Paul Ryan isn’t quite done flubbing the health care fight

Donald Trump’s White House desperately wanted the Republican-led House to vote today on the latest iteration of the GOP health care plan — not for any substantive reasons, but because West Wing officials thought it’d be cool to pass a bill out of the chamber before the president’s 100th day in office.”Next Wednesday is OK,” a senior administration official told the New York Times’ Glenn Thrush, “but Friday is a lot better.”This is, of course, a rather ridiculous way to approach policymaking — we are talking about the health security of tens of millions of American families, not some arbitrary, symbolic metric tied to a president’s fragile ego — and as it turns out, it’s not going to work. House Republican leaders announced last night that there’d be no vote on their American Health Care Act today or tomorrow.There are a handful of factors that contributed to this, but in the end, it was a matter of arithmetic: House Speaker Paul Ryan (R-Wis.) thought he might be able to pull together enough votes from his own caucus to get the bill through, only to discover that House Republicans still aren’t on board with their own party’s proposal.The GOP leader, in other words, is managing to flub the health care fight for the second time in two months. Indeed, consider what the Wisconsin congressman told reporters yesterday.

At the same press conference, Ryan defended a core provision of his plan by saying his home state of Wisconsin had a high-risk pool that “was pretty actually darned good.”As for the politics, the House Speaker added, “I think people’s seats are at risk if we don’t do what we said we would do…. We promised that we would do this. If you violate your promise, if you commit the sin of hypocrisy in politics, that’s the greater risk, I think, to a person’s seat.”Let’s take these one at a time.First, the idea that people with pre-existing conditions would be “better off” under the Republican plan is plainly bonkers. The GOP legislation would gut existing protections under the Affordable Care Act, leaving a system in which consumers with pre-existing conditions could be forced to pay exorbitant premiums.Second, Wisconsin’s high-risk pool didn’t work well at all, and thankfully for the state’s residents, it was shut down when the ACA became law.And third, Ryan believes House Republicans will be more popular with their constituents if they vote for a wildly unpopular piece of legislation that would leave tens of millions of Americans with no health coverage, raise premiums, raise deductibles, undermine essential benefits, and gut protections for those with pre-existing conditions. Is it any wonder so many rank-and-file GOP lawmakers are responding to the Speaker by saying, “Um, no”?We’re looking at a dynamic in which Paul Ryan is screwing up the substance and the politics of health care in equal measure. That’s not easy to do.