GOP Health Bill Tests Trump-Ryan Bond

WASHINGTON - President Donald Trump and House Speaker Paul Ryan are staring at a moment that could define or derail their tenures, with the vote on the GOP measure to repeal and replace Obamacare approaching and the tally seemingly moving against them.

The two are not natural allies, something that was clear during the presidential campaign. As any number of Trump controversies swirled, particularly those that raised questions about the nominee's temperament and judgment, Ryan, R-Wis., did his best to keep his party's standard bearer at arm's length.

But they began working closely after Trump's victory in November to set a strategy for their legislative agenda.

Health care was the first big item - the bill that would fulfill a central campaign promise for the GOP and open the way to other priorities, including a major tax cut.

Now, however, the outcome of the health care vote, scheduled for Thursday, appears in doubt.

Despite appeals by Trump, Vice President Mike Pence and other officials, some 30 Republicans, led by the conservative Freedom Caucus, but also including a number of the party's moderates, have indicated they will vote no. If they all follow through, that would be more than the 21 opponents the GOP can afford, which would doom the legislation.

"We easily have enough votes - with a buffer - to kill this legislation unless it's substantially improved," Rep. Mo Brooks, R-Ala., said Wednesday after a White House meeting designed to win over Freedom Caucus members.

The vote count leaves Trump and Ryan facing a key decision - whether to retreat or press forward at the risk of defeat.

Ironically, their predecessors faced a very similar moment on the same issue. In 2010, the day after a Republican scored a political upset to win the Senate seat once held by Edward Kennedy of Massachusetts, Democrats had to quickly decide whether to press on with the tough and uncertain fight over their health care overhaul.

President Barack Obama called it one of the most important phone calls he made as president: "Are you guys still game?" he asked then-House Speaker Nancy Pelosi, D-Calif., Obama recalled in a recent interview with the New Yorker. "Once Nancy said, 'I'm game,' then it was really just, at that point, a set of tactical questions," he said.

The decision to go ahead, and the eventual victory with the passage of the Affordable Care Act, bonded the former president with Pelosi, providing an experience they would use as a basis for trusting each other.

Trump and Ryan could forge a similar bond if they pull off a hard-won victory. An early defeat on such a high-profile issue, however, might drive them apart.

The two have different priorities, yet Republicans say they both realize the health care bill is essential to unlocking their agendas.

Trump sees health care reform as a means to an end, allowing the party to move on to other big-ticket items that appeal more to his sensibilities as a businessman and dealmaker.

Those around Trump say he is now motivated by a simple instinct that has less to do with policy than maintaining his image as a winner who is fulfilling campaign promises.

Ryan, by contrast, is deeply committed philosophically to repealing Obamacare. He also has a long-term interest in overhauling Social Security, Medicare and other entitlement programs that Trump has pledged to leave intact. He sees the rollback of Medicaid spending that the health care bill would accomplish as part of his larger agenda, even if Trump would not make the same case.

Both the White House and the speaker's office have gone out of their way in recent days to emphasize the extent of their partnership. Ryan has taken to praising Trump as "the closer" for the GOP team.

On Wednesday, as Trump continued that effort with time running short, White House press secretary Sean Spicer insisted there would be no backing down.

"Piece by piece, member by member, we're getting there," Spicer said of the vote count. "There is no Plan B."

Trump, however, offered a more equivocal note. Asked by a reporter whether he would persist on health care if the bill fails, he said simply: "We'll see what happens."

Washington Bureau's Lisa Mascaro contributed.

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Credit: By Noah Bierman and Michael A. Memoli - Washington Bureau