Trump demands Friday vote
President warns conservatives if health care measure fails, ‘Obamacare’ will stay
WASHINGTON — President Donald Trump delivered an ultimatum to House Republicans on Thursday night: Vote to approve the measure to overhaul the nation’s health care system on the House floor Friday, or reject it and the president will move on to his other legislative priorities.
The president signaled that the time for negotiations was over with rank-and-file Republicans who were meeting late at night on Capitol Hill to try to find common ground on the embattled package crafted by House Speaker Paul Ryan, RWis.
The move was a high-risk gamble for the president and speaker, who have both invested significant political capital in passing legislation
that would rewrite the 2010 Affordable Care Act. For Trump, who campaigned as a skilled dealmaker capable of forging a good deal on behalf of Americans, it could either vindicate or undercut one of his signature claims. If the measure fails, it would mean that “Obamacare” — something that congressional Republicans have railed against for seven years — would remain in place.
“Disastrous #Obamacare has led to higher costs & fewer options. It will only continue to get worse! We must #RepealANDReplace. #PassTheBill,” Trump tweeted from his official White House account as the meeting was wrapping up Thursday night.
It was far from clear, however, that Ryan and Trump have the votes to muscle the package through the House after several members of the hard-line House Freedom Caucus refused to back the package following a marathon session of negotiations Thursday with Trump and top aides.
“We have been promising the American people that we are going to repeal and replace this broken law,” Ryan said. “Tomorrow we’re proceeding.”
But the speaker refused to answer shouted questions from reporters after the meeting about whether he had the votes to pass the health care measure.
In a closed-door meeting with House Republicans on Friday night, according to Rep. Chris Collins, RN.Y., Office of Management and Budget Director Mick Mulvaney told his former colleagues “the president needs this, the president has said he wants a vote tomorrow up or down.”
“If for any reason it’s down, we’re just going to move forward with additional parts of his agenda,” Collins described Mulvaney as saying. “This is our moment in time.”
Ryan had intended to bring up his plan for a vote on Thursday, but criticism, mainly from conservatives, caused that strategy to unravel after Freedom Caucus members rejected Trump’s offer to strip a key set of mandates from the nation’s current health care law.
“They’re going to bring it up, pass or fail,” said Rep. Mike Simpson, R-Idaho.
By evening leaders accepted the proposed change conservatives had rebuffed earlier, which would eliminate the law’s “essential benefits” that insurers must offer under the ACA. Those include covering mentalhealth treatment, wellness visits, and maternity and newborn care.
They also added one sweetener for moderates, a six-year extension of a 0.9 percent additional Medicare tax on high-income Americans who earn above $200,000 if filing individually, or $250,00 if married and filing jointly. By keeping the tax in place, GOP leaders could provide another $15 billion to help some older Americans obtain health care coverage.
The negotiations over the legislation continued all day, even after leaders announced they would postpone a vote originally scheduled for Thursday.
As evening came, members of the conservative House Freedom Caucus filed into the office of Ryan, as did White House Chief of Staff Reince Priebus and Trump’s chief strategist, Stephen Bannon.
Meanwhile, a new analysis by the Congressional Budget Office released Thursday evening showed that changes House leaders made to the bill on 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.
The changes include a couple of conservative overhauls to the Medicaid program and language directing that $85 billion be used to help Americans ages 50 to 64 obtain coverage.
It was unclear how the new CBO score would affect legislative support for the bill, although Rep. Brian Mast, R-Fla., who is undecided, said it is “one of the things I’m considering as we read the bill.”
“When we look at the CBO score, we remember the discrepancy between what they said about Obamacare and what took place,” he added, noting that the office had overestimated the number of Americans who would gain coverage as a result of the law. “But it should be a spoke in the wheel.”
The new score was not the leadership’s biggest problem. Speaking to reporters Thursday afternoon, the Freedom Caucus chairman, Mark Meadows, R-N.C., said House leaders were still seeking another 30 to 40 votes to pass the bill.
“I’m desperately trying to get to yes,” Meadows said. “I think we need to make sure that it lowers health care costs.”
Passage of the bill would represent a major political victory for both the White House and House leaders, although 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-to48 advantage, and many of them want to maintain some of the current law’s more generous spending components.
GOP leaders can afford only 22 defections, given that one Democrat was expected to be absent Thursday. A Freedom Caucus spokeswoman said that “more than 25” members of the group oppose the bill.
Democrats relished the GOP’s current predicament. Members of the Congressional Progressive Caucus, who had scheduled a 4 p.m. rally against the bill, turned it into a short-term declaration of victory.
“Remember, they wanted to have their repeal and replace ready when Trump was inaugurated,” said Rep. Jan Schakowsky, D-Ill. “Now, here we are — they don’t have it, again. They’re looking for a sweet spot, and they won’t find one.”