A victory on health care continues to elude President Donald Trump and Speaker Paul Ryan in the first 100 days of the new administration.
House GOP leaders are falling short of the support needed to muscle their newly revised bill to repeal Obamacare over the finish line by Saturday, Trump’s 100th day in office. White House officials, after striking a deal with conservatives, had publicly raised expectations that the vote would occur this week. And they privately pushed Ryan (R-Wis.) to hand Trump something he could tout as a major legislative victory.
But GOP leaders are still struggling to get enough critics of the bill to back it, and a floor vote is not likely until next week. By Thursday afternoon, at least 15 lawmakers — most of whom opposed the original draft that Ryan yanked from the floor last month — had publicly declared their opposition to the latest plan. Just as many, if not more, said they were undecided.
More foreboding for House leaders, several centrist Republicans who backed earlier versions of the proposal, including Reps. Mike Coffman of Colorado and Adam Kinzinger of Illinois, said they were now undecided. Some even came out against the bill.
“Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing health care reform, and this bill does not satisfy those benchmarks for me,” said Rep. Ryan Costello, a centrist Pennsylvania Republican who voted for an earlier version of the bill in committee. “I remain a no vote on this bill in its current form.”
Multiple senior House Republican sources said Ryan and his top lieutenants have made progress and are increasingly confident that they’ll eventually garner enough support to force the bill through the chamber. They’ve locked down the most recalcitrant conservatives in the 238-member House GOP conference. And they say they’re making headway with some moderate Republicans wary of a constituent backlash if they support the health care overhaul.
Case in point: Three senior House Republican sources sounded confident Thursday that they’ve now secured a “yes” vote from House Appropriations Chairman Rodney Frelinghuysen, who came out against the bill several weeks ago. The influential New Jersey Republican’s office did not return multiple requests for comment.
But leadership still has a ways to go until they hit 216, the number of votes Ryan needs to pass the bill. Since no Democrats are expected to support the measure — which would gut some of Obamacare’s central consumer protections, repeal its taxes and phase out its massive expansion of Medicaid — Ryan can afford to lose only 22 members.
Moderates appeared to be the biggest headache for GOP leaders on Thursday.
Coffman told POLITICO that if the vote on the measure were called today, “I’d vote no.” Coffman said he has serious concerns about whether the latest draft does enough to protect coverage for people with pre-existing conditions, concerns echoed by just about every centrist opponent of the bill.
Reps. Pat Meehan of Pennsylvania, Jamie Herrera Beutler of Washington state and John Katko of New Yorkalso came out against the bill in statements Thursday, with Meehan specifically citing concerns about those with pre-existing condition as the reason for his opposition.
Meanwhile, a slew of House GOP moderates steadfastly refused to reveal their position on the measure. Rep. Elise Stefanik of New York, told a reporter to “contact my office” when asked about her position. Rep. Darrell Issa of California, who represents a district Hillary Clinton won handily in November, paused outside the House chamber for a reporter’s question only to ignore it and walk away when asked about the health care bill.
Moderates aren’t the only problem for leaders. A small number of staunch conservatives are also holding their ground against the latest plan despite Wednesday’s endorsement by the conservative House Freedom Caucus. Caucus member Andy Biggs of Arizona said he was a “no.” Rep. Rod Blum of Iowa said he was waiting to decide how to vote until he had read a study about how the legislation would affect premiums for group health insurance.
Meanwhile, other conservatives not in the Freedom Caucus, including Rep. Walter Jones, also said they’d vote against the bill Thursday. The North Carolina Republican said he couldn’t back something that had not been scored by the Congressional Budget Office.
“I’m still going to vote no,” Jones said. “I don’t see how anybody, with our nation going financially broke, can vote for a bill of such consequences without knowing the score.”
The Congressional Budget Office is not expected to release the latest score of the new draft for a few weeks, congressional sources said Thursday. The CBO score for an earlier version of the text estimated that 24 million more people could go uninsured over the next 10 years.
House leaders spent almost all Wednesday and Thursday buttonholing members, attempting to round up every vote possible. House vote counters such as deputy whipPatrick McHenry of North Carolina were seen roaming the chamber, corralling members who opposed the health care measure — including even Rep. Justin Amash of Michigan, one of the most ardent opponents of earlier versions of the health care plan. Amash, a Freedom Caucus member, has told reporters he’s still reviewing the bill despite the Freedom Caucus’ endorsement.
Vice President Mike Pence also trekked to Capitol Hill to meet with members of the Tuesday Group of moderate Republicans, though the meeting did not appear to yield any new votes for the measure.
Some mainstream and moderate Republicans stewed that the White House had rewarded what they see as bad behavior by the Freedom Caucus. After trying to work in good faith with leadership, the skeptics said they’re now being pressured to vote for a more conservative bill.
At the heart of the revised health care measure are changes negotiated by Freedom Caucus chairman Mark Meadows or North Carolina and New Jersey Rep. Tom MacArthur, a second-term lawmaker and co-chair of the Tuesday Group. Under the proposal, states would be permitted to waive some of Obamacare’s minimum coverage requirements and consumer protections, so long as they certified that they could offer an alternative that reduces premiums, enhances competition or increases the number of people with coverage.
Though the measure would technically preserve Obamacare’s guarantee of coverage for people with pre-existing conditions, it also allows insurers in those states to jack up premiums for sick people if they have a gap in coverage. To offset that risk, the bill includes a $130 billion fund meant to help keep premiums down for people with pre-existing conditions. But advocates like the American Medical Association, AARP and the American Hospital Association worry that it isn’t enough to do much good.
MacArthur said Thursday his goal in negotiating with the Freedom Caucus was to “make sure everybody has health insurance” and make sure health care “costs are under control.”
“I’m simply looking at which Republicans can we get to support a compromise that is helpful for moving along health care reform, which is desperately needed,” he said.
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