Republicans say they still plan to put the American Health Care Act up for a vote on Thursday, even as the White House and House Republican leaders worked through the night to whip up enough votes to ensure passage. "There is no Plan B," White House Press Secretary Sean Spicer said Wednesday. "There's Plan A and Plan A. We're going to get this done."
Late Wednesday, the White House and the conservative House Freedom Caucus reportedly reached a deal to strike ObamaCare's requirement that insurance plans cover 10 "essential health benefits" — including hospitalization, maternity and newborn care, mental health, emergency services — and the Freedom Caucus will press their other demands in a meeting with President Trump on Thursday morning. They want to scrap at least some of ObamaCare's Title One provisions, which include prohibitions against denying coverage due to pre-existing conditions and annual or lifetime coverage limits. Even with the changes, many members of the caucus would not commit to voting yes on the bill.
After news of the Freedom Caucus deal spread, House GOP moderates met with House Speaker Paul Ryan and his leadership team and balked at the changes. The House moderates say they are concerned that the AHCA will cause people to lose health insurance and raise costs for the poor and elderly, and the fact that Freedom Caucus members wouldn't sign on even with the hard-to-swallow changes made them even worse. "Everybody's frustrated," one lawmaker in the meeting told Politico. "Some moved; some stayed the same.... Nobody goes closer to the bill on that one."
The changes demanded by House Freedom Caucus members aren't opposed by most Republicans, but they would make passage in the Senate, already facing long odds, even more difficult, as they could render the bill ineligible for the filibuster-proof "reconciliation" process. Mike DeBonis explains the situation at The Washington Post: "The White House and GOP congressional leaders have told the Freedom Caucus that meeting their demands would essentially kill the American Health Care Act before it is born, but the Freedom Caucus, egged on by several conservative Republican senators, refuses to believe that is the case." House Republicans can't lose more than 22 votes. Peter Weber
House Republican leaders say they plan to hold a floor vote on the American Health Care Act on Thursday, regardless of the outcome, despite conceding late Tuesday that they currently lack the votes. With all Democrats opposed, Republicans can lose 21 votes and still push the ObamaCare replacement through, but according to The Hill's tally and House Freedom Caucus leaders, there are at least 22 firm no votes, plus six more House Republicans leaning toward voting against the legislation; The New York Times, citing a GOP aide, says as many as 36 Republicans are opposed to the bill or not yet swayed in its favor.
President Trump has thrown himself into flipping enough votes to ensure passage, spending much of Tuesday encouraging, cajoling, and horse-trading with reluctant House Republicans in public and private. Even if the bill does squeak by in the House, six Senate Republicans have said they oppose the legislation as written; three voting no would kill the bill. One of those no votes, Sen. Mike Lee (R-Utah), urged House Speaker Paul Ryan (R-Wis.) on Tuesday to cut his losses, saying on Fox News he is "strongly, strongly persuaded that it is not going to pass" and thinks "they should cancel the vote because they don't have the votes."
Republicans leaders are still predicting that reluctant members will come around, especially with Trump's ramped-up involvement. "A lot of folks are holding out because they think there will be a better offer," said Rep. Richard Hudson (R-N.C.). "I think he's got to make the case and the point that this is the final offer — take it or leave it." "We're not there yet," a top House Republican tells Politico. "I think we'll get there, especially with Trump working it, but we're not there right now." Trump's approval rating hit 37 percent in Gallup's daily tracking poll on Monday, The New York Times notes, and the AHCA is even less popular at 34 percent, per a recent Fox News poll. Peter Weber
President Trump spent much of Tuesday on Capitol Hill trying to rally Republicans around the American Health Care Act, the House Republican plan to replace the Affordable Care Act. His closed-door outreach included carrots and sticks, and at a National Republican Congressional Committee fundraiser Tuesday night, Trump urged Republicans to push forward with the "serious action" he said America voted for in November. "The House bill ends the ObamaCare nightmare," he said. "These are the conservative solutions we campaigned on, and these are the conservative solutions the American people asked us as, a group, to deliver. We are keeping our promises."
The GOP health-care plan is actually deeply unpopular, according to polls, and according to the Congressional Budget Office analysis, it will leave 24 million fewer people with insurance by 2026 versus ObamaCare. Especially hard-hit is the Affordable Care Act's Medicaid expansion, which will be phased out, along with taxes on the wealthy used to pay for federal subsidies and the individual mandate. In 2014, CNN notes, 25 percent of Americans treated for drug addiction were on Medicaid. That helps explain why Trump's push for the GOP plan finally cost him the support of Kraig Moss.
Moss wasn't a casual Trump fan — he sold his construction equipment for his upstate New York business and followed Trump to 45 campaign rallies, literally singing Trump's praises on a Trump-emblazoned guitar, CNN says. The GOP health-care bill "is an absolute betrayal of what Trump represented on the campaign trail," Moss told CNN. "I feel betrayed."
Moss' son, Rob, died of a heroin overdose in 2014 at age 24, and Trump frequently said on the campaign trail that he would work to help addicts through expanded treatment programs. The ACHA does the opposite, slashing funding for addiction treatment. "I did a lot to promote his candidacy," Moss said. "Now, I wish I had never sold my equipment." You can learn more about Moss and his story in the CNN report below. Peter Weber
President Trump is headed to Capitol Hill on Tuesday to try and rally House Republicans around the health-care bill they are expected to vote on this week, with uncertain prospects of passage. To win the support of conservative holdouts, House Speaker Paul Ryan released 43 pages of amendments to the bill on Monday night, including instant repeal of ObamaCare's taxes on high earners and certain medical companies, allowing states to attach work requirements to Medicaid, adding more restrictions on Medicaid's future growth, and allowing the Senate to increase tax credits for people 50 to 64, if it chooses.
Trump and House conservatives had hammered out many of those provisions in direct negotiations, but one specific amendment is aimed at a handful of Republican moderates from upstate New York. The provision would bar New York from making smaller counties pay for part of the state's Medicaid costs, potentially saving upstate counties some $2.3 billion a year, out of New York's roughly $27 billion Medicaid bill; New York City would still have to pay in. The amendment, which only affects New York, was pushed by Reps. John Faso and Chris Collins, Republicans from upstate New York districts.
"I suggested we put this in," Collins told The New York Times, "and the question that came back was, 'If we do it, can we get the New York votes?'" He said with the amendment, he believes eight of nine members of New York's Republican House delegation will vote yes. "If they did not have the New Yorkers, I'm not sure they could get it over the finish line," Collins said.
It's unclear if those extra votes will push the American Health Care Act over the finish line, or how those changes would be received in the Senate. Republicans sharply criticized Democrats in 2009 and 2010 for secret dealing and targeted provisions to win over on-the-fence members on the Affordable Care Act, with the most infamous example being the Cornhusker Kickback for Nebraska. The Huffington Post has come up with some similarly cutesy nicknames for the New York carveout: "The Buffalo Buyout ― or the Tammany Haul, or the Empire State Earmark, or whatever you may want to call it ― is a recognition that leaders are close, but can't afford to lose votes from moderates." Peter Weber
Hoping to appeal to more conservative members of Congress, House Speaker Paul Ryan (R-Wis.) submitted amendment packages to the Republican health-care plan on Monday night, three days before the scheduled vote on the House floor.
The changes include sharper cuts to Medicaid, including giving states the ability to impose work requirements for recipients; repealing tax increases this year instead of in 2018; and letting the Senate approve tax credits for people between the ages of 50 and 64. While Ryan's camp believes this will help him get to the 216 votes needed to pass the bill to the Senate, several conservatives in the House Freedom Caucus say there still are not enough votes. Catherine Garcia
The Republican health-care plan narrowly advanced out of the House Budget Committee on Thursday, with three conservative Republicans voting no, but it also hit some new turbulence. Four Republican governors wrote congressional leaders saying the bill would harm their states, and Sen. Susan Collins (R-Maine) said it "is not a bill I could support in its current form." Including Collins, three senators now say they won't back the bill, leaving it short of the votes it needs to pass. Republicans are turning to President Trump to whip up support, The Associated Press reports, but Trump is suggesting this bill is just an early draft.
House Speaker Paul Ryan (R-Wis.), the architect of the bill, put on a happy face Thursday, telling reporters, "We feel like we're making great strides and great progress on getting a bill that can pass."
But amid all the talk of changing the legislation to get enough votes, Republicans say they have not even started discussing an aspect of the legislation that hits close to home: What will happen to their own health insurance? Politico explains:
ObamaCare required members of Congress to enroll in the law's health insurance plans. But so far, Republicans aren't planning to require lawmakers to participate in the new insurance market they're proposing.... Health insurance for members of Congress — and their staffs — was one of the most contentious inside-the-Beltway fights in the long, drawn-out battle over ObamaCare. Lawmakers were stripped of the health insurance that other federal employees get and tossed into ObamaCare, initially without a contribution from their employer, the federal government — thanks to a Republican amendment introduced by Iowa Sen. Chuck Grassley. [Politico]
Republicans have some choices: They could put themselves and their staff back on the federal health insurance plan — a politically risky move — or stay on the exchanges set up under ObamaCare (if those exchanges survive the end of federal subsidies for insurance customers), or throw themselves into whatever new market they create. "I haven't given thought to that," Ryan said Thursday. "We have ObamaCare. We wouldn't have ObamaCare." You can read more at Politico. Peter Weber
The White House and House Republicans had spent days preparing to cast doubt on the nonpartisan Congressional Budget Office's estimates about the costs and benefits of the American Health Care Act, their plan to replace the Affordable Care Act, and when the CBO score came in worse than expected on Monday in terms of health insurance coverage, Health and Human Services Secretary Tom Price followed through. "We disagree strenuously with the report that was put out," Price said following a Cabinet meeting with President Trump. "It's just not believable is what we would suggest."
The CBO's projected 24 million fewer people covered under health insurance, though, is actually slightly rosier than an internal White House analysis of the GOP health-care plan, Politico reports. Under the Trump administration's analysis, 26 million people would lose coverage over the next decade under the AHCA, including 17 million people who would lose Medicaid coverage, 6 million leaving the individual market, and 3 million people losing their employer-sponsored plans. In all, 54 million Americans would be without health insurance by 2026, the White House estimates, almost double the number estimated under current law.
House Speaker Paul Ryan and White House budget director Mick Mulvaney have argued that the goal of the law is affordability rather than expanding coverage, even though Trump repeatedly promised both — affordable health coverage for everyone. Ryan has also been trying to sell wary conservatives on the plan's "de-federalizing an entitlement," by making states pay more for Medicaid coverage and sharply reducing federal support. Peter Weber
Vice President Mike Pence will go to Louisville, Kentucky, on Saturday to make the Trump administration's case for modifying the Affordable Care Act with a health-care overhaul.
Kentucky is home to Sen. Rand Paul, a leading Republican critic of the health-care bill now navigating the House, which Paul labels "ObamaCare-lite." "Conservatives across the land do not like [House Speaker] Paul Ryan's proposal," Paul said on Fox News Friday night. "It keeps the subsidies, keeps the taxes, keeps the mandate and actually has an insurance company bailout in it," he argued. "ObamaCare is a disaster ... But the only thing that's really united us over time is repeal. And if ObamaCare-lite is the replacement, conservatives aren't going to accept it."
Kentucky's Republican Gov. Matt Bevin said Friday he supports the repeal and replace plan but, like Paul, "is not impressed with what has currently been offered." Pence's trip will include a tour of an energy company with Bevin as well as a listening session with local business leaders. Earlier this month, he made similar trips to Wisconsin and Ohio. Bonnie Kristian