moving from an opposition party to a governing party comes with growing pains and, well, we're feeling those growing pains today. We came really close today, but we came up short:"
"We had no Democrat support. They weren't going to give us a single vote, so it’s a very difficult thing to do," President Trump said.
But in fact, the difficulty was not just from Democrats, but also from opposition within the Republican party. Just after noon, Ryan went to the White House, telling the president, they didn't have the 216 votes they needed. Vice-president Mike Pence canceled a trip to rush over to Capitol Hill, hoping to cajole Freedom Caucus conservatives.
It was a stunning defeat for the new president after he had demanded House Republicans vote on the legislation Friday, threatening to leave "Obamacare" in place and move on to other issues if the vote failed. The president's gamble failed. Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation's health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.
Republicans have spent seven years campaigning against former President Barack Obama's health care law, and cast dozens of votes to repeal it in full or in part. But when they finally got the chance to pass a repeal bill that actually had a chance to get signed, they couldn't pull it off.
Republican tax credits would have been based on age, not income like Obama's, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama's Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.
The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.
Democrats were uniformly opposed.
Henry Brady, Dean of the U.C. Berkeley Goldman School Of Public Policy says the showdown reveals the competing interests within the Republican party between four factions: traditional establishment Republicans, conservative Christians, libertarians and the tea party populists.
"I think there's a big problem within the Republican party. There's a big fissure, a big difference of opinion between the different groups," Brady said, "You have a Republican party where the different parts of it have very different ideologies about the way government should work."
'The Freedom Caucus is the group that's really emerged out of the tea party and it's the part of the Republican party that really does not believe that government should be doing very much," Brady said.
"This is a setback no two ways about it. But it is not the end of the story," Ryan said, listing other issues the GOP has in its sights, "We want to secure the border. We want to rebuild our military. We want to get the deficit under control. We want infrastructure and we want tax reform."
Ryan and President Trump admitted lessons learned.
"We learned a lot about loyalty, about the vote-getting process," the President said.
"I'm pleased as could be that the legislation has failed because I believe it's bad for America," said Alabama Republican Congressman Mo Brooks.
What happened on the floor is a victory for the American people, for our seniors, for people with disabilities, for our children, for our veterans," said House Minority Leader Nancy Pelosi of California, "Today a victory for the Affordable Care Act, more importantly, for the American people."
What happens next is unclear, but the path ahead on other priorities, such as overhauling the tax code, can only grow more daunting. And Trump is certain to be weakened politically, a big early congressional defeat adding to the continuing inquiries into his presidential campaign's Russia connections and his unfounded wiretapping allegations against Obama.
Now, after failing to repeal and replace, the question remains whether Republicans can recover and find enough unity to pass legislation.
"I think with taxes, they're going to run into the same problems," Brady said.