Speaker Paul Ryan spoke at the National Review Institute’s Ideas Summit in Washington, D.C. on Friday, where he attempted to convince conservatives who are skeptical of the House GOP health-care plan (the American Health Care Act) that it is a politically viable conservative-reform effort.

Ryan told National Review’s editor Rich Lowry, who interviewed the Speaker, that the House plan gives governors freedom to customize Medicaid to the needs of their states. It establishes “more federalism” because it creates state-based, high-risk pools (with some federal funds) with the goal of keeping premiums down.


As Republican leadership and the White House have insisted since the ACHA rollout, Ryan reiterated that there will be three phases to repealing and replacing Obamacare. First, Congress must pass the ACHA to gut the fiscal components of Obamacare. Because it largely doesn’t address regulatory policy, it cannot be filibustered by Democrats in the Senate and could pass with a simple majority. In the second phase, Tom Price, secretary of the Department of Health and Human Services, would have the regulatory flexibility that the legislature wouldn’t necessarily have to change many components of Obamacare. And third, Congress would pass further legislation to change the parts of Obamacare that can’t be done through budget reconciliation; any changes in this phase would need to meet the 60-vote threshold in the Senate.

“The president has been a great closer on this,” Ryan said. Trump plans to crisscross the country in the coming weeks — spending the most time in the states that voted for him and have Democratic senators up for re-election next year — to make the case for the Republican health-care plan.


The goal is for the Republican-majority Congress to reform the U.S.’s health-care system and the tax code in Trump’s first 200 days, Ryan said.