Speaker Paul Ryan and President Donald Trump — those awkward, sometimes reluctant allies — face the biggest test yet of their unusual relationship as the House barrels toward a dramatic vote this week on repealing and replacing Obamacare.

The stakes could not be higher for either of them.


The success of the new president's legislative agenda will hinge in large part on Thursday's vote in the House on the American Health Care Act, already being dubbed "Ryancare" or "Trumpcare." Failure would be a real blow to Trump, who has vowed over and over again to "repeal and replace horrible, disastrous Obamacare." It would damage the prospects of getting his other top priorities — from tax reform to funding his “beautiful wall" — through a GOP-controlled Congress.

Ryan, for his part, has put his legacy as speaker on the line. Sixteen months after taking over for ex-Speaker John Boehner, Ryan doesn't have a long list of legislative victories to show; in fact, his most notable achievement to this point may be simply surviving Trump's takeover of the party and victory in the presidential race. The two clashed often during the campaign, though Trump supported Ryan's reelection in January as speaker.

As the vote approaches, Ryan is under heavy pressure from both ends of his conference. The conservative House Freedom Caucus — the group that ousted Boehner — is growing restless, attempting to circumvent Ryan to negotiate directly with the White House in a bid to push the GOP health-care proposal farther right. If the Freedom Caucus derails the bill, it will have undermined Ryan's authority at a time when he needs it to pass Trump’s agenda.

Vulnerable and more moderate Republicans have their own concerns with Ryan's plan, particularly its rollback of Obamacare's Medicaid expansion. Democrats are already threatening to make the repeal vote the defining issue of the 2018 midterm elections.

Ryan clearly is aware of the risks he faces. The Wisconsin Republican has made clear to Trump and top House GOP lawmakers that he's willing to ignore the attacks from conservative hard-liners and outside groups against the House Republican plan, multiple leadership sources told POLITICO. Ryan has said this is the last job he's going to have in politics and he will do whatever it takes to succeed.

Appearing on "Fox News Sunday," Ryan expressed confidence that he will have the votes to prevail — in part because he feels Trump has his back. House leaders intend to make some Trump-backed changes to the bill this week to ensure it gets the needed 216 votes.

"I feel very good about it, actually; I feel like it's exactly where we need to be,” Ryan said. “And the reason I feel so good about this is because the president has become a great closer. He's the one who has helped negotiate changes to this bill with members from all over our caucus."

A victory for Ryan — and Trump — would jump-start the legislative effort to replace Obamacare, the issue that propelled Republicans to the House majority in 2010. It would also allow Republicans to move forward with a major tax reform package, another top priority for both the president and speaker.

And it would signal that their uneasy partnership can work — at least for now.

If he fails, Ryan will face a fierce backlash, one that could “mortally wound” his ability to be speaker, in the words of a close ally. He likely wouldn't face a challenge for his job, but also couldn't count on much support from Trump, who doesn’t like to lose and hasn’t forgotten the criticism Ryan leveled at him during the presidential campaign.

Bottom line: The rest of the GOP agenda will be endangered if Ryan loses Thursday's vote. The House majority would likely be at risk from emboldened Democrats. And Ryan can expect a fresh wave of criticism from conservative hard-liners, who have already turned against a man they backed for the job.

Ryan and his allies believe he'll win but that it will be razor close.

“I think he could hold on as speaker, but he’d be mortally wounded,” said a House Republican close to Ryan. "It would show he's doesn't have what it takes when it matters. If he wins, it's big, no matter what the Senate does. He's delivered on the biggest vote so far."

For weeks, Ryan has battled to protect his GOP alternative from concerted attacks by the far right, including conducting a wave of TV interviews. The GOP critics, led by the Freedom Caucus and some Senate Republicans, have dismissed the House plan as “Obamacare-lite." They even went around Ryan to White House chief strategist Steve Bannon in an unsuccessful attempt to get Trump in their corner. Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah), as well as House Freedom Caucus Chairman Mark Meadows (R-N.C.), met with Trump officials on Saturday in his home at Mar-a-Lago to talk about the issue.

Ryan could also see his proposal stall in the Senate in the face of GOP opposition, in effect forcing his members to cast a vote — and pay the political price — for a bill that never reaches Trump's desk.

Yet a win this Thursday will silence doubters of Ryan's leadership. Rep. Bill Flores (R-Texas) said passage of the bill would be a “huge victory” for Ryan, enabling Republicans to fulfill the No. 1 campaign promise they’ve been running on for years. Flores praised Ryan for engaging with governors, the health care community, and his own GOP Conference on the issue, calling conservative claims that Ryan left them out in the cold “absolutely BS — and please quote me on that.”

“He had a really tight strike zone, and we can’t throw balls outside of that strike zone or you could lose expansion state governors or non-[Medicaid] expansion state governors or people from the health care community,” Flores said. "The bottom line is Speaker Ryan is doing a great job in spite of relentless attacks."

"Even those people who are not enamored with the bill know Paul Ryan is doing the best he can, given the circumstances," added Rep. Trent Franks (R-Ariz.)., pointing to the restrictions any House bill will have to meet in order to considered by the Senate under its simple-majority requirement.

Rep. Charlie Dent (R-Pa.), chairman of the moderate Tuesday Group, told POLITICO: "I don't think anyone believes Paul Ryan is in danger of losing his job."

Ryan and his leadership team have also had to figure out how to use Trump, who even the speaker now openly refers to as "unorthodox."

On several occasions, Trump — more used to business negotiations than political maneuvering — appeared to leave the door open to more sweeping changes to the bill sought by conservatives. Among their asks: rolling back the Medicaid expansion more quickly, or instituting more stringent work requirements for Medicaid recipients than House leadership wanted.

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Ryan and other top Republicans warned Trump that such an approach would cost them votes from more moderate members. So the president agreed not to allow significant revisions at the behest of hard-liners because doing so would make it impossible to pass the bill.

The result is that the far right now appears to be boxed in, facing a choice between voting to replace Obamacare or voting against it.

Trump offered a few small concessions to the Republican Study Committee during a meeting with several of its members in the Oval Office on Thursday. The lawmakers, in return, pledged their votes on the spot. The changes gave wavering members such as Rep. Gary Palmer (R-Ala.) — who had voted against the Ryan-Trump bill in Budget Committee — and Rep. Robert Aderholt (R-Ala.) — who was leaning "no" — the political cover they needed.

Ryan also got a big boost when the National Right to Life Committee declared that it will "key vote" the legislation, meaning anyone who opposes it risks losing the support of the group.

"There's two groups on the right that really mean something when they give an endorsement: the NRA and the National Right to Life Committee," said the chief of staff of one swing-district GOP lawmaker. His boss is now voting for the bill.

By focusing on the Republican Study Committee and other more mainstream conservatives, Ryan and the rest of his leadership team — along with the White House — sought to isolate the Freedom Caucus and other hard-liners.

The move has the potential to backfire, however, if the Freedom Caucus sticks together in opposition to the Republican plan. Right now, the group believes it has the votes to do so.

During a panel with reporters last Wednesday, Freedom Caucus members were asked whether the health care negotiations were turning into a “referendum” on Ryan’s speakership.

None said they wanted to oust him. But their answers showed they clearly aren’t happy with Ryan, either.

Meadows said “the way [the health care proposal] was rolled out was not indicative of an open process.” Freedom Caucus members for weeks have quietly fumed that Ryan cut them out of the equation, prompting their move to go around leadership with a direct appeal to the White House.

The group also railed against a Ryan-aligned outside group trolling conservatives in their own districts to vote for the bill — and warned them to lay off. American Action Network, a super PAC aimed at helping House Republicans, has run ads in Freedom Caucus members' districts and just last week started robo-calling their constituents to urge them to tell their House members to vote for the bill.

At one point, Raúl Labrador (R-Idaho) suggested Minority Leader Nancy Pelosi (D-Calif.) — perhaps the GOP’s most despised figure on the left — was a more effective speaker than Ryan.

“I don’t think this is a referendum on Paul Ryan … but he does need to figure out what it means to have a majority,” Labrador said. “Sometimes I give credit to Nancy Pelosi, that she knew what it meant … implementing the promises that she made to constituents.”

Labrador added: “Maybe Paul Ryan needs to take a couple of lessons from Nancy Pelosi and learn what it means to have the majority. … Having the majority does not mean playing defense; it means playing offense."

