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Paul Ryan's make-or-break moment on Obamacare will test his power, legacy and relationship with Trump

It’s a make-or-break moment in House Speaker Paul D. Ryan’s crusade to pass the GOP’s Obamacare replacement amid growing opposition from critics in his own party who see a chance to topple not only the bill but perhaps his young speakership as well.

No other Republican has staked his political capital on passage of the House GOP plan to repeal and replace the Affordable Care Act as much as Ryan. He’s hawked the plan almost daily on television and radio, using a wonkish PowerPoint demonstration, and he’s worked furiously to drum up support in Congress and the White House.

“People say it’s like herding cats. It’s not herding cats. It’s herding ravenous tigers,” said Rep. Barry Loudermilk (R-Ga.), a conservative who has yet to give his support to the House bill.

Whether the Wisconsin Republican can pull off the legislative lift as the bill heads to a House vote next week will establish not only Ryan’s power and legacy, but also the tone of his rocky relationship with President Trump.

Americans are skeptical about the Republican plan to replace Obamacare, new poll shows »

So far the White House appears only too happy to let Ryan carry the load of promoting the bill. Some of the president’s advisors have long been gunning to replace Ryan, and a misstep over the healthcare repeal bill could open the door.

On the other hand, success would cement Ryan’s reputation as a power broker and party leader.

“There’s a lot on the line here — not only for Paul Ryan as speaker, but for us as a conference, for us as a party and obviously for the president,” said Rep. Tom Cole (R-Okla.) “The president’s much better off with a strong speaker than a damaged speaker — and vice versa — the speaker’s better off with a strong president.”

But with opposition rising from both moderate Republicans and the hard-right House Freedom Caucus, Ryan’s best hope now seems to be amending his widely panned bill in order to ensure at a minimum that it passes the House.

And if the House bill fails? “There’s going to be some damage control to be done,” Loudermilk said.

Ryan appeared unflappable Thursday as Capitol Hill swirled with a familiar energy of unrest within the party.

Conservatives balked at the bill they complain does not sufficiently repeal Obamacare. More traditional Republicans worried their constituents will be left without healthcare, particularly if the Medicaid provisions in the law are undone.

The last time Republicans were this divided — in 2015 — then-House Speaker John A. Boehner abruptly resigned.

Some of the attacks have started to get personal against Ryan and appear designed to drive a wedge into his already fraught relationship with Trump.

Breitbart News, the website once run by top Trump advisor Stephen K. Bannon, has railed against the bill. This week the site circulated an old audio recording of Ryan trashing Trump during last year’s campaign, before the men set their differences aside.

Ryan dismissed the attacks as the usual Washington "chattering class stuff." In a particularly upbeat mood Thursday as Trump arrived to celebrate St. Patrick’s Day at the Capitol, the speaker insisted his was not a go-it-alone strategy but one that has the full backing of the White House.

“The president of the United States is the one who's bringing people together, sitting around a table, hashing out our differences, so that we can get to a consensus document,” Ryan said.

Vice President Mike Pence worked Wednesday to convince competing factions that the administration heard their concerns, but made no promises the White House would address perceived shortcomings in the bill.

An initial whip count by GOP leaders was not expected to produce enough votes for passage.

And in a sign of the challenges he faces, Ryan now acknowledges that the bill will undergo “necessary refinements” to win broader support.

“Look, he is trying to guide a piece of legislation though,” said Rep. Bill Flores (R-Texas), a former chairman of the conservative Republican Study Committee. “For people to second-guess from the bleachers is really troubling.”

Conservatives are hopeful Ryan will adjust the bill with changes in their direction, perhaps by more quickly ending Obamacare’s expansion of Medicaid or putting in place a work requirement for those receiving government-backed health insurance.

A side-by-side comparison of Obamacare and the GOP’s replacement plan »

”He’s listening to everybody. He’s talking, much more open to ideas, in all fairness,” said Rep. Morgan Griffith (R-Va.), who has yet to back the bill.

But pushing the bill rightward risks alienating more traditional Republicans who could withhold their votes or, as Minority Leader Nancy Pelosi said, “walk the plank” by voting for an unpopular bill that is dead on arrival in the Senate.

That would make passage in the House a symbolic victory for Ryan, but leave open the question of whether it was a substantive achievement.

In the Senate, Republicans are openly abandoning the bill, promising changes if it lands there.

At the White House with Trump and GOP senators this week, the chatter quickly turned to what some saw as the botched rollout, according to those familiar with the private meeting. They grumbled that House Republicans did not consult enough with outside groups to ensure the bill would have more grass-roots support.

“The White House isn’t going to take a fall on this,” said one Republican Senate aide, granted anonymity to discuss the situation.

Even though Trump has vowed to campaign for the legislation, he devoted just a few minutes to it at a rally Wednesday in Nashville. Republicans are hoping for a stronger push from him at his rally in Kentucky on Monday.

Democrats sense the president’s apprehension.

“President Trump has slapped his name on buildings, ties, steaks, hotels and golf clubs, but not on a bill that he says he supports,” said Senate Minority Leader Charles E. Schumer (D-N.Y.) “Every single day we learn more and more about this bill and more and more Americans turn against it. That's why Donald Trump doesn't want his name on the bill.”

lisa.mascaro@latimes.com

@LisaMascaro

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