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Thursday may have been Paul Ryan’s best day as speaker of the House. Or according to Democrats, his worst. After months of tense negotiations, false starts and unrelenting pressure from President Donald Trump, a weary-looking Ryan and his leadership team pushed through legislation to repeal and replace Obamacare. It passed with one vote to spare, 217 to 213, with 20 Republicans and all Democrats opposed. (Bresnahan and Haberkorn, 5/4)

Getting his own party to agree on a conservative health care overhaul turned out to be a massive lift for House Speaker Paul Ryan, but he finally got it done Thursday, with hardly any votes to spare. “A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote,” Ryan said from the House floor, referring to the GOP’s repeated vows to repeal Obamacare. (Gilbert, 5/4)

For Republicans, the successful House vote Thursday to repeal and replace ObamaCare was a moment of celebration. But it also was a time for inward reflection. The past two months exposed deep divisions within the broad 238-member GOP conference, saw President Trump unleash Twitter attacks on individual GOP members and factions, and raised questions about whether Speaker Paul Ryan (R-Wis.) and his team could deliver on the GOP’s top campaign promise. (Wong, 5/4)

The Republican health care overhaul might never become law, but it has already changed the life of one American: Reince Priebus, who knew it was his best and perhaps last hope of becoming an empowered White House chief of staff. President Trump placed much of the blame for his first, failed push to repeal the Affordable Care Act in March on Mr. Priebus, the harried and ambitious former Republican National Committee chairman. (Thrush and Haberman, 5/5)