Did Paul Ryan flip-flop on how to pass a big health care bill?

U.S. House Speaker Paul Ryan of Wisconsin, accompanied by U.S. Rep. Cathy McMorris Rodgers, R-Wash., speaks to reporters on Capitol Hill in Washington, following a Republican Caucus meeting. (AP Photo/Cliff Owen)

U.S. House Speaker Paul Ryan of Wisconsin, accompanied by U.S. Rep. Cathy McMorris Rodgers, R-Wash., speaks to reporters on Capitol Hill in Washington, following a Republican Caucus meeting. (AP Photo/Cliff Owen)

As legislation to dramatically overhaul the Affordable Care Act neared a vote in the Republican-controlled U.S. House of Representatives, critics said that Speaker Paul Ryan, R-Wis., was hypocritical in how he brought a revised bill to the floor.

In March, a bill known as the American Health Care Act was pulled from the floor by GOP leaders because it didn’t have enough votes to pass. That was considered a major defeat for both congressional Republicans and President Donald Trump, who campaigned on the repeal and replacement of President Barack Obama’s far-reaching health care law.

Republican leaders adjusted the bill following negotiations with both the conservative and moderate wings of the party. A new version passed the House on Thursday by a 217-213 vote margin.

In addition to decrying the substance of the bill, Democrats and other critics took House Republicans to task for seeming to ram the bill through the chamber without adequate procedural safeguards.

One concern was that the Congressional Budget Office — the nonpartisan office that analyzes the impact of pending legislation — had not reviewed the new version of the bill. Another was that the full text of the revised bill and the relevant amendments was only posted on the Web on Wednesday evening, less than 24 hours before the House was scheduled to vote on it.

The CBO reviewed the original bill, and in doing so, it found that the measure would lead to an additional 24 million Americans being uninsured by 2026.

Some argued Ryan and House Republicans were hypocritical for voting on a new version without a new CBO score, and they pointed to Ryan’s past comments as evidence.

On June 23, 2009, Ryan signed on to a letter to the then-director of CBO seeking a wide-ranging analysis of the Affordable Care Act, which then-Speaker Nancy Pelosi, D-Calif., was trying to pass.

“Before Congress changes health care as the American people know it, we must know the likely consequences of the House Democrat legislation, including the number of people who would lose access to their current insurance, the number of jobs lost due to business taxes, the number of uninsured people who would obtain coverage, and the extent of the cannibalization of employer coverage due to Medicaid expansion.”

Then, in an appearance on MSNBC in July 2009, Ryan personally criticized the Democrats’ procedural handling of the bill in the House. “I don’t think we should pass bills that we haven’t read, that we don’t know what they cost,” Ryan said.

To determine if Ryan’s past remarks and current actions amounted to a flip-flop, so we sought advice from a range of congressional experts and veterans of House floor action.

Generally, we found a sharp partisan divide.

Donald Wolfensberger, a former Republican staffer on the Rules Committee who now studies Congress at the Woodrow Wilson Center, said the bill did not require a new CBO score. Its previous iteration already had been analyzed by the agency.

Several Republicans with House floor experience said they have no quarrel with how Ryan has handled the bill.

“It is well established that when you are in the minority, you complain about procedure, and when you are in the majority, you complain about partisanship,” said John Feehery, an aide to Dennis Hastert, R-Ill., when he was House speaker. “Nothing about Ryan’s comment strikes me as unusual or otherwise inappropriate.”

Glenn LeMunyon, a former floor specialist to then-House Majority Whip Tom DeLay, R-Texas, said the revised Republican bill “is not some new incarnation of health care policy. It is very similar to that which has been in the works for many months. This is not a situation where cost estimates are a complete unknown at all.”

But congressional experts more aligned with Ryan’s critics say his earlier remarks and his present actions are at odds.

Former Rep. Martin Frost, D-Texas , was a longtime member of the House Rules Committee. He said Ryan’s positions are inconsistent.

When asked to consider the argument that the three amendments are simply minor tweaks that don’t merit a separate CBO score, he responded, “Nothing is minor in this bill.”

Norm Ornstein, a longtime follower of congressional procedure who has been critical of Republicans from his perch at the American Enterprise Institute, said that Ryan’s past comments definitely conflict with his recent actions.

Ornstein seconded Frost’s assessment that voting on a bill this far-reaching without a revised CBO score is essentially unheard of.

The perception that Pelosi unfairly strong-armed the ACA to passage while ignoring longstanding procedures has helped shape the perception of Ryan’s actions today.

“We have been around long enough to know about pots calling kettles black, and shoes being on the other foot,” Wolfensberger said. “Neither party has a monopoly on procedural abuses, shenanigans and shortcuts. This is the new normal, and has been for the last few decades — not deliberative democracy.”

In other words, the contrast between Ryan’s words in 2009 and his actions in 2017 are par for the course in Congress in recent years. But while Ryan was within his rights to handle the Republican health care bill as he did, his 2009 comments conflict with his 2017 actions. We rate this a Full Flop.