Northwest Arkansas Democrat-Gazette
Trump to GOP: ’18 seats on line
He’s said to warn on health votes
WASHINGTON — President Donald Trump on Tuesday warned wavering House Republicans that their jobs were on the line in next year’s elections if they failed to back a GOP bill that would replace the Patient Protection and Affordable Care Act.
The countdown quickened toward an expected vote Thursday on legislation undoing much of the law that provides health coverage to some 20 million Americans. Trump huddled privately with rank-and-file Republicans just hours after GOP leaders unveiled changes intended to pick up votes by doling out concessions to centrists and hard-liners alike.
“If we fail to get it done, fail to [meet] the promises made by all of us, including
the president, then it could have a very detrimental effect to Republicans in ’18 who are running for re-election,” said Rep. Mike Conaway, R-Texas. “If it fails, then there will be a lot of people looking for work in 2018.”
Trump’s message to Republicans was that “if you don’t pass the bill, there could be political costs,” said Rep. Walter Jones, R-N.C.
“I’m gonna come after you, but I know I won’t have to, because I know you’ll vote ‘yes,’” Trump said, according to several Republican lawmakers who attended the meeting. “Honestly, a loss is not acceptable, folks.”
After the meeting, Trump was confident that the legislation will pass in the House.
“We’re going to have a real winner,” he told reporters. “There are going to be adjustments, but I think we’ll get the vote on Thursday.”
For Trump, who talked up the House bill the previous evening at a raucous rally in Kentucky, the presentation was the latest example of his mounting urgency to secure a major legislative victory in the early months of his presidency and repeal the signature law of President Barack Obama.
“That’s just the demeanor of this president. He wants to get this bill done,” said Sen. David Perdue, R-Ga., a Trump ally. “I don’t hear that as a threat. It’s a statement of reality.”
After the meeting, Rep. Mark Meadows, R-N.C., the chairman of the hard-line House Freedom Caucus, told reporters that the president had not closed the sale, describing the call-out as merely good-natured and insisting that conservative holdouts will continue to press for a tougher package.
“I’m still a ‘no,’” Meadows said. “I’ve had no indication that any of my Freedom Caucus colleagues have switched their votes.” The group has about 30 members.
Many Freedom Caucus members left Tuesday’s meeting resolved to continue to oppose the bill.
“The president always does a good job in these settings,” said Rep. Jim Jordan, R-Ohio, a co-founder of the caucus. “But the legislation is still bad, and doesn’t do what we told voters we would do.”
Meadows said he didn’t take Trump’s remarks that he would “come after” him too seriously. “I didn’t take anything he said as threatening anybody’s political future,” he said.
Said Rep. Harold Rogers, R-Ky., a supporter of the bill: “Oh, he was kidding around. I think.”
White House spokesman Sean Spicer said later in the day: “Mark Meadows is a longtime, early supporter of the president. [Trump] had some fun at his expense this morning during the conference meeting.”
Asked whether Trump believed that Republicans who opposed the bill would be damaged at the ballot box, Spicer answered: “I think they’ll probably pay a price at home.”
Spicer explained that statement was not a threat but “a political reality.”
The GOP bill would scale back the role of government in the private health insurance market and limit future federal financing for Medicaid. Fines enforcing the requirement that virtually all Americans have coverage would be eliminated.
The nonpartisan Congressional Budget Office estimates that 24 million fewer people will have health insurance in 2026 under the GOP bill.
Trump warned House Republicans they’d seal their political doom if they wavered, with the party potentially losing majority control of the House. Still, several conservatives were steadfast in their opposition even after the session with Trump and the leadership’s changes.
“The president wouldn’t have been here this morning if they have the votes,” said Rep. Rod Blum, R-Iowa, a member of the Freedom Caucus who complained that the GOP bill leaves too much government regulation in place.
Rep. Don Bacon, R-Neb., said he was persuaded to back the bill in part by Trump’s urging and the changes.
“I think a vote ‘no’ is a vote for Obamacare,” Bacon said,
referring to Obama’s health care law. “We can vote for this and continue to make it better. I intend to vote ‘yes’ Thursday.”
Speaker Paul Ryan, R-Wis., told reporters that if Republicans pass the legislation, “people will reward us. If we don’t keep our promise, it will be very hard to manage this.”
Ryan downplayed the chance that Freedom Caucus members could band together to bring down the measure and said that conservatives should be pleased that many of their demands likely would be in the legislation — such as limiting the expansion of Medicaid and including work requirements for those who receive coverage from the program for the poorest Americans.
Ryan said conservatives eventually will realize that pushing for more extensive changes, such as ending payments to states that accepted the Medicaid expansion, could jeopardize the legislation’s chances in the Senate.
“If you get 85 percent of what you want, that’s pretty darn good,” he said. “We don’t want to put something in this bill that the Senate is telling us is fatal.”
SOME CONCERNS
If the bill advances, prospects are uncertain in the Senate, where Republicans hold a slim majority. Six GOP senators have expressed misgivings, including Tom Cotton of Arkansas, who said Tuesday that he cannot support the House bill.
Republican Sen. John Boozman, Cotton’s fellow Arkansan, said he wasn’t sure what the House bill ultimately will contain.
“I don’t really know what the American Health Care Act consists of right now. It’s constantly changing,” he said.
“Arkansas and its governor
would very much like to keep the [Medicaid] expansion,” Boozman said. “So I think at the end of the day, there will be some compromise.”
In an interview, Senate Majority Leader Mitch McConnell, R-Ky., signaled he’d use Trump’s clout to pressure unhappy Republicans in his chamber. McConnell said he’s optimistic that in the end, no Republican senator will want to be held responsible for the Affordable Care Act’s survival.
“I would hate to be a Republican whose vote prevented us from keeping the commitment we’ve made to the American people for almost 10 years now,” McConnell said.
Sen. Lisa Murkowski, R-Alaska, expressed reservations about the Medicaid revisions, saying she wants the bill’s backers to “show me” how the legislation would be fair to her state.
Unlike some lawmakers, such as Sen. Ted Cruz, R-Texas — who recently visited Trump’s Mar-a-Lago resort in Palm Beach, Fla., to talk health care with the president — Murkowski said she hasn’t been similarly wooed.
Perdue said Trump was engaged in selling the House bill to senators.
“A few votes get to be more critical here,” he said. “He’s been having dinners. … He’s listening and trying to probe what it will take to get this bill done and how to fix it right.”
Sen. Rand Paul, R-Ky., who has pressed Trump to abandon the bill, insisted that the legislation is fading in the House.
“There are enough conservative votes for it not to pass in its current form,” he said. “Negotiation begins in real earnest in the next 24 hours or so once they discover they don’t have the votes. My count is there are more than enough votes to stop the Ryan plan.”
Some GOP governors also have weighed in.
In a letter Tuesday to every member of Michigan’s congressional delegation, Gov. Rick Snyder, a Republican, warned that the House GOP bill “shifts significant financial risk and cost from the federal government to states without providing sufficient flexibility to manage this additional responsibility.” Letters were sent to each House member detailing how many residents in their districts depend on both traditional Medicaid and the expanded Medicaid program created by the Affordable Care Act.
The House GOP bill would end Obama-era subsidies based on people’s incomes and the cost of insurance. A Medicaid expansion to 11 million more low-income people would disappear.
Instead, the bill would provide tax credits based chiefly on age to help people pay premiums. But insurers could charge older consumers five times the premiums they charge younger people instead of Obama’s 3-1 limit, and would boost premiums 30 percent for those who let coverage lapse.
The revisions by House GOP leaders to round up votes come at a cost — literally. Congressional budget experts had projected that the original bill would cut federal deficits by $337 billion over a decade. But that amount is dwindling as top Republicans dole out provisions helping older and disabled people.
To address criticism that the bill would leave many older people with higher costs, GOP leaders have taken an unusual approach. They added language paving the way for the Senate, if it chooses, to make the bill’s tax credit more generous for people ages 50-64. Republicans said the plan sets aside $85 billion over 10 years for that purpose. And the income tax threshold for deducting medical expenses would be lowered to 5.8 percent, from the current 10 percent.
The leaders’ proposals would accelerate the repeal of tax increases Obama imposed on higher-earners, the medical industry and others.
On Medicaid, the changes would provide higher federal payments to help states care for older and disabled beneficiaries. States would be able to impose work requirements for able-bodied adults. But the bill still would limit future federal financing for Medicaid, seen by many state officials as a cost shift.
In a bid to cement support from upstate New Yorkers, the revisions also would stop that state from passing on more than $2 billion a year in Medicaid costs to upstate counties, though it exempts Democratic-run New York City from that protection.
Information for this article was contributed by Ricardo Alonso-Zaldivar, Alan Fram, Matthew Daly, Kevin Freking, Richard Lardner, Stephen Ohlemacher and Thomas Beaumont of The Associated Press; and by David Weigel, Kelsey Snell and Robert Costa of The Washington Post.