House seems ready to rush through health-care bill

The Washington Post Sunday - - NEWS - @PKCapi­tol PAUL KANE paul.kane@wash­post.com

By most mea­sures, Repub­li­cans face a nearly im­pos­si­ble task of finding enough votes to pass their long-promised re­peal of the Af­ford­able Care Act through a Se­nate that seems ir­rec­on­cil­ably di­vided.

A core group of mod­er­ates and main­stream con­ser­va­tives re­mains re­sis­tant to the Repub­li­can pro­posal that slashes Med­i­caid fund­ing, while a small but crit­i­cal bloc of con­ser­va­tives keeps push­ing to move the bill fur­ther in their di­rec­tion.

Yet by one mea­sure, Repub­li­cans have never been closer to re­peal­ing large chunks of what they dis­miss as “Oba­macare.” Within two or three short weeks, the GOP will prob­a­bly ei­ther be rev­el­ing in its un­ex­pected vic­tory or mired in deep in­fight­ing over the party’s fail­ure to live up to a pledge it has made over the past seven years.

Some Repub­li­cans re­main op­ti­mistic — and Democrats fear­ful — that Se­nate Ma­jor­ity Leader Mitch McCon­nell (R-Ky.) can pull off the ne­go­ti­at­ing tricks nec­es­sary, but he still faces an up­hill fight in win­ning the votes to pass the Bet­ter Care Rec­on­cil­i­a­tion Act by his ten­ta­tive dead­line by the end of this month.

If McCon­nell can make it hap­pen, House Repub­li­cans seem ready to quickly pass the Se­nate ver­sion of the leg­is­la­tion and send it to Pres­i­dent Trump’s desk for his sig­na­ture.

At least that’s the as­sess­ment of two key House ne­go­tia­tors, one from the con­ser­va­tive and one from the mod­er­ate flank.

“I have no doubt in my mind that if it passes the Se­nate — in some­thing close to what it’s like now — that it will pass the House,” said Rep. Tom MacArthur (R-N.J.), a mod­er­ate who ne­go­ti­ated por­tions of the bill that passed the House in early May.

His con­ser­va­tive coun­ter­part, Rep. Mark Mead­ows (R-N.C.), called the lat­est Se­nate ver­sion “a step in the right di­rec­tion” and sug­gested it would “have to be a big move” away from the current draft to sink the bill in the House. Ei­ther way, he said, con­ser­va­tives will not ob­ject if House Speaker Paul D. Ryan (R-Wis.) takes the Se­nate bill and places it on the House floor in a take-it-or-leaveit mo­ment.

“I re­al­ize the re­al­ity is, we’re not go­ing to change it when it comes back here,” said Mead­ows, chair­man of the House Free­dom Cau­cus, the most con­ser­va­tive group in Congress.

Ryan has gone out of his way to avoid com­ment on specifics of the Se­nate ver­sion of leg­is­la­tion. But Ryan has in­formed the House to ex­pect im­me­di­ate con­sid­er­a­tion if the Se­nate can find the votes. “If Se­nate is go­ing to give us a health-care bill, we’re go­ing to stay and fin­ish the health-care bill,” he told re­porters Thurs­day.

This is a re­ver­sal of the standard op­er­at­ing pro­ce­dure of the last 61/2 years of the GOP ma­jor­ity in the House. Time and again, House Repub­li­cans pulled a leg­isla­tive face plant and re­lied on McCon­nell to clean up their mess. In 2011, the then-Se­nate mi­nor­ity leader had to step in af­ter House Speaker John A. Boehner’s failed talks with Pres­i­dent Barack Obama left the na­tion on the brink of de­fault, and in 2013, Boehner’s House GOP drove the strat­egy into a fed­eral gov­ern­ment shut­down, which ended only through McCon­nell’s deal­mak­ing. But this time, the ne­go­ti­at­ing fail­ure could be on McCon­nell.

If McCon­nell works his magic, there’s no guar­an­tee Ryan can ram the Se­nate bill through the House, where the orig­i­nal bill passed in May by a slim mar­gin, 217 to 213. Some House con­ser­va­tives are balk­ing at the Se­nate’s re­fusal to re­peal all of the taxes that were in­cluded by Democrats when they passed the 2010 law, and some mod­er­ates are wary of a pro­vi­sion Sen. Ted Cruz (R-Tex.) won that would al­low in­sur­ers to sell low-cost plans in ad­di­tion to those that meet higher stan­dards im­posed by the ACA.

But MacArthur and Mead­ows be­lieve that in its current form, the Se­nate bill can prob­a­bly pass the House — and if it does hap­pen, it will pass quickly.

For sev­eral weeks they have pro­vided a feed­back loop to key Se­nate ne­go­tia­tors over what they think their al­lies in the House would ac­cept with­out too much de­bate.

Af­ter votes ended Fri­day, Mead­ows stuck around Wash­ing­ton rather than mak­ing his usual eight-hour drive to western North Carolina. He had a call with Cruz, a key ally to the Free­dom Cau­cus, and his sched­ule called for a White House meet­ing this weekend with peo­ple he would only iden­tify as “se­nior ad­min­is­tra­tion of­fi­cials” to dis­cuss the Se­nate leg­is­la­tion.

MacArthur’s role ne­go­ti­at­ing with Mead­ows cost him his lead­er­ship role in the Tues­day Group, par­tic­u­larly be­cause of their pro­vi­sion that would elim­i­nate guar­an­teed cov­er­age for some pre­ex­ist­ing con­di­tions. The mod­er­ate cau­cus of House Repub­li­cans split ranks on the House vote, and shortly there­after MacArthur stepped down as co-chair­man of the Tues­day Group.

But he has re­mained in talks with the mod­er­ates who did sup­port the House bill, and in re­cent weeks he has had ex­tended talks with a half-dozen Se­nate Repub­li­cans. MacArthur was par­tic­u­larly pleased that McCon­nell added a $45 bil­lion fund to fight the opi­oid epi­demic.

Over­all, MacArthur thinks the emerg­ing Se­nate bill is pretty sim­i­lar to what the House al­ready sup­ported. The Cruz amend­ment is not that dif­fer­ent from what he and Mead­ows were try­ing to do on the pre­ex­ist­ing con­di­tion is­sue.

“Their bill is on the frame­work that we sent them; they didn’t start from scratch. And so they’re mak­ing ad­just­ments around the edges, but di­rec­tion­al­ity, they’re do­ing the same things we did,” he said.

Mead­ows’s big­gest worry is that McCon­nell will yield to the Repub­li­cans from Med­i­caid­ex­pan­sion states who be­lieve the Se­nate ver­sion goes too far in cut­ting the en­ti­tle­ment pro­gram, even af­ter adding about $115 bil­lion to help with pre­mium costs and fight opi­oids. “If it shifts hard to the left, it doesn’t get out of the Se­nate, and even if it does, it’s dead here,” he said.

MacArthur, who now has drawn sev­eral Demo­cratic chal­lengers for next year, has told col­leagues that there is no po­lit­i­cal gain from switch­ing their yes vote to a no vote. “If you voted the bill out of com­mit­tee, if you voted for it on the floor, the ads are al­ready writ­ten against you. And to try to change now, I think, gets you noth­ing. You know, it’s all the calo­ries and half the fla­vor,” he said.

As he left the Capi­tol on Fri­day, Mead­ows had to tem­per his op­ti­mism about the bill’s chances in the House — be­cause he knows that McCon­nell still hasn’t locked down its pas­sage in the Se­nate.

“We’re still not there, though; we’re still sev­eral sen­a­tors short,” he said.

J. SCOTT APPLEWHITE/AS­SO­CI­ATED PRESS

Rep. Mark Mead­ows (R-N.C.), se­cond from left, and oth­ers par­tic­i­pate in a news conference Wed­nes­day on Capi­tol Hill in Wash­ing­ton.

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