The Hill reports today that Paul Ryan, in an interview to be aired today, has said that he doesn’t want to work with Democrats on an healthcare reform bill. The potential for doing so only arose after both moderates and the radical-right Freedom Caucus derailed the AHCA from even coming to a vote, because both factions opposed it in the House (for entirely different reasons). Frustrated at the outcome, Trump implied that he might work with Democrats to come up with a bipartisan bill. In actuality, this is the only possibility for a bill which could be stomached by the public, and brought into play the intriguing possibility that some true no-brainer reforms, like allowing the government to negotiate on drug prices, could be brought into the picture, even though it seems inevitable that any bill palatable to the GOP would also probably require tax cuts for the rich and a reduction of the subsidy level that’s in effect under the ACA. And that, unfortunately, means people losing coverage. The White House, for its part, could probably give a crap; Trump wants to be able to point to the accomplishment. His willingness to sign off on the AHCA clearly indicates he doesn’t care if he breaks some of his campaign promises on the substance of whatever he signs into law. One might argue that the AHCA was so bad (with only 17% public approval) that he’s literally willing to sign off on anything just to say he got reform done.
If Ryan is steadfast in his refusal to work with Democrats to craft a bipartisan bill that could actually clear both houses of Congress, though, reform is likely to be a dead issue. The Freedom Caucus are real bomb-throwing radicals – described as “lemmings wearing suicide vests” by Devin Nunes (of all people) – and they won’t sign off on anything other than full ACA repeal, with no “replacement.” They want fully unregulated, pre-reform health insurance, the way it was before the ACA – with spiraling costs, shitty plans providing no meaningful coverage, excluded preexisting conditions, and tens of millions priced out of the market entirely. In short, the very mess that necessitated reform in the first place. Anything that gets done on healthcare reform that actually provides subsidies or keeps any of the Medicaid expansion intact is dead on arrival with those folks. So anything that gets done on healthcare will have to be done despite them, and that means reaching across the aisle, or nothing.
See the Hill article here: http://thehill.com/policy/healthcare/326448-ryan-breaks-with-trump-on-healthcare-no-dems