Paul Ryan is going to take the most blame for the failure of repeal and replace, and rightly so. He had the ball, and it ended up being a debacle. He gambled this his close vote would be more like the close votes of Nancy Pelosi, who had a president of her own party standing with her, rather than those of John Boehner, who didn’t. Instead, this was Boehner redux. There was no getting around that the substance of the bill was poor and the process–premised on passing the bill through the House and the Senate in four weeks–was even worse. It was only going to get over the finish line based on pure muscle and there are limits to what that can achieve, even in the House where the leadership has such inherent power.
If the loss is a blow to Ryan, it’s a party-wide failure. It’s not as though the Speaker came up with the bill and the strategy on his own. President Trump and the Senate were on board. I assumed that Trump would end up being a good intra-party salesman, with a carrot (his knack for schmoozing) and a stick (attacks on Twitter). But he didn’t know enough to be effective and his seat-of-the-pants decision to give into the Freedom Caucus on “essential health benefits” lost more moderates than it gained conservatives, while Trump clearly had no idea of the policy implications. His insistence during most the day that the House hold a zombie vote, going through with the floor vote even when a defeat was assured, was bizarre and amateurish.
Maybe Congress and the administration can transition relatively smoothly to tax reform, but I doubt that’s going to be any easier–it’s just as complicated and also involves using reconciliation to avoid a filibuster. An alternative route would be to try to do a smaller corporate tax reform with some Democratic votes, although so many Democrats are opposed to Trump as a matter of principle, that may be impossible. If tax reform bogs down, the White House may feel it has no choice but to resort to Obama-style unilateral governance, emphasizing Trump’s core issues of immigration, trade, and his war with the media/leakers, where he has a lot of authority to act on his own.