WASHINGTON – The Republican health care overhaul spearheaded by House Speaker Paul Ryan, Wisconsin, and backed by President Donald Trump suffered a significant setback Wednesday, as personal appeals by both the president and vice president failed to sway conservatives to back the bill.
In a last-ditch effort to persuade key GOP opponents of the bill to stand down, Vice President Pence huddled with members of the House Freedom Caucus in his office Wednesday morning, while Trump met with 18 House Republicans at the White House.
While Rep. Steve King, who met with Trump, came out in favor of the bill Wednesday, that single switch was not enough to put the measure over the top. GOP leaders can afford only 22 defections, given that one Democrat is expected to be absent Thursday. A Freedom Caucus spokeswoman said Wednesday that “more than 25” members of the group oppose the bill.
The Washington Post has not independently verified that count, but multiple members who left the group’s meeting Wednesday afternoon said they remain opposed.
The caucus’ message, spokeswoman Alyssa Farah tweeted, is “start over.”
Rep. Mark Meadows, the Freedom Caucus chairman, said Pence had offered the group gathered in the Eisenhower Executive Office Building “a couple of options” at the meeting, but there was “no official offers tendered on either side.”
By the time House Freedom Caucus members met – along with GOP Sens. Rand Paul and Ted Cruz, as well as Michael Cannon of the conservative Cato Institute, their opposition to the bill had solidified.
“There’s not enough votes to pass this,” Meadows said. “Nothing’s changed.”
Several caucus members leaving the meeting said they would not accept the changes floated by Pence, since White House and leadership negotiators were offering to support future changes to the bill once it was considered in the Senate.
“There have been promises of hopes that something constructive might happen in the Senate, but that’s after we vote, and that’s not going to work,” said Rep. Mo Brooks.
Elsewhere in the Capitol, GOP leaders were working to clear the bill’s final procedural hurdle. House Rules Committee Chairman Pete Sessions said the measure would allow Americans “to make their own health care decisions” and create the kind of competitive insurance market that will expand health care coverage without excessive government mandates.
But Rep. Jim McGovern questioned why lawmakers would move it to the floor when the Congressional Budget Office had not yet issued a new analysis of the bill in light of tweaks the majority made to it on Monday.
“I don’t think we should be meeting on a bill when we don’t even know how many people it will hurt,” said McGovern, whose motion to adjourn was defeated by a vote of 7 to 2. The bill, he added, would provide “massive cuts for the well off, at the expense” of poorer Americans.
Sessions predicted the congressional scorekeeping would come out sometime Wednesday night: “We will not go to the floor without that CBO score.”
Conservatives continue to press for changes to the bill that would eliminate more of the Affordable Care Act’s insurance mandates – which require plans to include, among other things, mental health, prescription drug and preventative care coverage. That, they argue, is the only reliable way to force down premiums.
Ryan, who hopes to bring the bill to the floor for a vote on Thursday, called opposition to the measure part of “the tempest of the legislative process” in a radio interview Wednesday morning with conservative host Hugh Hewitt. He did not rule out that further changes could be made to the bill to win additional votes. But the speaker warned that fulfilling those GOP demands would violate Senate budget rules and leave the bill vulnerable to a blockade by Democrats.
“Our whole thing is we don’t want to load up our bill in such a way that it doesn’t even get considered in the Senate,” Ryan told Hewitt. “Then we’ve lost our one chance with this one tool we have.”
Ryan said he remains confident that the measure will pass the House. “This is the one chance we have to actually repeal Obamacare and replace it with the stuff we believe in,” he said, referring to the Affordable Care Act. “The president is all in, we all made this promise, and that’s why I’m confident.”
Still, complications stemming from the bill’s last-minute tweaks appeared to add yet another political headache Wednesday, as veterans’ groups discovered that the latest draft might make them ineligible for a tax credit. A change made to ensure the measure would comply with Senate rules ensures that individuals can only qualify for the bill’s tax credits if they “are not eligible” for other types of coverage, including those provided Veterans Health Administration.
In an email, House Ways and Means Committee spokeswoman Lauren Aronson said the issue would be fixed in subsequent legislation. “This amendment makes no change to veterans’ healthcare. In working with the administration and the Veteran Affairs Committee, we will continue to ensure that America’s veterans have access to the best care available.”
Two dozen GOP lawmakers remained firmly opposed to the health-care overhaul on Tuesday amid a high-stakes persuasion campaign led by Ryan and Trump – more than enough to block the bill. There were also rumblings that a Thursday vote could be delayed if leaders are unable to secure enough votes beforehand.
Trump made a public pitch for the measure Wednesday during a panel in the Roosevelt Room with the newly-confirmed Centers for Medicare and Medicaid Services director, Seema Verma, and female medical professionals.
After praising the doctors, nurses and health-care aides in the room, Trump declared, “Unfortunately Obamacare is making their lives so much more difficult, as you all know. And putting enormous barriers in the way of helping patients, who we are going to help and get this thing done, and get it figured out.
When reporter asked whether he would keep trying to overhaul the ACA if the House bill failed, the president replied, “We’ll see what happens.”
Trump had made his pitch to lawmakers on Capitol Hill Tuesday, arguing the measure’s passage would represent a powerful, if symbolic, achievement for both the president and the House speaker. Even if the House approves the package, the legislation faces an uphill battle in the Senate.
In a Tuesday morning address to a closed-door meeting of House Republicans, Trump used both charm and admonishment in selling the GOP plan, reassuring skittish members that they would gain seats in Congress if the bill passed.
He singled out Meadows, who has helped lead the right-wing opposition to the bill.
“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 lawmakers who attended the meeting. “Honestly, a loss is not acceptable, folks.”
Trump’s remarks – which Meadows said he took as good-natured ribbing – reflected his mounting urgency to secure a major legislative victory in the early months of his presidency and fulfill a central campaign promise by repealing the signature domestic achievement of President Barack Obama. Passing a health-care measure is key to unlocking momentum for the president’s other legislative priorities such as tax reform and infrastructure spending.
But Paul emphasized Wednesday that House conservatives would “stand on principle,” and had no political incentive for doing otherwise.
“We ran on repealing Obamacare,” said Paul. “Back at home, no Democrats like this and at least half of Republicans don’t like this.”
In addition to conservatives, who do not think the proposal does nearly enough to undo the Affordable Care Act passed by Democrats in 2010, some moderates fear it will harm their constituents as well as their party’s prospects at the ballot box.
During the Rules Committee session Wednesday, Republicans acknowledged the legislation would undergo even more changes before it reaches Trump’s desk.
“Look, this is a legislative process,” said House Ways and Means Committee Chairman Kevin Brady, when asked about the issue by Rep. Tom Cole. “I assume the Senate will continue that improvement process as we hand this ball over to them.”
Cole reiterated the point, saying lawmakers in both parties should keep in mind, “This isn’t a once and forever bill, or vote, or anything of the kind. ... What we do today isn’t going to be the final word.
On Tuesday afternoon, Trump hosted more than a dozen members of the Tuesday Group, a moderate House faction, in the Oval Office for a lower-key lobbying session that involved Trump asking each person to relay their concerns about the bill.
Going into the White House meeting, Rep. Leonard Lance described himself as “a strong lean no,” citing a variety of concerns. “My views are based on fundamentals in the legislation,” he said. “I don’t see the lower premiums in this bill.”
After the meeting, he said his views had hardened: “I’m a no,” he told reporters.
Many of the changes were made to placate conservatives, including giving states the option to take a fixed Medicaid block grant and to impose work requirements on childless, able-bodied adults covered under the program. Others responded to broader concerns about the sufficiency of the tax credits offered to help Americans purchase insurance.
One revision was more narrowly targeted – added at the behest of a group of Republicans in upstate New York who wanted to end their state’s practice of commandeering local tax revenue to fund state Medicaid benefits.
That compounded the concerns of Rep. Daniel Donovan, a Tuesday Group member who represents parts of New York City that would be hurt by the change.
“I have four hospital systems in my district; they are my biggest employers,” he said. “All of them have grave concerns about how they are going to survive if this gets passed.”
After the White House session, Donovan said he welcomed the meeting with Trump but had not reached a final decision: “We’ll know on Thursday. Some of these things have to be addressed.”
One surprising holdout was Rep. Lou Barletta, who was among the first House members to endorse Trump and has emerged as one of his most stalwart backers. But he is a hard-liner on illegal immigration and cited the issue Tuesday in opposing the bill.
The tax credits offered under the GOP plan, he said, could be claimed by an individual who is not “lawfully in this country and eligible to receive them.”
“I would have a hard time explaining to families in the 11th District ... why they should be helping to pay for the health expenses of someone who broke the law to get here and has no right to those federal dollars,” he said.
The Washington Post’s Abby Phillip contributed to this report.
