J Scott Applewhite / AP

If you've been watching House Speaker Paul Ryan over the years, you understand why he has more riding on the success or failure of the Obamacare replacement bill than just about any other Republican: because it's his baby.

  • He's the one who pulled together the "Better Way" plan on which it was based — along with his former House colleague, Health and Human Services secretary Tom Price — and he's been working on Republican health care ideas since the days of the Obamacare debate in 2009.
  • All of that helps explain why he pulled out the PowerPoint at yesterday's weekly press conference and spent half an hour lecturing reporters on health care terms ("what is a death spiral?") and how the bill is supposed to work.
  • It also explains why he spent so much time insisting he's not about to get outflanked on the right on health care reform. "These are long-standing conservative principles that those of us who've been working in health care for about 20 years have been fighting for," Ryan said. (He even threw in a Reagan reference, about how the conservative icon wanted to give states more control over Medicaid.)
  • And it explains why he was so adamant that conservatives shouldn't miss the moment: "This is something that we, as conservatives, have been dreaming about for decades. This is the chance, and the best and only chance we're going to get."

What he thinks the problem is: Ryan thinks the conservatives are objecting to the bill mainly because they don't understand the limits of the budget "reconciliation" process, which prevent them from doing some of the things they want to do, like letting health insurers sell plans across state lines. He's taking care of that by assuring them those bills will move separately.

Why it matters: Anyone who has this much pride of authorship could have a harder time dealing with other conservatives who disagree on some of the basic solutions, like refundable tax credits or how to end Medicaid expansion. In the meantime, Trump met with Freedom Caucus members on Thursday and signaled he's open to changes.

And Ryan is about to face weeks of negotiations with Republicans who disagree with him. A gentle reminder from Senate Finance Committee chairman Orrin Hatch in a floor speech yesterday: "We have two chambers in Congress for a reason."

Key quote: "What we hear from the White House is, this is a work in progress," said Freedom Caucus member Mark Sanford, per the Washington Post. "Then we hear from leadership, take it or leave it."

Go deeper

Updated 50 mins ago - Politics & Policy

Ohio Gov. Mike DeWine again tests negative for coronavirus after positive result

Photo: Justin Merriman/Getty Images

Ohio Gov. Mike DeWine (R) tested negative for COVID-19 for a second time after initially testing positive last week, he announced Saturday.

Why it matters: 73-year-old DeWine was set to meet President Trump Thursday on the tarmac at an airport in Cleveland and was tested as part of standard protocol.

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 1 a.m. ET: 19,571,989 — Total deaths: 726,781 — Total recoveries — 11,939,109Map.
  2. U.S.: Total confirmed cases as of 1 a.m. ET: 4,997,929 — Total deaths: 162,423 — Total recoveries: 1,643,118 — Total tests: 61,080,587Map.
  3. Politics: Trump signs 4 executive actions on coronavirus aid — Democrats, and some Republicans, criticize the move
  4. Public health: Fauci says chances are "not great" that COVID-19 vaccine will be 98% effective — 1 in 3 Americans would decline COVID-19 vaccine.
  5. Science: Indoor air is the next coronavirus frontline.
  6. Schools: How back-to-school is playing out in the South as coronavirus rages on — Princeton, Johns Hopkins, Howard to hold fall classes online.
Updated 2 hours ago - Politics & Policy

Republicans and Democrats react to Trump's coronavirus aid action

President Trump speaks to workers at a manufacturing facility in Clyde, Ohio, on Thursday. Photo: Scott Olson/Getty Images

Some Republicans joined Democrats in criticizing President Trump Saturday night for taking executive action on coronavirus aid, with Democratic leaders demanding the GOP return to negotiations after stimulus package talks broke down a day earlier.

Why it matters: Trump could face legal challenges on his ability to act without congressional approval, where the power lies on federal spending. Sen. Ben Sasse (R-Neb.) was the most vocal Republican critic, saying in a statement: "The pen-and-phone theory of executive lawmaking is unconstitutional slop."