The TrumpRyanCare debacle

Repealing the Affordable Care Act was meant to be the first demonstration of the power and effectiveness of a unified Republican government. It has turned out to be a display of incompetence and cruelty.

Republican leaders withdrew the American Health Care Act before a vote scheduled for Friday afternoon after it became clear that they did not have the votes to pass it. Many far-right conservatives opposed the bill because it would not have completely repealed the A.C.A. or Obamacare. And some more moderate Republicans said they would vote no because the bill would cause immense damage — 24 million people would lose health insurance over 10 years and millions of others would be hit with higher premiums and higher out-of-pocket costs. Surely, many of them were also thinking about a recent Quinnipiac University poll showing that 56 percent of American voters opposed the legislation and just 17 percent supported it.

When Barack Obama was president, Republicans in the House voted dozens of times to repeal the health care law in a symbolic exercise meant to appeal to their base. But never did they present a plan that could improve on the law for their constituents. Still, GOP. leaders imagined that with the House, Senate and White House in their hands, what had once been a hollow threat could become actual policy. That they failed in this legislative effort could well affect the rest of their agenda — tax cuts for the rich, changing the corporate tax structure and new infrastructure spending. The debacle shows President Trump and Paul Ryan, the speaker of the House, that they can’t count on automatic Republican majorities, especially when they’re offering a destructive, incoherent measure.

Which is pretty much what happened here. Despite their ceaseless attacks on the health care act since Mr. Obama signed it into law in March 2010, Mr. Trump, Mr. Ryan and their colleagues have never had a workable plan that could gain the support of a congressional majority. That is why they rushed their turkey of a bill to the floor without going through the laborious process of holding hearings and building coalitions. The last-minute wheeling and dealing did nothing to disguise the bill’s underlying and increasingly obvious purpose, which was to reduce taxes for the wealthy by cutting benefits for the needy.

Meanwhile, the great dealmaker at the White House was completely ineffectual. Mr. Trump spent a few days cajoling and threatening lawmakers, then threw up his hands and said he had done all he could and was now moving on to other matters. Groups representing doctors and hospitals, as well as public interest groups like AARP and the American Civil Liberties Union, fought hard, and even Republican governors like John Kasich of Ohio and Brian Sandoval of Nevada opposed the bill.

In fact, as Republicans moved closer to a vote, public support for Obamacare went up — 49 percent of those polled this month by the Kaiser Family Foundation had a favorable view of the law, up from 43 percent in December. Obamacare, though not without flaws, has done a world of good. The percentage of Americans who do not have health insurance has fallen to 9.1 percent, from 16.3 percent in 2010. A 2016 Kaiser study of people who gained insurance in California found that 77 percent of them said their health needs were being met very well or somewhat well. By comparison, only 49 percent of those people said their needs were being met three years earlier.

There is no doubt that improvements are needed. Deductibles and premiums are too high for many people, and too many young people are forgoing insurance altogether. More generous subsidies for people with modest incomes could bring the cost of health care down at a relatively small expense to the government.

The worry now among advocates for lower-income Americans and the sick is that the Trump administration might seek to undermine the health care law through administrative steps. For example, officials could seek to reduce subsidies that help people earning just above the federal poverty line pay for out-of-pocket costs. Republicans in the House sued the Obama administration in 2014 to block those subsidies. That case is still pending, and the Trump administration could decide to stop defending the subsidies. Such a move would only compound the mistakes it made by trying to rush a half-baked bill through the House.

Friday’s outcome is good for the country, but humiliating for the Republican leadership. For Mr. Trump, it is a rather brutal reminder that campaigning is the easy part.