(Bloomberg) House Speaker Paul Ryan has used a soft touch to win over rebellious conservatives. But, with his Obamacare replacement bill at stake, he’s delivering a tougher message: It’s time to fall in line.

“This is an all-hands-on-deck, because you know what? We all ran on repealing and replacing Obamacare,” Ryan said Wednesday, warning that the health care system will collapse if Congress doesn’t act. “This is why we have to pass it with something better.”

House Speaker Paul Ryan holding up a copy of the American Health Care Act, with House Majority Leader Kevin McCarthy
House Speaker Paul Ryan holding up a copy of the American Health Care Act, with House Majority Leader Kevin McCarthy Zach Gibson/Bloomberg

The with-us-or-against-us tone is a departure for Ryan, who has up to now trod carefully around the fiercely anti-establishment members who helped oust his predecessor, John Boehner. 

Now the 47-year-old speaker has little choice but to take a firmer line, bolstered by President Donald Trump’s tweets, to drum up the votes for the first true make-or-break moment of his speakership. The House Ways and Means Committee voted 23-16 early this morning to approve its portion of the overhaul, which House leaders unveiled this week.

The extent to which Ryan needs to force his party to get on board with an Obamacare replacement measure that has been attacked by a wide range of conservatives will be an early indicator of how much of his ambitious agenda he’ll be able to accomplish this year—including a comprehensive overhaul of the tax code. Turning those big-ticket policy goals into law is the GOP’s best sales pitch for the 2018 midterm elections.

“Everyone wants to have the grassroots, up from the bottom, but ultimately you have to get stuff done,” said John Feehery, who was a spokesman for former House Speaker Dennis Hastert and now heads the communications practice at QGA, a public affairs company. “Leadership is all about knowing when you’ve have enough input from the masses and that’s when you lead.”

Trump Tweets

Ryan has two main weapons in his arsenal. One is the GOP’s urgency to repeal President Barack Obama’s Affordable Care Act after more than six years of using it as a rallying cry. Any member who votes against the bill supported by leadership will be accused of wanting to keep Obamacare.

The other is Trump himself, and his Twitter megaphone. Pressure from Trump is most effective in the House, where all members are up for re-election in 2018 and more purely Republican districts tend to be passionately pro-Trump.

“In most of our districts he’s an extremely popular president and an extremely talented communicator,” Kentucky Republican Brett Guthrie said in an interview. “He’s very willing to use his political capital to move this forward.”

Ryan said he spoke with Trump twice on Tuesday as reactions to the leadership’s health care bill were rolling in.

“Doing big things is never easy, but we have made a promise, and we’re going to keep that promise,” Ryan said Tuesday, holding up a copy of his draft legislation. “That is exactly what this bill does.”

Full Repeal

Even with support from the White House, Ryan faces early headwinds from within his own conference. An analysis for the Republican Study Committee, a group of about 170 House conservatives, called the tax credits in Ryan’s bill “Republican welfare entitlement.”

The most vocal members of the conservative House Freedom Caucus have said they still support Kentucky Senator Rand Paul’s plan that hews more closely to a 2015 repeal bill approved in the House and Senate.

Jim Jordan, a Republican from Ohio and a founder of the conservative Freedom Caucus, said members ran on a full repeal of Obamacare and all the related taxes. He said he’s open to negotiating with House leaders, but the current bill doesn’t go far enough.

“You don’t just have something handed down from leadership and say this is how it’s going to be,” Jordan said. “The American people just saw the plan today. I think they probably want to see a debate.”

Ryan says that debate already happened, with input from members helping to craft the House GOP "Better Way" policy agenda published last June, and a series of health care-focused listening sessions this year.

Of the 237 Republicans in the House, 175 attended at least one of the four meetings held by leadership to hear member concerns about health care, according to Chris Bond, spokesperson for Steve Scalise, the majority whip. Scalise’s office also hosted five staff briefings attended by 385 staffers from 234 offices, Bond said.

Growing Pains

Ryan said Wednesday he’s confident that he’ll get the votes he needs in the House to send the bill to the Senate. He said more than 60 percent of his members have never served under a Republican government, which might explain why they are used to digging in their heels on principle.

“What you’re seeing is, we’re going through the inevitable growing pains of being an opposition party to becoming a governing party,” Ryan said. “It’s a new feel, it’s a new system for people, but it’s all the more reason why we have to do what we said we would do and deliver for the American people.”

It’s also a new style of leadership for Ryan, who casts himself as a “policy guy” who tries to stand above the noise of politics, especially during the bumpy first few weeks of the Trump administration. Since becoming speaker in October 2015, he has employed what he calls a “bottom-up” approach, which aims to give rank-and-file members more say in the outcomes of legislation.

Some conservatives were initially skeptical of Ryan, but many praise him for giving more power to House committees and being less dictatorial.

“I think there’s a real desire, and I applaud the speaker for being willing to give deference to the committees and I think that that’s a good style,” said Representative Mark Meadows, a North Carolina Republican and chairman of the House Freedom Caucus.

Judged on Results

But now Ryan will be judged on results, not only on repealing Obamacare, but also for an overhaul of the tax code he has pledged to bring to a vote before the August recess.

Ryan has shown some ability to wrangle his restive caucus, mostly notably pushing through a difficult Puerto Rico debt bill last year. But the stakes are much higher this time around.

“You also have to be willing to get your fingernails dirty,” Feehery said. “By that I mean not wonky policy stuff, but you know trading votes and getting policies so you get the votes. It’s not necessarily glamorous work, but there are a lot of deals that have to get cut.”

Ryan does have a few carrots to offer House members. At a conference meeting Wednesday morning, he offered to match funds raised by GOP lawmakers for the month of March, according to a person who was in the room but asked not to be identified when speaking about the closed-door event.

The offer wasn’t tied to any specific policy, the person said. Team Ryan, the speaker’s national political operation, sent $4.4 million to the National Republican Congressional Conference last month, along with the $3.4 million he sent in January.

- Anna Edgerton