Mike DeBonis, Sean Sullivan, Ed O’Keefe
House Speaker Paul D. Ryan (R-Wis.) headed to the White House midday to brief President Trump on an overhaul of the nation’s health-care system, amid mounting evidence that enough House Republican would spurn their pitches and send the bill to defeat.In one stunning defection, Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced at midday that the health care bill is “currently unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.”
“We need to get this right for all Americans,” he said.
Other members who had raised concerns about the bill — both conservative and moderate — said the late changes had done nothing to change their minds.
Rep. Paul Gosar (R-Ariz.), a Freedom Caucus member, was one of six Republicans who voted against a procedural resolution bringing the bill to the floor.
“You know what? I came here to do health care right,” said Gosar, a dentist. “This is one chance we that can get one-sixth of our GDP done right. It starts with here.”
Still, the sales pitches from Trump and Ryan appeared to be having some effect. At least three lawmakers who had previously pledged to vote against the bill indicated that they had changed their minds.
At the heart of the argument: Keeping the Affordable Care Act is a worse outcome than passing a potentially flawed replacement.
“You want to score a touchdown, but sometimes, on the fourth down, you kick a field goal,” said Rep. Joe Barton (R-Texas), the longest-serving member of Congress in the Freedom Caucus. “The choice is yes or no. I’m not going to vote no and keep Obamacare. That’d be a stupid damn vote.”
Earlier Friday, a panel that sets rules for House floor debate approved the revised legislation, sending it to the full House for several hours of debate. Trump, meanwhile, took to Twitter to try to close the deal.
“After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!” Trump tweeted Friday morning.
Asked by a reporter Friday morning what he would do if the bill fails, Trump shrugged and said: “We’ll see what happens.”
Trump also said he didn’t feel the process had been rushed and that Ryan should remain as speaker if the bill fails.
Trump briefly answered shouted questions at the White House after an announcement of a presidential permit for the Keystone XL pipeline, a revived project that the president touted as creating jobs.
In a last-ditch attempt to force a vote, Trump dispatched White House budget director Mick Mulvaney to the U.S. Capitol on Thursday night to tell rank-and-file Republicans in a closed-door meeting that he was done negotiating .
It was a high-risk gamble for Trump and Ryan, who have invested significant political capital trying to pass legislation that would replace the 2010 Affordable Care Act. For Trump, who campaigned as a skilled negotiator capable of forging a good deal on behalf of Americans, it could either vindicate or undercut one of his signature claims.
Leaders were focused especially on winning over members of the hard-line House Freedom Caucus, most of whom have so far refused to back the bill. Asked if GOP leaders had secured the votes early Friday, House Majority Leader Kevin McCarthy (R-Calif.) chuckled at a reporter: “You guys ask me the same question every day. You know I don’t talk about Fight Club.”
Rep. Mark Meadows (R-N.C.), who chairs the caucus, said late Thursday that he was leaning against the legislation. He did not immediately respond to requests for comment on Friday morning.
And Rep. Andy Harris (R-Md.), a caucus member who had been a hard “no” earlier in the week, told NPR on Friday morning that he could potentially vote yes.
“If I think that premiums are going to come down enough . . . I could be a yes,” Harris said, citing a letter Trump sent Thursday to Freedom Caucus members outlining administrative steps he could take to address that issue. “But my yardstick is, will premiums come down enough under these actions?”
Rep. Peter King (R-N.Y.), a moderate who had expressed qualms as recently as Tuesday, when he was singled out by Trump inside a private meeting of House Republicans, said he had all but decided to vote for the bill.
“I’m not one they should worry about,” he said.
King said Trump and GOP leaders had a powerful closing argument, making members choose between the Republican bill and the ACA.
“What’s the alternative?” he said. “If it’s this or stick with Obamacare, it’s a pretty heavy decision to make if you’re that opposed to Obamacare.”
But Rep. Louie Gohmert (R-Texas), one of Trump’s most ardent congressional supporters, said he remained opposed to the legislation because it made more political sense to keep current law than to start rewriting it.
“A no vote means we save Donald Trump from a Democratic majority in 2019,” Gohmert said. “If this passes, then Obamacare stays.”
Of his colleagues in the Freedom Caucus, Gohmert said: “Most of them are gonna vote no, and will save the Trump presidency from this lie that they have been handed.”
In another tweet on Friday, Trump homed in on the Freedom Caucus, saying, “The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!”
With 237 House Republicans, party leaders can afford only 21 or 22 defections, depending on how many Democrats are present on Friday. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation. An unsuccessful vote could also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.
No matter what happens in the House, the ultimate fate of the legislation hinges on the Senate. There are at least a dozen skeptics of the bill among Senate Republicans, who maintain a slim 52-to-48 advantage, and many of them want to maintain some of the current law’s more generous spending components.
Defeat of the legislation would mean that Obamacare — something that congressional Republicans have railed against for seven years — would remain in place.
Republicans convened a Rules Committee hearing at the crack of dawn Friday, where they sought to sign off on the final changes they made to the bill the previous day. In a snug room near the House chamber, the meeting quickly turned into a tense partisan clash, as Democrats expressed their disgust with the measure and Republicans sought to defend their legislation.
“You never intended for there to be a health plan of consequence for this nation,” said Rep. Alcee Hastings (D-Fla.), raising his voice as he spoke.
He added: “What we will have done is helped rich people. And we will not have helped poor people.”
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and one of the bill’s architects, forcefully rejected Hastings’s claim during testimony before the rules panel, saying he was “offended” by the remark. He tried tempering the tone of his exchange with Hastings, who wouldn’t oblige.
“I’m mad as hell about what you all are doing!” the Democrat exclaimed.
Later, House Minority Leader Nancy Pelosi (D-Calif.) said that the GOP bill would levy an “age tax” and “veterans tax” in order to lower taxes on the richest Americans.
“It’s in their DNA,” she told reporters. “They can’t help themselves.”
Rep. Joe Crowley (D-N.Y.) added that some Republicans were likely “ashamed” by a process that had been defined by “backroom deals,” turning an old Republican attack back onto the majority.
“For what? To keep a seven-year old campaign promise?” said Crowley. “So Trump doesn’t send a mean tweet about you? That’s not leadership; that’s politics.”
On Thursday night, a rowdy group of Republicans burst out of their closed-door meeting like explorers on a quest for glory. “Burn the ships,” one Republican shouted to House Majority Whip Steve Scalise (La.), invoking the command that Hernan Cortes, the Spanish conquistador, gave his men upon landing in Mexico in 1519.
The message was clear, to the GOP leaders now and the Spaniards in 1519, there was no turning back.
“Only way to do it,” Scalise told a packed elevator of lawmakers.
After the meeting, and during an unrelated late-night vote, Ryan got down on a knee to plead with Rep. Don Young, an 83-year-old from Alaska who is the longest-serving Republican in Congress and remains undecided.
When the speaker finished with Young, he spent about 10 minutes in an animated discussion with Rep. Mo Brooks (R-Ala.), one of the bill’s most outspoken critics. At one point, the speaker took his own arms and held them up, his hands at face level, then slowly lowered them to his waist — presumably trying to demonstrate his belief that the bill will lower costs.
Ryan had intended to bring up his plan for a vote Thursday, but that plan unraveled after Freedom Caucus members rejected Trump’s offer to strip a key set of mandates from the nation’s current health-care law. White House Chief of Staff Reince Priebus and Trump chief strategist Stephen K. Bannon trooped up to Ryan’s office to make the case personally, warning recalcitrant conservatives that the only alternative would be to accept the ACA as the law of the land.
By evening, leaders adopted the proposed change conservatives had rebuffed earlier, eliminating the law’s “essential benefits” that insurers must offer under the ACA in an effort to reduce premium costs. Those benefits include covering mental-health treatment, wellness visits, and maternity and newborn care, and states would have the option of adding them back next year.
They also added one sweetener for moderates, a six-year delay in repealing a 0.9 percent additional Medicare tax on high-income Americans who earn above $200,000 if filing individually, or $250,000 if married and filing jointly. By keeping the tax in place, GOP leaders could provide an additional $15 billion to the states to help cover treatment for mental health and substance abuse issues, as well as maternity and infant care.
Meanwhile, a new analysis by the Congressional Budget Office released Thursday evening showed that changes House leaders made to the bill Monday do not alter a projection that 24 million more Americans would be uninsured by 2026 under the bill. In addition, the updated bill would cut the deficit by $150 billion over the next decade — nearly $200 billion less than the earlier version of the legislation.