“First you get the votes, then you take the vote,” the Washington saying goes.

Paul Ryan failed to get the votes for his health bill. So he’s not taking the vote.

Republican leaders told members of Congress Friday that the House vote on the American Health Care Act, which President Donald Trump demanded for Friday, will not in fact happen.

President Trump just called me. Still on phone.

"We just pulled it," he tells me. — Robert Costa (@costareports) March 24, 2017

Greg Walden, a key Republican committee chairman who helped craft the bill, told reporters that the bill was now “Dead. DOA.”

Though President Trump and Speaker Ryan went down to the wire trying to twist enough arms and win the necessary votes to pass the AHCA through the House, they could not in fact get enough support to get the bill over the finish line. And by some accounts, they weren’t even close.

The problem was that the bill was hammered with opposition from two distinct parts of the Republican caucus.

From the right, a bloc of conservatives aligned with the House Freedom Caucus argued that the AHCA kept far too much of Obamacare in place, and opposed the bill for not doing enough to roll it back.

Meanwhile, other members of the party were deeply worried that the bill would cause many of their constituents to lose insurance coverage — a sort of Coverage Caucus.

In the end, Trump and Ryan couldn’t satisfy enough members of both blocs, especially because any concessions to one group repelled members of the other.

For instance, as a sop to the Freedom Caucus, the final version of the bill eliminated Obamacare’s requirement that individual market insurers cover 10 “essential health benefits” in their plans.

But that concession drove, for instance, Rep. Rodney Frelinghuysen (R-NJ), a veteran member who chairs the House Appropriations Committee, to switch from “undecided” to “no” on the day of the vote.

It is not yet clear what the next step for health reform will be. But for now, it’s stuck.

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A very damaging blow to the “repeal Obamacare” effort

Now, this setback is not necessarily the death of the long-held Republican dream of repealing and replacing Obamacare. After all, we’re only two months into Trump’s presidency, and the Affordable Care Act was signed 14 months into Barack Obama’s. Theoretically there is still ample time for this Congress to develop a new compromise to win over more of the holdouts.

But there are many reasons that could prove quite difficult.

First, there are other things to do, and many Republicans seem to want to move on to those other things. That number includes President Trump himself, who demanded this vote be held before a deal was in hand because he’s tired of negotiating on health care and wants to move on to other priorities like tax reform. (Health reform has never been an issue particularly close to Trump’s heart.) So if the urgency to pass a health bill dissipates now, it may never return.

Second, this defeat came partly at the hands of House conservatives. Any revised bill that could win them over would be more likely to alienate moderates. It would also be even less likely to pass the Senate than Ryan’s original version (which was incredibly unlikely to pass the Senate).

Third, it may be now or never to use the special Senate process that could pass health care with a majority vote. That’s because Congress wants to pass a new budget resolution that would put tax reform on that “budget reconciliation” track. But the chamber’s rules seem to hold that the Senate can only have one revenue-related bill set up for reconciliation at a time — which means they’d be giving up their opportunity to use it for a health bill, and that any future health bill would need 60 votes to beat a filibuster.

Finally, this defeat means there’s blood in the water. Trump’s approval rating is already historically low for a new president, and that the FBI confirmed this week that it’s looking into whether his associates coordinated with Russia during the campaign. Now, the new administration has failed in its first-high profile legislative effort, as has Speaker Ryan. This failure will lead to a blame game, embolden their opponents, and make future successes more difficult.

What does President Trump do now?

We don’t yet know what will come next, but Trump has signaled in recent days that he’ll wash his hands of health care.

He’s long seemed uncomfortable discussing it, and is clearly more interested in other topics. The bill wasn’t his but Paul Ryan’s, and it in fact violated Trump’s campaign promises. Trump has repeatedly argued that the issue isn’t even a political winner for Republicans.

The president could decide to let Health and Human Services Secretary Secretary Tom Price do what he can to reshape health policy through the executive branch, and let everything else lie.

Still, it is clear that many Republicans in Congress have defied President Trump’s wishes. The president hates to lose and he hates to be embarrassed, so someone will have to get the blame for this fiasco.

Will that be Speaker Ryan, who failed to come up with the necessary votes? Will it be the holdout Republicans in the Freedom Caucus? Or will it be his own White House chief of staff, Reince Priebus, who’s reportedly argued in favor of Ryan’s legislative strategy? We don’t yet know who will get most of the blame, but the fallout for this high-profile failure will surely ripple through the young administration.