House Speaker Paul D. Ryan (R-Wis.) tells a packed room of journalists that there would be no vote Friday on the American Health Care Act because it lacked the votes to pass. (Melina Mara/The Washington Post)

President Trump and House Speaker Paul D. Ryan made it a binary choice: You’re either for their health-care legislation or you’re for “Obamacare.”

From Reps. Trent Franks (R-Ariz.) to Rodney Frelinghuysen (R-N.J.), spanning the party’s ideological spectrum, the answer came back Friday: No, it’s much more complex. It was filled with several different options and possible routes ahead, and dozens of Republicans agreed with their sentiment.

That left Republicans well short of the votes they needed to fulfill a seven-year promise to destroy the 2010 Affordable Care Act once they were fully in charge, delivering a stinging defeat to both Ryan and Trump.

It also suggested a new dynamic in which both the right and left flanks of the Republican conference are emboldened to challenge leadership. And that could make each future negotiation more difficult as the issue matrix gets more complicated and the pockets of internal GOP resistance continue to grow, not shrink, in the new era of Trump’s Republican-controlled Washington.

Some parts of these botched negotiations looked a lot like the recent past. Franks and his House Freedom Caucus cronies played the role of obstructionists who will buck party leaders no matter if it’s John A. Boehner, Ryan’s predecessor, or now Trump, as well. These ideologues gobbled up tons of attention, resulting in much care from Trump, Vice President Pence and top West Wing advisers.

(Jenny Starrs/The Washington Post)

By lunchtime Friday, Franks still would not commit to publicly supporting the bill — even though he admitted it was far better than current law. “Of course it is, yeah, it’s a lot better than Obamacare, of course it is. There’s not even any comparison,” Franks said a few hours before the legislation went down in flames.

Franks remained upset that conservative proposals were left out of the bill because they would have violated Senate budget rules, meaning that the proposal to replace the ACA was nowhere near to his liking.

“That still is like putting dirt in ice cream,” he said.

Other parts of the negotiation, however, were new and quite different from the previous six years of Republican control of the House. Nothing capped this off more than the stunning announcement Friday morning from Frelinghuysen, just three months into his hold on the coveted Appropriations Committee gavel, that bucked leadership.

“Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents,” he said in a statement.

A 22-year veteran whose family traces its establishment lineage to the Continental Congress, Frelinghuysen won his chairmanship uncontested with the blessing of Ryan and the leadership team. He’s not someone who rocks the boat — he supported impeachment articles against President Bill Clinton — but his pronouncement Friday sent a jolt through the Capitol.

He also joined a long list of influential centrists who rejected the proposal on policy grounds, not out of fear politically. Frelinghuysen has received more than 60 percent of the vote in all but one election.

(Alice Li,Jayne Orenstein/The Washington Post)

If anyone should back Ryan — he’s a new committee chairman, he’s safe back home — it would have been Frelinghuysen. Instead, he sent a message to a few dozen other Republicans who have more troubling districts that they, too, should break from the president and the speaker.

In some corners, Republicans saw the past week as a defining moment when lawmakers went from the hypothetical exercise of previous fiscal proposals, which they knew the White House of President Barack Obama would block, into the world of live ammunition in which these proposals could become law.

That gravity, among moderates and some mainstream conservatives as they saw Trump agree to concessions to the Freedom Caucus, altered votes. “Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” said Rep. Joe Barton (R-Tex.), a Freedom Caucus member whom Trump had won over to support the bill.

By the time Ryan arrived at the White House, delivering the bad news about the whip count for the vote, those Republicans were doing just that. Rep. Barbara Comstock (R-Va.), who brought Ryan into her suburban district outside Washington, broke against the bill, followed by Rep. David Joyce (R-Ohio).

Joyce’s district, a mix of suburbs and working-class towns east of Cleveland, actually went for Trump by more than 11 percentage points, as Joyce was reelected by a 25-percentage-point margin. In the past, his biggest political fear has been a primary challenge from the right, yet the slight hint of Trump-fueled challengers to those opposed to the bill did not sway Joyce.

Ohio Gov. John Kasich (R) had accepted expanded Medicaid funding as part of increasing insurance coverage through the ACA. Ryan’s American Health Care Act would phase out the Medicaid coverage.

Joyce made a simple, binary choice about Obamacare: “The American Health Care Act was not a better solution.”

This new combination, with Ryan’s right and left flanks willing to buck him and the new president, presents deep concern for the long-term effort to take up the more complicated effort to overhaul the corporate and individual tax codes.

Before they can even get there, however, Ryan faces an April 28 deadline to come up with a funding stream for the federal agency budgets through the end of the fiscal year. In previous federal spending fights, the Freedom Caucus has refused to lend a hand unless policy riders were attached. Democrats, who have been relied on in the past to backfill those lost conservative votes, have signaled they will not do so this time if the legislation includes funding for controversial measures such as Trump’s request for funding to build a border wall.

That messy task falls to Frelinghuysen’s committee — and it will become much more difficult for the new chairman to ask for loyalty votes on his legislation just a few weeks after he walked away from Ryan on the AHCA. Democrats believe this attempt, and failure, has left Republicans politically in charge of health care from now on. They can’t complain about something if they can’t come up with their own fix.

“If it passes, they have to answer for it,” House Minority Leader Nancy Pelosi (D-Calif.) told reporters early Friday. “If it doesn’t pass, they have to answer for that as well.”

Some Republicans rejected that, but others took a more holistic view. Passing the Ryan legislation would have only led to a very messy fight in the Senate, setting up what might have been an even more contentious fight later in the spring between the two different pieces of legislation.

Said Rep. Mark Amodei (R-Nev.), who opposed the legislation: “Even if it passes today, it’s like — I wanna pick these words very carefully — the adolescent dance school will still continue in full view.”

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