President Trump and House Speaker Paul D. Ryan are staring at a moment that could define or derail their tenures, with the vote on the GOP measure to repeal and replace Obamacare approaching and the tally seemingly moving against them.

The two are not natural allies, something that was clear during the presidential campaign. As any number of Trump controversies swirled, particularly those that raised questions about the nominee’s temperament and judgment, Ryan (R-Wis.) did his best to keep his party’s standard bearer at arm’s length.

But they began working closely after Trump’s victory in November to set a strategy for their legislative agenda.

Healthcare was the first big item — the bill that would fulfill a central campaign promise for the GOP and open the way to other priorities, including a major tax cut.


Now, however, the outcome of the healthcare vote, scheduled for Thursday evening, appears very much in doubt.

Despite appeals by Trump, Vice President Mike Pence and other officials, some 30 Republicans, led by a rebellious group of conservatives known as the Freedom Caucus, but also including a number of the party’s moderates, have indicated they will vote no. If they all follow through, that would be more than the 21 GOP opponents needed to defeat the legislation if all Democrats join them.

“We easily have enough votes — with a buffer — to kill this legislation unless it’s substantially improved,” Rep. Mo Brooks (R-Ala.) said Wednesday after a White House meeting designed to win over Freedom Caucus members.

The vote count leaves Trump and Ryan facing a key decision — whether to retreat or press forward at the risk of defeat.


Their predecessors faced a very similar moment on the same issue. In 2010, the day after a Republican scored a political upset to win the Senate seat of the late Edward M. Kennedy of Massachusetts, Democrats had to quickly decide whether to press on with the tough and uncertain fight over their healthcare overhaul or concede defeat.

President Obama called it one of the most important phone calls he made as president: “Are you guys still game? Because if you guys are still game, we’ll find a way,” he asked then-House Speaker Nancy Pelosi (D-San Francisco), Obama recalled in a recent interview with the New Yorker. “Once Nancy said, ‘I’m game,’ then it was really just, at that point, a set of tactical questions,” he said.

The decision to go ahead, and the eventual victory with the passage of the Affordable Care Act, bonded the former president with Pelosi, providing an experience they would use as a basis for trusting each other.

Trump and Ryan could forge a similar bond if they pull off a hard-won victory. An early defeat on such a high-profile issue, however, might drive them apart.


Presidents don’t typically choose the congressional leaders they’ll work with, even in their own parties. And there’s ample evidence that neither Trump nor Ryan would have chosen the other in their respective roles.

On the eve of his inauguration, Trump made light of some of their previous conflicts but professed to be working in tandem. Ryan would be the one who would studiously write the bills and he would deliver the signatures on legislation that conservatives had been waiting on for eight years, Trump said.

“I really, really love Paul,” he said. “I just want to let the world know, we’re doing very well.”

Aides to both men say Trump and Ryan are likely to speak multiple times daily most days, most often of late so Trump can probe Ryan about which lawmakers need some presidential arm-twisting.


Michael Steel, a former GOP leadership aide, said Ryan, despite his public criticism of Trump during the 2016 campaign, is skilled at cultivating trust with older politicians, who often view him as a protege.

“Most of his career, he’s always been the youngest guy in the room, and he’s been really successful at building strong relationships with older political figures, like he did with Gov. Romney in 2012,” said Steel, who served as Ryan’s press secretary during the vice presidential campaign that year.

Ryan has learned that his wonky style of communication is wasted on Trump given the president’s lack of interest in policy details, Steel said. But he has come to value Trump’s eagerness to exert pressure on wavering Republicans.

The two have different priorities, yet Republicans say they both realize the healthcare bill is essential to unlocking their agendas.


Trump sees healthcare reform as a means to an end, allowing the party to move on to other big-ticket items that appeal more to his sensibilities as a businessman and deal maker, especially tax reform and trade negotiations.

During the campaign, and as recently as a rally with supporters this week, Trump has expressed relatively little interest in the details of repealing Obama’s healthcare law. He would often bring up the subject perfunctorily in rallies, briefly ticking off the promise to repeal Obamcare near the end of his campaign speeches after much longer riffs denouncing trade deals or Hillary Clinton.

Those around Trump say he is now motivated by a simple instinct that has less to do with policy than maintaining his image as a winner who is fulfilling campaign promises.

“He’s a very objective-oriented person, and he’s very linear,” Christopher Ruddy, a confidant who leads the conservative website Newsmax, said recently.


Ryan, by contrast, is deeply committed philosophically to repealing Obamacare. He also has a long-term interest in overhauling Social Security, Medicare and other entitlement programs that Trump has pledged to leave intact. He sees the rollback of Medicaid spending that the healthcare bill would accomplish as part of his larger agenda, even if Trump would not make the same case.

“This is entitlement reform in and of itself,” said one GOP congressional aide.

Both the White House and the speaker’s office have gone out of their way in recent days to emphasize the extent of their partnership. Ryan has taken to praising Trump as “the closer” for the GOP team.


“President Trump was here to do what he does best, and that is to close the deal,” Ryan said Tuesday after the president addressed the full House Republican conference. “He is all in and we are all in to end this Obamacare nightmare.”

On Wednesday, as Trump continued that effort with time running short, White House Press Secretary Sean Spicer said there would be no backing down.

“Piece by piece, member by member, we’re getting there,” Spicer said of the vote count. “There is no Plan B.”

Trump, however, offered a more equivocal note. Asked by a reporter whether he would persist on healthcare if the bill fails, he said simply: “We’ll see what happens.”


Times staff writer Lisa Mascaro contributed to this report.

noah.bierman@latimes.com | @noahbierman

michael.memoli@latimes.com | @mikememoli

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