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Axios Vitals

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Good afternoon ... Today's news demands an extra special edition of Vitals. No getting around it — House Republicans' decision to pull the bill creates a lot of uncertainty about the future of Obamacare. It's still "the law of the land," as House Speaker Paul Ryan put it a few minutes ago, but it's also in the hands of an administration and a GOP Congress that hates it and isn't interested in helping it succeed.

And I can't include video in these emails, but here's your soundtrack for the day's events. Keep checking the Axios health care news stream for what happens next, and sign up for our breaking news alerts here.

The aftermath: There is no Trumpcare Plan B

Greg Ruben / Axios

President Trump likes to say that the easy thing to do would be to "let Obamacare fail" and blame the Democrats. Now, that might actually happen. It's the closest thing any Republican has articulated to a Plan B now that their repeal plan has gone down in flames.

The White House has been publicly insisting there was no Plan B in case the bill failed, and now that the bill has been pulled, it's pretty clear there's no backup plan now, either. "We're going to go back and figure out what the next steps are," House Speaker Paul Ryan told reporters at a press conference a few minutes ago. A disappointed-looking House Energy and Commerce Committee chairman Greg Walden was blunt with reporters: "This bill's done."

Trump put a more positive spin on it: He says he's going to wait for Democrats to come to him, and then they'll work on a new health care bill together. "They're going to reach out whenever they're ready," Trump said. But his message was the same: Democrats will come to him because Obamacare is about to have "a very bad year" with "explosive premium increases."

Why they're stuck: Republicans didn't spend any time discussing a backup plan because they didn't want to believe they needed one. "We have not discussed a Plan B. I'm being authentic and genuine. There's no backroom discussions ... This has been all-in," Republican Study Committee chairman Mark Walker told reporters this morning. One senior GOP aide told Caitlin Owens that Republicans "will have to do a lot of soul searching."

  • What's next: Trump says he's moving on to tax reform: "I think we have to let Obamacare go its way for a while."
  • Ryan's warning to Democrats: Don't gloat, because Obamacare's problems are "going to get even worse."
  • Ryan suggested there won't be any Republican efforts to help the law through its struggles, like the huge premium hikes in the last enrollment season: "It is so fundamentally flawed that I don't know that that is possible."
  • That could change now that the bill's defeat is a reality. If nothing else, Health and Human Services secretary Tom Price has promised other measures to relax Obamacare's rules through administrative actions, and there's no reason those measures couldn't go forward.
  • And it doesn't mean all Republicans will want to just give up and leave Obamacare in place. "If we stopped there, it would be an unacceptable failure of insight or perserverance," Freedom Caucus member Trent Franks told reporters this morning. "Sometimes the greatest victories of all happen at 12:01 instead of 11:59." But he couldn't articulate what the next step would be.

Reality check: There's really no such thing as "leaving Obamacare in place" under a Republican administration that hates it. The law has needed a tremendous amount of implementation funding and support from the Obama administration, and it's not going to get it under Trump and Price. And some of the problems in the insurance market have been caused by the loss of "risk corridor" payments for health plans with expensive customers — which were cut because of Republican opposition.

The new talking point: "If we can't change the law on our own, and the law is what Obama and [Nancy] Pelosi and [Harry] Reid passed, pretty hard to say it's the GOP's fault," the senior Republican aide said.

How it happened

  • Last night, Trump sent a message to GOP leaders that he wanted the House to vote on the bill today. The leadership went ahead, even thought they weren't confident they had the necessary 216 votes in hand.
  • This morning, top Republican leaders were trying to sound confident, and insisted that Trump had done everything he could to win over the GOP holdouts. Trump "solidified several votes" from moderate Republicans yesterday, Walden told reporters.
  • But they weren't that confident. Rep. Tom Cole, who's close to Ryan, on whether they had enough votes: "Close."
  • And by late morning, it was clear they weren't close enough. Ryan went to the White House to give Trump the bad news.
  • While they were meeting, White House press secretary Sean Spicer was insisting to reporters that the vote would go ahead.
  • At 3 pm Eastern, Trump and Ryan talked by phone. Ryan said he told Trump that the smartest thing to do would be to pull the bill. He says Trump agreed.
  • At 3:45 pm Eastern, Ryan broke the news to House Republicans.

The blame game

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"At the end of the day, this isn't a dictatorship ... They're the ones who have to answer to their constituents why they didn't live up to the promises they made."

— White House press secretary Sean Spicer, on the Republicans who wouldn't vote for Obamacare repeal

"We're going to be living with Obamacare for the foreseeable future. I don't know when we're going to get the votes we need."

— Ryan