Paul Ryan Says Health Care Bill On Track, Despite Increasing GOP Opposition

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The Republican Party's most passionate pitch man for its health care bill was at it again Wednesday morning with the same message: Everything is going according to plan.

"This is the plan we ran on all of last year. This is the plan that we've been working — House, Senate, White House — together on," House Speaker Paul Ryan told FOX Business News. "Now as we get closer to finish, going through the committee process, you inevitably make those refinements and improvements as you go through that process. That's exactly where we are right now."

Right now, Republicans are fighting each other, while Democrats sit on the sidelines. They are as unified against President Trump and the American Health Care Act as Republicans were against President Obama and the Affordable Care Act.

The speaker is possessed by an unshaken confidence that this bill is better policy for the country, and that failure would be disastrous for the Republican Party politically.

"The worst thing we could do is not follow up on our word," he told conservative radio host Laura Ingraham. "We need to keep our word. And our word was: We would repeal and replace this law. It is within our own power as Republicans to do as much of repeal and replace as possible. It is our obligation to do that."

Even against a backdrop this week that includes hard-line conservatives and activists groups rallying against the bill, increasing opposition to the bill from Senate Republicans, and tepid public support from President Trump — who has tweeted more this week about Snoop Dogg than the Congressional Budget Office report — the speaker rejects any questions that suggest the health care bill is faltering in Congress.

"We are all on the same page. Absolutely," Ryan told Ingraham.

The speaker has a point. Much of the infighting around the health care bill is normal for a legislative battle of this size and impact. The fact that right now senators are skeptical, party activists are angry, and the health care industry is opposed are not, by themselves, unusual. There's still a long way to go before this fight is over. It's just unclear who will be declared the winner.

Vice President Mike Pence, one of Ryan's closest allies on health care, continues to work the halls of the U.S. Capitol, meeting with Republican factions and working to assuage concerns that the bill is not conservative enough.

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One troubling sign for Republicans is just how uncoordinated, and sometimes conflicting, their messages are to their members and the public. When the CBO dropped a report that Republicans had already anticipated would forecast lower coverage rates and higher costs for some Americans, the reaction from the White House and key players in Congress was completely scattershot.

Health and Human Services Secretary Tom Price attacked the CBO (even though he helped pick its director, Keith Hall), the speaker embraced it, Senate Republicans used it to call for changing course, and President Trump himself has largely stayed quiet.

Now Republicans are under increasing pressure to change the bill, but it's unclear how they can find a path to passage in both the House and Senate. The bill is not subject to a filibuster, which should make it easier in the Senate, but it also means they can lose only two Republican senators and get it through the chamber.

House Republicans have effectively one more chance to change the bill before it comes to the floor for a vote. The House Rules Committee, effectively run by the speaker's office, sets the terms for floor debate. The committee can make changes to the bill via amendment before it comes to the floor. Members will have their own chance to offer amendments on the floor, but that process is largely for show as party leaders largely control which amendments get votes.

Some hard-line conservatives want to speed up the timeline to end the Medicaid expansion under the Affordable Care Act, but doing so would likely doom the bill in the Senate.

Across the Capitol, an increasing number of senators, including Sen. John Thune, R-S.D., a member of party leadership, want to change the bill to make refundable tax credits more generous for older, lower income Americans. But that could increase the cost of the legislation, and in turn, make it tougher to get through the House.

Back at the White House, President Trump's personal thoughts on all of this remain entirely unclear. White House spokesman Sean Spicer insists the president is all-in, as do Pence, Ryan and Price. Yet, The Washington Post reports that Trump's inner circle is increasingly skeptical that the health care bill as written is a good idea.

Influential conservative media outlets in the Trump administration, including Breitbart News and Newsmax, have come out in opposition to the legislation.

The president is travelling to Kentucky next Monday for a rally in Louisville where he will presumably make the case for the health care bill. Trump won the state by a large margin, but Kentucky has seen one of the highest drops in uninsured rates under the ACA. The state's junior senator, Rand Paul, is almost certain to vote against the health care bill if it comes up for a vote.

It's an odd choice to make the case for the GOP health care plan, or to try to pick up a vote.

Or maybe, as Ryan says, it's all according to plan.