Donald Trump crowed for months he would strike a "terrific" deal on health care. His ambitions ended in a brief phone call Friday afternoon, in which Speaker Paul Ryan told him the truth: He was nowhere close.

The businessman president, who sold himself to tens of millions of disillusioned voters last year as the only outsider who could tame a broken capital, ended his first confrontation with lawmakers overmatched, outmaneuvered and ultimately empty-handed.


“We learned a lot about some very arcane rules,” Trump said in the Oval Office soon after the defeat of his effort to undo President Obama’s health care law.

It was actually the most basic fact of Congress that set Trump back: the majority rules. And despite a 22-seat margin for error in the House, Trump had proved unable to corral support for a plan to repeal the law, one of Trump’s key campaign pledges.

His failure to advance legislation through a single chamber of Congress controlled by members of his own party — despite it being a cornerstone of the Republican agenda for more than half-decade — casts doubt both on Trump’s much-bragged-about dealmaking skills and the GOP’s path forward.

“It's a black eye for the speaker and the president,” said Scott Reed, the top strategist of the U.S. Chamber of Commerce, which supported the measure.

The setback, described in interviews with multiple senior administration and congressional officials, was especially humiliating because Trump was sunk not by Democrats but by his inability to ride herd over the same rebellious element of the Republican conference that previously bucked Speaker Paul Ryan’s predecessor John Boehner out of his job. Most House Republicans have never served in the majority under a Republican president and it’s unclear how in the future they will cobble together a governing coalition.

“The Republican Party is still operating as an opposition party,” said Josh Holmes, a former chief of staff to Senate Majority Leader Mitch McConnell, who added, “If they can't break the fever…it says an enormous amount about the prospects of tax reform, infrastructure and some sort of immigration proposal.”

Trump himself seemed almost relieved to move on from the health care fight, even as other White House officials were fretting about the long-term implications of what one senior White House official called a "clear embarrassment for us."

The president himself wasn’t nearly as upset about the health care defeat as he was about the size of his inauguration crowds, Attorney General Jeff Sessions’ decision to recuse himself from the investigation into Russia’s meddling in the 2016 election or the repeated legal setbacks on his travel-ban executive order, which has been blocked by multiple courts. “No bullshit, I think he's actually pretty comfortable with the outcome. He wants to move ahead and do taxes,” another senior White House official said.

But tax reform — which no president or Congress has been able to tackle successfully for more than three decades — is no easy task, especially as Republicans had banked on deficit-cutting from any health package to give them a financial cushion in that endeavor. “Yes,” Ryan conceded Friday, “this does make tax reform more difficult.”

For weeks Trump had seemed disinterested and disengaged from the specifics of the health care fight, both behind closed doors with his aides and at public rallies. Trump “just wanted to get something he could sign,” said one adviser who talks to him frequently. “He was over it.” He would often interrupt conversations on the law to talk about other issues, advisers and aides said.

In one phone call with Ryan earlier this month, Trump told the House speaker that he had a problem with the bill. It wasn’t over Medicaid expansion, maternity coverage, deductibles or insurance premiums. Rather, it was that he didn’t like the word “buckets”—which Ryan had been using to describe the parts of their plan.

“I don't like that word buckets. You throw trash in buckets. I don't like that word,” Trump said, according to two people familiar with the call. Trump preferred “phases.” Ryan agreed and adopted the term.

It was the kind of messaging detail Trump focused on during the campaign, when he described his plan as “repeal and replace — with something terrific.” But by February, Trump confided to a group of the nation’s governors visiting Washington D.C. that undoing Obamacare would be more involved. “Nobody knew healthcare could be so complicated,” he said.

In the closing days of negotiations, Trump found himself stuck in the middle of an ideological tug-of-war between the two factions at the extremes of a deeply fissured House Republican conference — with every concession offered to the hardline House Freedom Caucus driving away votes from the moderate Tuesday Group, and vice versa.

The arguments for the legislation from the White House were political. “This is your chance,” press secretary Sean Spicer urged lawmakers on Friday hours before the bill died. The arguments against it were based in policy, where Trump was less comfortable.

When Trump trekked to Capitol Hill to make his case in person on Tuesday, lawmakers were mostly nonplussed. “Not a whole lot about health care, except to vote for it,” Rep. Walter Jones, R-N.C., said afterward. He remained opposed.

Other lawmakers said Trump wasn’t at all conversant in the specifics and mainly wanted to talk about his popularity in their districts – or how voting against the proposed bill could hurt them politically. But the proposed law ended up polling below 20 percent – and the president's approval rating dropped below 40 percent.

Short the votes, Trump trotted out one of his favorite deal-making tactics late Thursday to seal the deal: the ultimatum. All House Republicans were told by Trump’s top lieutenants that the bill was take-it-or-leave-it proposition, and their only chance to get rid of Obamacare.

In the days and hours leading up to a vote that looked bleak, the White House did little to tamp down expectations. “He is the closer,” Spicer labeled Trump.

Trump pushed hard for a floor vote up until the final minute. Senior administration officials maintained deep into Friday afternoon that they wanted the roll call "to make them vote against the president on live TV,” in the words of a third senior White House official.

“We are voting,” this person said, 45 minutes before it was called off.

It was straight out of Trump’s The Art of the Deal playbook, where he wrote simultaneously about boldness and maintaining a willingness to retreat. “I never get too attached to one deal or one approach,” Trump wrote. “For starters, I keep a lot of balls in the air because most deals fall out.”

That might work in the real estate business, where there’s always another property to develop, or another contractor to hire. But it backfired in Congress, where time and political capital are not unlimited, where the last deal impacts the next and where there is no alternative set of lawmakers to whom Trump can pitch his next demands.

The setback could also shake up the internal dynamics of a White House, where infighting among rival factions has become the norm. Some pointedly noted that Trump’s son-in-law and senior adviser, Jared Kushner, spent the run-up to the vote in Aspen. Some pinned blame on chief of staff Reince Priebus, who is close to Ryan and had been expected to help Trump navigate the complexities of Capitol Hill. Others faulted chief strategist Steve Bannon for failing to mobilize his former company, Breitbart News, on behalf of the bill, or to corral hardliners on the Hill.

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Indeed, the blame game began even before the vote was called off. “This is 100 percent a Ryan failure,” said the third White House official. While Trump wasn’t upset with Ryan, multiple senior officials said, a number of his advisers and aides were trashing the speaker before the vote – and Ryan told others he expected to get the brunt of the blame.

By midday Friday, the health care bill was hemorrhaging support, as the powerful chairman of the House Appropriations Committee came out against the bill. Ryan came to the White House to brief Trump on the bleak outlook.

But even as Trump and his top advisers wanted to forge ahead, they were showing sign of worry. Spicer no longer embraced the term “the closer.” GOP leadership pushed to drop what was now seen as a kamikaze mission. And a little after 3 p.m., Trump talked to Ryan again — the two had a 45-minute conversation late Thursday night about the law.

“He talked to Paul Ryan for a few minutes, who said he was at least 10 and 15 votes short,” one of the senior White House officials said. Ryan said he planned to pull the vote unless Trump objected, and Trump said he was OK with that.

Ryan explained soon after what it meant to a national television audience: “We’re going to be living with Obamacare for the foreseeable future.”

Trump got off the phone, scribbled down some notes and dialed up reporters to give his side before the full White House staff was even briefed. The president was most focused on the news coverage and how it reflected on him, as he had been throughout, telling advisers how much the criticism of the law on TV bothered him.

In the Capitol basement after the vote was cancelled, Republican lawmakers were gathered to hear what came next. The Rolling Stones refrain Trump often played at his rallies was playing in the background: “You can’t always get what you want.”

Tara Palmeri and Jake Sherman contributed reporting.