The best details of how the GOP health care bill died

On Monday night, the Republican plan to repeal and replace Obamacare died when two GOP senators defected, making a total of four who had announced their opposition to the bill. By Wednesday morning, the inside story began coming out as to how the plan — a signature campaign promise from President Trump and a regular refrain from Republicans over the past seven years — failed to gain traction.

According to reports from the New York Times, Washington Post, and Politico, the failure of the bill came as a result of secrecy, miscommunication, and mutual frustration among GOP senators and the White House.

The Washington Post’s Robert Costa, Kelsey Snell, and Sean Sullivan reported that Trump’s Monday dinner with GOP senators — as the health care bill was in its death throes — was a “loose” discussion of many issues, healthcare among them:

[Montana Senator Steve] Daines described the group’s conversation, which also touched on issues ranging from health care to the debt limit, as loose — as if Trump “sat down and went out to dinner with friends, acquaintances, people you work with. It was just dinner to talk about what’s going on.”

During the discussion, as the New York Times’s Jennifer Steinhauer, Glenn Thrush, and Robert Pear reported, President Trump vented his frustration about opposition to the bill:

He told the lawmakers how annoyed he was with one Republican who was not there, Senator Rand Paul of Kentucky, who had gone on television over the weekend to oppose a Senate health care bill that once held the promise of victory for Mr. Trump. It is one thing to vote no, Mr. Trump told the group, according to one of the guests. It is another, the president said, to go on all of the Sunday shows and complain about it.

Though the White House was holding a meeting with senators, Politico’s Annie Karni and Eliana Johnson reported that this kind of rhetorical engagement was more common from the White House than substantive policy engagement:

Trump, according to multiple sources on the Hill, was never steeped in the details of the health care bill. They said he was unable to sit down with members of Congress and convince lawmakers with substantive objections that he had better answers or to understand their concerns and explain why the bill addressed them.

Politico’s Karni and Johnson also wrote that “the White House played virtually no role in crafting the Senate bill,” but the Washington Post did report last-ditch efforts to woo Republicans during the National Governors Association meeting last weekend. The Post reported that Pence — a former governor himself — wasn’t met with open arms at the meeting:

Instead of rousing cheers on the waterfront in Providence, R.I., Pence was greeted with an icy air of skepticism Friday as he pitched the legislation, which would reduce federal Medicaid funding and phase out coverage in dozens of states.

Governor Dan Malloy (D-CT) said the White House continued its attacks on the CBO during the meetings, according to the Post account:

Malloy singled out a private breakfast session Saturday, in which administration officials sought to win over governors on the Senate legislation, as particularly problematic for the White House’s sale. He said one official sought to discredit the Congressional Budget Office; less than a minute later, another official cited a CBO statistic to defend his argument.

Another Politico report, from John Bresnahan and Burgess Everett, indicated that Senate majority leader Mitch McConnell was largely held responsible for the bill, its process, and ultimately its failure:

McConnell and his top aides assembled the proposal privately, holding it so tightly that no other senators were sure what was in it; some lawmakers complained that lobbyists and the media received information before they did. When the first version of the McConnell plan ran into a buzz saw of criticism from moderates over Medicaid cuts and lack of funding to fight the opioid epidemic, McConnell drafted another version, which was also designed to appeal to wary conservatives.

They noted that the bill was strongly associated with McConnell throughout the process:

The lack of committee hearings and votes put McConnell in a box in another way, as well. It was the “McConnell bill” or the “McConnell plan.” And as McConnell was busy drafting the bill, these Republicans formed their own cliques or groups, and then lobbied for changes to the plan. When these GOP senators didn’t get what they wanted, they balked at giving their support.

McConnell has always said he was a “regular order” guy. And this time, his failure to use that process hurt him.

Inside the White House, Karni and Johnson reported, Chief of Staff Reince Priebus had the most at stake:

“He pushed health care first,” one senior administration official told Politico in the weeks leading up to Monday evening’s Senate blowup. “He owns the outcome.” Another senior West Wing aide noted dismissively that “the goose was cooked with the first House bill — and that was Reince and his friends.”

This, of course, feeds into the semi-regular rumors that Trump is looking for a replacement chief of staff:

Trump has been grilling friends about potential replacements for Priebus, but one holdup in finding an appropriate successor is the structure of his White House. At least one person turned down the job, according to a source, after telling the president there were too many competing power centers in the West Wing for him to be successful in the post.