Trump pushes wary Congress for an­other health law fight

The Washington Post - - POLITICS & THE NATION - BY PAIGE WIN­FIELD CUN­NING­HAM, KELSEY SNELL AND JOHN WAG­NER paige.cun­ning­ham@wash­post.com kelsey.snell@wash­post.com john.wag­ner@wash­post.com Robert Costa and Damian Paletta con­trib­uted to this re­port.

Pres­i­dent Trump is push­ing Congress to­ward an­other dra­matic show­down over the Af­ford­able Care Act, de­spite big out­stand­ing ob­sta­cles to a be­lea­guered re­vi­sion plan and a high-stakes dead­line next week to keep the gov­ern­ment run­ning.

The fresh pres­sure from the White House to pass a re­vi­sion was met with skep­ti­cism by some Capi­tol Hill Repub­li­cans and their aides, who were re­cently hu­mil­i­ated when their bill failed to reach the House floor for a vote and who worry now that lit­tle has changed to sug­gest a new re­vi­sion would fare any bet­ter.

The ef­fort re­flects Trump’s sense of ur­gency to score a vic­tory on Oba­macare re­place­ment and move on to other leg­isla­tive ob­jec­tives, no­tably tax re­struc­tur­ing. Pass­ing an Af­ford­able Care Act re­vi­sion would also al­low the pres­i­dent to show progress to­ward a ma­jor cam­paign prom­ise as he com­pletes his first 100 days in of­fice.

“The plan gets bet­ter and bet­ter and bet­ter, and it’s got­ten re­ally good, and a lot of peo­ple are lik­ing it a lot,” Trump said at a news con­fer­ence Thurs­day. “We have a good chance of get­ting it soon. I’d like to say next week, but we will get it.”

Con­gres­sional Repub­li­cans also worry that they must at­tract Demo­cratic sup­port to fund the gov­ern­ment past the month’s end — a step they must take by mid­night April 28 to avoid a shut­down. That could be­come dif­fi­cult if Democrats grow alien­ated by the ef­fort to al­ter former pres­i­dent Barack Obama’s key do­mes­tic pol­icy achieve­ment, which some White House of­fi­cials said they hope will come up for a vote as early as Wed­nes­day.

Sev­eral con­gres­sional GOP aides, who spoke on the con­di­tion of anonymity to talk openly about the on­go­ing ne­go­ti­a­tions, said they worry that the rushed process threat­ens to cre­ate an­other em­bar­rass­ing pub­lic fail­ure over health care. The sched­ule would also make it nearly im­pos­si­ble for law­mak­ers to fin­ish their work in time for of­fi­cial score­keep­ers to pro­vide a clear es­ti­mate of how much the leg­is­la­tion would cost or af­fect cov­er­age num­bers.

House GOP aides in Wash­ing­ton worked fu­ri­ously to scale back ex­pec­ta­tions for a quick vote on the leg­is­la­tion, cit­ing the fact that law­mak­ers have not been fully briefed on the dis­cus­sions. There was no dead­line for fin­ish­ing the leg­is­la­tion as of Thurs­day evening, and GOP lead­ers have not com­mit­ted to plans for a Wed­nes­day vote, ac­cord­ing to one House GOP lead­er­ship aide.

The fresh hopes for re­sus­ci­tat­ing the Amer­i­can Health Care Act are pegged to an amend­ment be­ing of­fered by Rep. Tom MacArthur (R-N. J.) that aims to at­tract enough con­ser­va­tives and mod­er­ates that the mea­sure can pass in the House. White House of­fi­cials said lan­guage would be cir­cu­lated among mem­bers in the next few days, and the mod­i­fi­ca­tions will be dis­cussed Sat­ur­day in a con­fer­ence-wide call as Repub­li­cans pre­pare to re­turn to Wash­ing­ton.

The MacArthur amend­ment would al­low states to ob­tain per­mis­sion from the fed­eral gov­ern­ment to write their own list of es­sen­tial health ben­e­fits and al­low in­sur­ers to charge peo­ple with pre­ex­ist­ing con­di­tions higher pre­mi­ums, as long as they also make a high-risk pool avail­able to those pa­tients — a change con­ser­va­tives have de­manded.

As a con­ces­sion to mod­er­ates, the amend­ment would also add back fed­eral re­quire­ments for es­sen­tial health ben­e­fits, which the mea­sure’s cur­rent ver­sion in­stead leaves up to states.

House lead­er­ship and com­mit­tees are tak­ing a sec­ondary role in the ne­go­ti­a­tions, which are be­ing largely car­ried out by MacArthur, head of the mod­er­ate Tues­day Group, and Rep. Mark Mead­ows (R-N.C.), chair­man of the con­ser­va­tive House Free­dom Cau­cus. Mem­bers from both groups had balked at vot­ing for the bill last month, forc­ing lead­ers to pull it from the floor at the last minute.

Mead­ows was si­lent Thurs­day on whether he sup­ports the pro­posed changes.

Apart from the pub­licly em­bar­rass­ing strug­gle to reach con­sen­sus on an Af­ford­able Care Act re­vi­sion, some Repub­li­cans are also un­com­fort­able with re­fo­cus­ing on health care just as they are try­ing to build good­will with Democrats to pass a stop­gap bud­get plan to keep the gov­ern­ment open past April 28.

Repub­li­can lead­ers have al­ready ad­mit­ted that they are un­able to craft a spend­ing bill that can ap­pease the far-right flank of the GOP, and they have turned to Democrats to de­liver votes in­stead. Democrats have so far been will­ing to work with Repub­li­cans to avoid a gov­ern­ment shut­down, but any ef­fort to sched­ule a vote to re­peal the Af­ford­able Care Act could de­stroy those talks and threaten a gov­ern­ment shut­down that Repub­li­cans have vowed to avoid.

“There isn’t go­ing to be a warm, fuzzy feel­ing,” House Demo­cratic Cau­cus Chair­man Joseph Crow­ley (D-N.Y.) said of the im­pact a health-care re­peal ef­fort would have on spend­ing talks.

Congress has five days next week to pass a spend­ing bill, a tight time­line un­der the most gen­er­ous of cir­cum­stance that would be nearly im­pos­si­ble to meet if House lead­ers also try to force a vote on the re­peal leg­is­la­tion. Sev­eral Repub­li­can and Demo­cratic aides said there is a chance that both par­ties could agree to pass a short-lived spend­ing bill — one that kept the gov­ern­ment open one week, for in­stance — to give ne­go­tia­tors time to com­plete a broader spend­ing agree­ment. But Democrats are al­ready warn­ing that they could walk away if GOP lead­ers push for re­peal.

“It doesn’t re­ally bode well in terms of ne­go­ti­at­ing with us that they’re go­ing to try to push off the vote on the [spend­ing bill] to ac­com­mo­date them on a bill we think is dis­as­trous,” Crow­ley said.

Asked whether a health-care bill or fund­ing the gov­ern­ment should be Congress’s top pri­or­ity, Trump said Thurs­day that he be­lieves both could get done.

“I think we want to keep the gov­ern­ment open, don’t you agree?” Trump said. “So I think we’ll get both.”

Trump would like to show progress on health care by Day 100 of his ad­min­is­tra­tion but is not overly con­cerned about the ex­act day a bill might pass the House, said a se­nior ad­min­is­tra­tion of­fi­cial, who was not au­tho­rized to speak pub­licly and spoke on the con­di­tion of anonymity. The of­fi­cial ac­knowl­edged that House pas­sage of a bill next week is am­bi­tious and said prospects will be clearer once more mem­bers have had an op­por­tu­nity to re­view the leg­isla­tive lan­guage.

Mean­while, White House Of­fice of Man­age­ment and Bud­get Di­rec­tor Mick Mul­vaney said Thurs­day that the White House would be open to fund­ing some Demo­cratic pri­or­i­ties — po­ten­tially in­clud­ing pay­ing in­sur­ance sub­si­dies as part of the Af­ford­able Care Act — if Democrats would agree sep­a­rately to fund parts of the White House’s agenda in up­com­ing bud­get talks.

Mul­vaney’s com­ments sug­gested that the White House could try to use the Oba­macare sub­sidy pay­ments as lever­age to ex­tract fund­ing to cre­ate a wall along the U.S.-Mex­ico bor­der.

“This is the first real test of whether the Democrats, specif­i­cally in the Se­nate, are in­ter­ested in ne­go­ti­at­ing, in­ter­ested in com­pro­mis­ing,” Mul­vaney said.

Mead­ows and MacArthur are gaug­ing their mem­bers’ sup­port for the pro­posed changes, ac­cord­ing to aides and lob­by­ists. Mod­er­ate Repub­li­cans worry about de­priv­ing con­sumers of cer­tain health-care ben­e­fits, and some con­ser­va­tives say they think the GOP plan leaves too much of the Democrats’ health-care law in place.

Yet some mod­er­ates said Thurs­day that they view the MacArthur amend­ment as a con­ces­sion to con­ser­va­tives, as it would al­low states to opt out of some of the Af­ford­able Care Act’s in­sur­ance reg­u­la­tions they view as cru­cial.

“I don’t think the Tues­day Group has dis­cussed, ap­proved or has prior buy-in,” said one se­nior aide to a mod­er­ate Repub­li­can House mem­ber. “I don’t see how this gets ei­ther the Free­dom Cau­cus or the Tues­day Group.”

Democrats have been will­ing to work with Repub­li­cans to avoid a gov­ern­ment shut­down, but any health law re­peal ef­forts could de­stroy those talks.

CHIP SOMODEVILLA/GETTY IMAGES

Rep. Tom MacArthur (R-N.J.) pro­posed an amend­ment meant to ap­pease con­ser­va­tives and mod­er­ates.

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