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What a health care bill's failure could mean for the Trump presidency

The withdrawal of a bill dismantling Obama-era health policy could signal broader fissures within the GOP. Its defeat in the Republican-controlled House is the latest setback threatening Trump’s presidency.

For years, Donald Trump's trademark salesmanship has succeeded in boardrooms, on the set of reality television and most recently on the presidential campaign trail. In the US legislature this week, however, it failed him.

On Friday, the president told House Speaker Paul Ryan to withdraw a Republican health care reform bill moments before a vote was due to take place. The American Health Care Act (AHCA), drafted by House Republican leaders, was the latest attempt to dismantle Former President Barack Obama's Affordable Care Act., known as Obamacare.

Ryan pulled the Trump administration's repeal and replace bill after it failed to gather enough support in the majority Republican House.

"We're going to be living with Obamacare for the foreseeable future,"he said.

USA Washington - Paul Ryan äußert sich nachdem die Republikaner ihre Gesundheitsreform zurückzogen (Reuters/J. Ernst)

House speaker Paul Ryan said Congress "just didn't get a consensus" to allow the health reforms to pass.

Obama's 2010 health care reform extended medical insurance to an additional 25 million people, bringing the country's rate of uninsured people to a record low. But premiums and other rising costs forced some insurers out of the market, limiting insurance options for many consumers.

The 7-year-old health care scheme has already survived two Supreme Court challenges. While its latest death defiance does not mark the end of an enduring political debate, it does cast uncertainty on the effectiveness of Trump's governing style.

Why the health care bill fell apart: a diverse Republican coalition

While Trump blamed Democrats for failing to support the bill, he also seemed to acknowledge the role his own inexperience played in the defeat.

"We learned a lot about loyalty,” the president said after the bill was withdrawn. "We learned a lot about the vote-getting process.”

Earlier in the week Trump issued an ultimatum to House Republicans to either vote for the plan, or live with Obamacare. In the process of courting hard-line conservatives opposed to the bill, he alienated moderate Republicans who initially supported it.

Stuart Diamond, a professor who teaches negotiation at the University of Pennsylvania, said Trump’s coercive tactics backfired.

"Threats don't work in general," he said. "They cause damage to relationships. They definitely don't work in a situation with a lot of different stakeholders, where the power is distributed."

The Washington Post cited almost 50 representatives wary of voting for the AHCA, while The Hill's whip list said 36 Republicans would unequivocally vote no. The lists included veteran members of the conservative House Freedom Caucus, those associated with the more centrist Tuesday Group, and representatives from districts where Democratic candidate Hillary Clinton won in last year's presidential election.

This unlikely coalition of ideologically and geographically diverse Republican members of Congress is what forced House leaders to pull the bill.

Watch video 00:51

How are Americans reacting to the failure of the health care bill?

What this means for President Trump and his party

Two months into office, the Trump administration has already faced a number of setbacks. Courts have quashed its immigration restrictions and a national security advisor has resigned amid a continuing inquisition into the Trump campaign's ties to Russia.

President Trump is leading a very rare, unified government that controls the House, the Senate, and the White House. That Republicans could not reach consensus on health policy beyond just disliking Obamacare after seven years may say more about the party's fractures than the country's health care legislation.

Trump repeatedly vowed that once he assumed office, his top priority would be repealing Obamacare. The fight over the AHCA calls into question the effectiveness of "The Closer's” governing. 

It's not all bad news

Even if the bill had passed the House, it would have been confronted with months of negotiations and revamping in the Senate. The early defeat of the AHCA allows Trump to avoid the complex, hostile and time-consuming process of writing comprehensive health care policy on which the party can agree.

It also means Republican representatives will not have to face the consequences of pushing through an unpopular bill. If the bill eventually became law, 24 million people could have lost health coverage. Some Republicans feared they would have suffered at the polls like their Democratic counterparts did seven years ago. Obama's controversial Affordable Care Act was seen to have played a major role in Democrats losing seats in the 2010 Congressional Election.

Although the Trump administration has no plans to revisit health policy for at least a year, the president is certain his office will see the end of the Obama-era law.

"It's imploding, and soon will explode," Trump said. "And it's not going to be pretty."

The White House is now preparing to steamroll ahead with the next item on its agenda: overhauling the US tax code.

Watch video 04:12

US health care – Q & A with Betsy Leimbigler, JFK Graduate School in Berlin

mcm/jm (Reuters, AP)

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