Politics

Analysis: Why Ryan Has Stepped Into the Senate Health Care Debate

Speaker has typically steered clear of offering advice or taking on other chamber

Speaker Paul D. Ryan has signaled the Graham-Cassidy health care measure in the Senate will get a House floor vote. (Tom Williams/CQ Roll Call)

Speaker Paul D. Ryan doesn’t like to meddle in Senate affairs — except when he does.

Throughout July when the Senate was working through various proposals to partially repeal and replace the 2010 health care law, Ryan frequently declined to comment on what the other chamber was considering.

But now as the Senate prepares to bring another health care overhaul plan to the floor, the speaker has openly endorsed the bill and privately suggested he could usher it through the House.

On top of that, Ryan told senators the House would not take up a bipartisan health insurance market stabilization proposal that was in the works until it collapsed Tuesday amid the last-ditch repeal-and-replace effort.

The Wisconsin Republican’s decision to dip into a debate that he previously stayed out of has an easy explanation, which he offered Monday when he endorsed the proposal authored by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.

A Graham-Cassidy Call to Arms, for Both House Leaders

“We hope the Senate does pass Graham-Cassidy,” Ryan said at a news conference at a Harley-Davidson facility in his home state. “We are encouraged at the development of Graham-Cassidy. And I am encouraging every senator to vote for Graham-Cassidy because it is our best last chance to get repeal and replace done.”

New approach

The “best last chance” feeling among Republicans has led to an all-hands-on-deck lobbying effort by Senate, House and White House leaders.

But it’s likely not the only reason Ryan has decided to get involved. And it’s certainly not the approach he took when the Senate considered earlier versions of a health care overhaul.

“As tempting as it is to comment on the Senate’s deliberation and their process, I want to give them the space to get their job done,” Ryan said July 13 when asked about a repeal-and-replace measure the Senate leadership was releasing that day, as well as the still developing Graham-Cassidy alternative.

That leadership plan failed to draw the needed support, and the Senate ultimately decided to try to pass a so-called skinny repeal bill as a way to go to conference with the House. Ryan also declined to weigh in on that option.

“I’m going to reserve judgment until I see what the Senate actually produces,” the speaker said July 27, just hours before the bill was defeated.

So if Ryan wanted to “reserve judgement” and give the Senate space on health care in July, why is he not doing so now?

Right time to talk

One answer is likely because senators didn’t want Ryan to stay quiet on the issue.

When the Senate was getting ready to vote on the skinny repeal bill, several senators said they would have a hard time voting “yes” without knowing whether Ryan would actually agree to go to conference. (Some senators had unfounded fears that the speaker was planning to call an up or down vote on the skinny repeal bill, even though it had no shot of passing the House.)

Ryan, after reserving judgement earlier in the day, issued a statement late July 27 to appease the senators, saying the House would agree to go to conference in an effort to keep the repeal-and-replace effort alive. But he added a caveat that the Senate would have to act first on whatever the conference committee produces and offered some harsh words for the struggling chamber.

“The burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise, as the House has already done,” Ryan said. “Until the Senate can do that, we will never be able to develop a conference report that becomes law.”

Ryan’s motivation at the time was clearly to protect his members from having to take another difficult vote on a health care measure without knowing whether it could pass the Senate.

Giving senators cover

Senators’ need for assurances on what the House will do may also be why Ryan told Senate Majority Leader Mitch McConnell, Graham and likely other senators that a bipartisan market stabilization plan that Health, Education, Labor and Pensions Chairman Lamar Alexander and ranking Democrat Patty Murray had been negotiating is not a viable health care solution for House Republicans.

“He says, ‘Listen. I’m not going to prop up Obamacare. I can’t do that,’” Graham told reporters, recounting his conversation with Ryan.

“So this idea of a bipartisan … there is no deal here, a bipartisan deal, that’s going to change fundamentally the way Obamacare works,” Graham added. “And Paul Ryan, I think he’s willing to put his speakership at risk over immigration, over taxes, over funding the military, but he’s not going to put his speakership at risk over propping up a system that won’t work.”

As Graham’s comments suggest, the goal of Ryan pre-emptively shooting down the Alexander-Murray talks before they could even reach a deal was to signal to lawmakers hesitant to support the Graham-Cassidy measure that it’s their only option and they shouldn’t hold out hope for a bipartisan solution.

While saying an Alexander-Murray deal would not pass the House, Ryan did suggest he could get the votes needed to pass Graham-Cassidy.

“Paul Ryan told me to my face: ‘If you pass it, we pass it,’” Graham said at a news conference Tuesday after the weekly Senate Republican Conference luncheon.

In a later conversation with reporters, Graham clarified what Ryan said: “He didn’t guarantee it would pass. He said, ‘I think it will pass.’”

Giving the House cover

If Ryan were indeed that bullish about the bill’s prospects in the House, it could be because he’s trying to provide himself and his chamber with some political cover in the event that the Senate fails again.

President Donald Trump and conservative groups attacked McConnell and his chamber over their failure to repeal President Barack Obama’s signature domestic achievement after repeated campaign promises to scrap the health care law. 

Ryan certainly doesn’t want any of that criticism flowing toward him and House Republicans, since they already passed a repeal-and-replace bill.

This is a risky move, however, because if the Senate does succeed in passing the Graham-Cassidy measure, it will not be an easy vote for House members.

Between GOP moderates from states such as New York and California, whose states stand to lose a lot of funding under the proposal, and conservatives who wanted to repeal more of the law than the bill does, it’s unclear whether the House could pass Graham-Cassidy without some significant arm-twisting. And unlike in the Senate, where McConnell can still make changes to the bill, Ryan won’t have the ability to amend the measure to win over hesitant members.

Get breaking news alerts and more from Roll Call on your iPhone or your Android.