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The risk of Paul Ryan’s top-down approach to the health care bill

Paul Ryan Holds Weekly Press Briefing At The Capitol Photo by Win McNamee/Getty Images

House Speaker Paul Ryan is calling the shots on the Republican plan to replace Obamacare.

The bill was drafted in his office, it was pushed through committee after committee per his request, and on Monday night — three days before the House of Representatives is scheduled to vote on the bill — he submitted a manager’s amendment to the bill, a package of changes to be considered in the Rules Committee on Wednesday, one day before the floor vote.

In theory, this top-down approach from the House leadership, where the speaker runs the show, is not new in Congress; it’s in part how former Democratic House Speaker Nancy Pelosi managed to get Obamacare through to the Senate in 2009.

But Ryan seems to be taking it further, Joshua Huder, a senior fellow at Georgetown University’s Government Affairs Institute, said. While Ryan’s team maintains the bill went through a transparent and regular order to the House floor, Huder notes that there is a particular lack of open deliberation among Republican lawmakers this time around.

On Monday, Huder tweeted that the American Health Care Act will be the “perfect case study to examine this new leadership. ... They’re basically doing it alone.” I called him to talk through the effects of Ryan’s style of leadership on the health bill.

He argues that rank-and-file members of the Republican Party have no direct impact on the language used in the health bill, which poses a political dilemma: This approach might be the only way to get the bill to the House floor, but it also ties lawmakers to an Obamacare replacement plan they had little control over crafting.

Our conversation has been lightly edited for clarity.

Tara Golshan

What’s unique about the way House Speaker Paul Ryan is pushing this health bill through?

Joshua Huder

It’s not unusual for speakers to draft legislation in their own office and then drop it on the floor — that hasn’t been abnormal since [Former Speaker of the House Sen. Dennis Hastert (R-IL)] and [Former Speaker of the House Newt Gingrich (R-GA)]. At the same time, for a bill of this magnitude, it is surprising.

Simply because the politics are difficult. There are two ways to go: You can open it up and let everyone have a bite at it, or you can go do what speakers have increasingly done since the 1990s and shut everyone else out and dictate the policy for everyone else. Either you are working with [committees] closely or you have decided that this is too big for them to handle.

In terms of how Paul Ryan is handling it, this is an extraordinarily speaker-centered process, basically telling committees with jurisdiction not to change the bill.

The whole committee rubber-stamping thing, the no hearings, this is much more centralized than what we see previous speakers go through on a major rewrite of legislation like this.

Tara Golshan

Having a heavy-handed approach threatens Ryan’s career too, though, doesn’t it?

Joshua Huder

It’s an enormously risky process. On one hand, you are essentially shouldering the blame for everything that will or can go wrong. You are risking your leadership looking inept, looking like it can’t control its caucus, that it can’t deliver on promises it has been making for the past seven years. All of those things are significant.

On the other hand, you have to think of a way that this bill could get through the process other wise. Can Energy and Commerce write a bill that’s going to pass the rest of the House the way leaders want it to pass — with mostly, if not all, Republican votes? Not likely. Can Ways and Means do that? Not likely.

You saw this trend in the [Affordable Care Act] debate in 2009 — you had all these committees drafting different pieces of legislation, none of which could get across the House floor. So Nancy Pelosi made the agreement — she took just parts of all these pieces, crammed them into one legislative vehicle, and rammed it through the House.

In many ways, this bill can’t get across the line without some kind of leadership interference, but on the other hand, this is much more heavy-handed than what Nancy Pelosi was doing, because there was no deliberative process in the committees.

This was drafted by leadership, dropped onto its committees. They are essentially rubber-stamping it. Now they are going to go to the floor. This is far different than taking pieces that were negotiated past in the Energy and Commerce and Ways and Means Committee and the Education and Workforce Committee and then passing different pieces of that, giving a little bit of language to your moderate members, and getting it across the line.

The style is different, but in line with a strong leadership mentality. Potentially it’s the only way this bill gets through, but also very heavy-handed.

Tara Golshan

There have been a lot of opposing viewpoints on the plan within the Republican Party, which only really reared their heads during the Budget Committee. Is that a product of Ryan’s top-down approach as well?

Joshua Huder

The Budget Committee is a term-limited committee. Meanwhile, Energy and Commerce and Ways and Means are not only not term-limited but they are two of the most important committees in Congress. They have such important policy jurisdictions.

If you are somebody who has disagreements on the bill itself, that particular committee is not the place you want to voice those because it means you could lose that particular committee assignment.

If the speakership is doing this in a heavy-handed manner, which it appears they are, [lawmakers would be] risking their political careers and their policy careers in many respects if they go against the leadership, because those are really high-priority committees in the leadership.

The Budget Committee has no important policy jurisdiction other than to pass a budget resolution. It has very little direct policy impact, which is why you saw the Freedom Caucus pushing back a little. They’re not going to be there in two years anyway. [And] the budget committee can’t change the bill.

It’s more evidence of the heavy-handed nature that the leadership is pushing this bill through. Either it’s going through on their terms or it’s not going through.

Tara Golshan

Do you think there is change in the level of transparency with this bill?

Joshua Huder

Not having a bill out for public debate, and negotiating behind closed doors, is not fundamentally different than what’s happened in the House in the last couple of decades and what happened in the Senate under Harry Reid for the entire time of his majority leadership. In certain ways, you need that space to make negotiations with your members, who are making tough choices for the constituency. It gives you some negotiating leverage, because you are not doing any of this with the minority party at all. That’s the difference between the Senate and the House. The House is an internal debate between Republicans, and Speaker Ryan is going to shoulder all of this.

Does it lead to transparency issues? Absolutely it does. It’s more [about] deliberation than transparency — this is a process where most members are being shut out.

Tara Golshan

What risks does that open Republican members to?

Joshua Huder

If you don’t allow members to vote on amendments, you give them zero leeway to distance themselves from the particular bill if they have to. If you aren’t allowed to distance yourself from the tax exemptions, that’s something that is going to be hung around your neck come the elections. If you can’t distance yourself from rolling back Medicaid, that’s going to come back.

It really just leaves an all-or-nothing composition; leaders are driving caucus, but the problem is some members don’t like the way it is being driven, and they are going to make it very clear they weren’t part of the process — they didn’t get to introduce language. And how effective is that defense against challengers in primaries? That’s not a great talking point.

Tara Golshan

What’s the White House’s role in this approach?

Joshua Huder

Normally you would see the White House in front of this thing. Now you see Paul Ryan in front of this thing and the White House backing up talking points he give out.

On the other hand, this is a bill and not a law. They are maybe just waiting for the Senate to take it on. What influence they have in the House right now, we will find out real soon. Either Thursday is a calamity and the White House doesn’t weigh in at all or you have a scenario that it passes, and it’s whether or not the White House weighs in then.

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