Recriminations have begun flying among Republicans even before the House votes Friday on a plan that aims to repeal and replace the Affordable Care Act.
President Trump and House Republican leadership are adamant that the bill, titled the American Health Care Act, must pass. But that outcome was in deep doubt on Friday morning, as lawmakers on both flanks of the GOP expressed skepticism.
Trump will be seriously damaged if the legislation goes down to defeat.
The moment of political peril is exposing the deepest fault line in the new era of Republican control in Washington — the unhealed wound between Trump loyalists and the GOP establishment personified by Speaker
(R-Wis.), which dates back to last year's presidential race.
Criticism of Ryan from Trump World is erupting into the open. Perceived Ryan allies such as White House chief of staff Reince Priebus are also in the loyalists' sights.
Complaints range from the contents of the legislation itself to the decision to press for healthcare reform before moving on to other big-ticket items in the president's agenda, notably tax reform.
The sequencing was "a blunder," one Trump ally told The Hill on condition of anonymity, adding that "Reince put way too much trust in Ryan."
Tax reform, the source added, would have been "far less controversial. Now, you are going to have to carry all this baggage into [the battle over] taxes. I think it was a tactical mistake."
Other Republican voices, including those who remain optimistic that a way forward can be found on healthcare, contend that the legislative plan Ryan proposed guaranteed significant conservative opposition, running headlong into difficulty from the get-go.
"I think they should have been bold right out of the box, with a more conservative policy proposal that would have really fixed the problems," said Greg Mueller, a GOP strategist and long-time Trump supporter. "You always negotiate from your strongest position, not your weakest. Their starter bill was like something you might have compromised on in the end."
Mueller insisted that Trump himself had not been badly damaged, at least so far, because "the nation is seeing the president rolling up his sleeves and getting to work."
But asked about the impact of the push for House legislation potentially coming up short, he acknowledged, "Would it be a short-term setback? Sure."
There are signs that the president himself is even less sanguine.
A New York Times report Thursday night sent reverberations across Washington with its assertion that Trump had told "four people close to him that he regrets going along with Speaker Paul D. Ryan's plan to push a health care overhaul before unveiling a tax cut proposal more politically palatable to Republicans."
The Times report also indicated that three key Trump aides — son-in-law and adviser Jared Kushner, chief strategist Stephen Bannon and economic adviser Gary Cohn — shared at least some of those misgivings.
Meanwhile, the drumbeat of anti-Ryan commentary among conservative media commentators has reached a new intensity and has spread beyond Breitbart, the news organization once run by Bannon that has long been critical of the Speaker.
On Thursday evening, Fox News's prime-time hours were permeated by critical comment about Ryan.
On "The O'Reilly Factor," stand-in anchor Eric Bolling pressed White House press secretary Sean Spicer on whether the president was "disappointed" in Ryan or believed he should step down as Speaker if the healthcare push failed. Spicer denied both suggestions.
Conservative commentator Ann Coulter complained to anchor Tucker Carlson on the same network that the Republican agenda at present seemed "to be Paul Ryan's priorities … the standard GOP corporatist stuff."
And Sean Hannity, an anchor and self-described Trump supporter, lamented that "the legislative branch [has] now failed the president. … President Trump was not served well by his party in the House of Representatives. And he has been put in the position now to do their job and do all the heavy lifting on this bill."
The criticism being voiced in Republican circles is not only going in one direction.
A Wall Street Journal editorial published Friday took issue with the House Freedom Caucus, the heart of conservative opposition to the bill. Headlined "The Freedom-From-Reality Caucus," the piece lamented that "by insisting on the impossible over the achievable, these self-styled guardians of conservative purity could become the worst friends conservative ideas and free markets have had in decades."
The president himself took to Twitter on Friday morning to assert that the Freedom Caucus, "which is very pro-life and against Planned Parenthood," would be in effect helping the reproductive health group if it blocked the legislation.
At the White House press briefing the previous afternoon, Spicer showed irritation with members of the House Republican Conference who had voted against the Affordable Care Act repeatedly during President Obama's time in the White House — when they knew the president was sure to veto their legislation — but who are balking at the current plan.
"You've taken a bunch of these free votes when it didn't matter because you didn't have a Republican president," Spicer said. "And you got to vote for repeal and go back and tell your constituents something like 50 times. Well, this is a live ball now. And this is for real, and we're going to do what we pledged to the American people and keep our word."
To be sure, the healthcare bill might yet pass in the House. But even that outcome, if it happens, won't conceal the tensions that now lie starkly exposed.
The Memo is a reported column by Niall Stanage, primarily focused on Donald TrumpDonald TrumpMulvaney: Let states figure out 'essential health benefits' How President Trump can restore sanity to America's labor laws Planned Parenthood head to Ivanka Trump: 'Stand for women' MORE's presidency.