Updated at 4:55 p.m. ET
House Speaker Paul Ryan on Friday withdrew the much-maligned bill to replace the Affordable Care Act from the floor Friday as Republican dissent swelled.
The move came just minutes before the U.S. House of Representatives was set to vote on the American Health Care Act. GOP leadership in the House frantically tried to muster the votes to save the bill during floor discussion despite a growing number of defections from moderates and ultra-conservatives.
“This is a disappointing day for us. Doing big things is hard," Ryan said during a news conference Friday afternoon. "All of us, myself included, will need time to reflect on how we got to this moment, what we could have done to make it better.”
Ryan visited President Donald Trump at the White House on Friday before returning to the House floor for debate on the bill, telling the president they did not have the 216 votes necessary to pass the legislation. Trump issued an ultimatum on Thursday, telling the GOP they needed to pass the AHCA or Obamacare would live on.
Ryan acknowledged that Republicans would be moving forward with other parts of their agenda including tax reform and strengthening the border.
“I don't know what else to say other than Obamacare is the law of the land. It will remain the law of the land until it's replaced," Ryan said. “We're going to be living with Obamacare for the foreseeable future.”
GOP leaders could face a crisis soon when jittery insurers must announce whether they'll sell plans for 2018 and how they'll price them. Ryan said his big concern is that the ACA insurance market could collapse, with exiting insurers and soaring premiums. “We'll try to prop it up but it's so fundamentally flawed that I don't know if it's possible.”
Trump echoed Ryan's remarks later Friday afternoon, saying Republicans were "very close" but couldn't overcome the Republican criticism and lack of Democratic support.
“We'll end up with a truly great healthcare bill in the future after this mess known as Obamacare explodes," Trump said in the Oval Office Friday afternoon after the bill was pulled. “We learned a lot. We learned a lot about loyalty. We learned a lot about the vote-getting process. We learned a lot about some arcane rules in the House and Senate.”
Repealing the Affordable Care Act was a key promise in many GOP campaigns across the country, including Trump's. House Republicans spent much of the last seven years casting dozens of votes to overturn Obama's signature healthcare reform law.
Ultra-conservatives in the House reportedly rejected Trump's offer Thursday morning to include a repeal of the ACA's minimum essential benefits requirement in the proposed American Health Care Act. Members of the House Freedom Caucus said they needed more changes in the bill to reduce health plan premiums or else they would vote against it.
But many experts say administration actions and inactions, notably the failure to fund payments to insurers to cost-sharing reductions and reinsurance, have contributed to the instability. Ryan said the House bill would have funded reinsurance and risk-sharing pools, but that won't happen now.
GOP fence-sitters broke against the bill Friday, with House Appropriations Committee chairman Rodney Frelinghuysen of New Jersey announcing his opposition due to late revisions made to win over conservatives.
Those changes, he said, raised “serious coverage and cost issues.” Republicans from Medicaid expansion states like New Jersey were particularly nervous about backing the bill, which would effectively end Medicaid expansion in 2020.
Chris Fanning, chief marketing officer at the not-for-profit Geisinger Health Plan in Pennsylvania, said his organization fully intended to offer individual market plans for 2018, whether or not the GOP bill passed. “It's part of our mission,” he said. “It's not our intent to move away from this market.”
As of Thursday afternoon, 37 House Republicans, mostly Freedom Caucus members, had declared their opposition to the bill, the Washington Post reported. A handful of more moderate GOP members, including Rep. Charlie Dent of Pennsylvania, announced their opposition, spurred by proposed revisions that likely would further reduce Medicaid spending and coverage. Rep. Rodney Frelinghuysen (R-N.J.), chair of the House Appropriations Committee also came out against the AHCA, saying it would raise healthcare costs.
In the hours leading up to the AHCA's demise, Republicans on the House floor mostly supported the bill, but conceded the proposal wasn't exactly what they wanted.
"We either pass a good but imperfect bill, or we keep Obamacare in place," Rep. Jodey Arrington (R-Texas) said.