GOP scrambles to save health plan

Trump issues ultimatum that he’ll leave Obamacare in place if House vote fails

WASHINGTON — Seven years to the day after former President Barack Obama signed his landmark health care law, a fractious Republican-led House failed to coalesce around a long-promised repeal plan, forcing party leaders into an embarrassing postponement of a vote laden with symbolism.

The delay Thursday left Republican leaders scrambling to recover from the first significant legislative setback of President Donald Trump’s 63-day-old administration. Trump had predicted a close vote right up until the moment Republican leaders conceded they had not been able to unify their divided 237-member conference. “Everybody knows it’s no good,” Trump said of the Affordable Care Act, which Republicans derisively dubbed Obamacare. “It’s only politics.”

On Thursday night, Trump threatened to leave Obamacare in place and move on to other issues if Friday’s vote fails.

The risky move, part gamble and part threat, was presented to GOP lawmakers behind closed doors.

In Trump’s first major test of party unity, some 30 or more Republicans, including at least a half-dozen from Texas, threatened to balk at a House GOP repeal plan that hard-right conservatives said would not go far enough to dismantle Obama’s signature 2010 law.

With the vote count in flux until the end, the final hours saw frenzied negotiations between Trump and a conservative bloc known as the Freedom Caucus. Simultaneously, the White House and House Republican leaders worked to allay the concerns of a more moderate faction called the Tuesday Group, whose members echoed the concerns of Democrats about weakening protections for the poor and elderly.

That gave the president and his allies in Congress little room for error.

“Both the Republican majority and the president just found out that health care really is difficult,” said Houston Democrat Gene Green, who serves on one of the House committees that shaped the controversial GOP plan that appears to be a work in progress.

Even with House passage, which could come as early as Friday, ultimate success for the GOP’s current Obamacare replacement plan remains far from certain.

Some analysts predicted the last-minute changes to mollify House conservatives could sink the bill in the Senate.

Democrats, who oppose the bill uniformly, predict that more than 20 million Americans who gained insurance under the ACA are at risk of falling off the rolls again, including nearly 2 million in Texas.

GOP does the math

For Republicans, the agonizing vote calculus got closer as talks reached a fevered pitch. With five vacant seats in the House, Republicans need 216 votes to pass the bill. Assuming every Democrat is voting “no,” that means they can afford only 21 defections.

That has given enormous leverage to the roughly 30-member Freedom Caucus, well out of proportion to its size. For House Speaker Paul Ryan, whose name has become synonymous with the GOP bill, the endgame came down to a bet on whether some members of the group, despite their objections, would be reluctant to vote against a Republican president on his first major policy proposal.

Freedom Caucus Chairman Mark Meadows, a Republican from western North Carolina, said that between 30 and 40 Republicans, including himself, remained “in the ‘no’ category” hours before Thursday’s scheduled vote.

“We’ve not gotten enough of our members to get to ‘yes’ at this point, under what we’re currently considering,” he said. “However, I would say that progress is being made.”

Among the most outspoken critics is Rep. Louie Gohmert, a Republican from Tyler who often was on television as the face of conservative frustration with the GOP repeal effort.

“I know what we promised, and I know that we have got to do better for the people in America that put their faith in us,” he said Thursday on NBC 5 in DallasFort Worth.

In a separate appearance on Fox, Gohmert said the GOP plan does not go far enough to eradicate coverage requirements under Obamacare that critics say have forced up premiums. “We made clear — we promised a repeal of Obamacare,” he said. “What is on the table, what they are bringing up tomorrow does not do that.”

Among a half-dozen Texas Republicans who counted themselves as undecided or had taken no public position included Houston Reps. Ted Poe and John Culberson.

Houston-area Reps. Michael McCaul, Pete Olson and Brian Babin also had indicated they were evaluating last-minute changes in the bill, many of them sweeteners intended to induce support from recalcitrant Republicans.

Rep. Randy Weber of Friendswood appeared to be leaning toward “no,” tweeting Thursday the bill “needs more vetting.”

One of the leading architects of the GOP replacement legislation was House Ways and Means Chairman Kevin Brady of The Woodlands.

“We continue to make progress,” he said Thursday. “We continue to work on the legislation. We’re determined to get it right.”

Brady described concerns by Freedom Caucus members related to “essential health benefits” prescribed in the legislation, which he referred to as “the last remaining issue.”

The principal demand of members of the hard-right caucus, he said, relates to options given states for choosing which benefits are part of state-directed plans.

States come into play

But, amid discussions about striking Obamacare requirements for certain benefits — such as mental health coverage, drug addiction treatment and maternity care — moderate Republicans have moved away from the bill, compounding GOP leaders’ challenge.

“My belief is, in the end, giving states that power to consider and approve plans with their designs will make health care plans more affordable for certain populations,” Brady said.

An updated Congressional Budget Office analysis Thursday projected the revised GOP plan still would leave 24 million more people without insurance in a decade but lowered its estimate of deficit reduction to $150 billion over 10 years, down from a $337 billion reduction from the earlier version of the health care bill.

Rep. Lloyd Doggett, D-San Antonio, a key Democratic strategist on health care, predicted the GOP struggles will continue.

“Some want Obamacare replaced with Nothingcare,” he said. “Some prefer LittleCare and really don’t care much about who loses health insurance. I think these factions will eventually reach agreement on hiking premiums for older Americans and taking away meaningful health insurance from even more families.”

One major remaining problem for some conservatives is the GOP’s plan to replace the ACA’s “individual mandate” to buy insurance with a “continuous coverage” requirement, enforced by a 30 percent surcharge for people who go more than 63 days without insurance.

“Republicans promised to end the tyranny of the individual mandate, but instead House Speaker Paul Ryan has made it worse, by punishing those who lose their coverage because they lost their job or discontinued it because premiums got too high,” said Rick Manning, president of Americans for Limited Government, one of several conservative groups that have been fighting the bill.