WASHINGTON — The Republican health care overhaul spearheaded by House Speaker Paul Ryan of 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 Mike 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, R-Iowa, 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 caucus’ message, spokeswoman Alyssa Farah tweeted, is “start over.”
At the same time, two more Republican moderates — Reps. Frank LoBiando of New Jersey and David Young of Iowa — announced their opposition Wednesday, increasing pressure on leaders to win over the conservatives.
Rep. Mark Meadows, R-North Carolina, 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 had huddled along with GOP Sens. Rand Paul of Kentucky and Ted Cruz of Texas and 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, because 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, R-Alabama.
Conservatives are seeking to eliminate more of the Affordable Care Act’s insurance mandates, known as “essential benefits,” which require plans to include, among other things, mental health, prescription drug and preventive 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 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.”
In a Facebook video Wednesday afternoon, King said he had gotten “a full and firm commitment” from Trump that Senate Majority Leader Mitch McConnell, R-Kentucky, would strip the current essential benefits requirement once the bill reaches the upper chamber and that the president “will use his political leverage to again go public and work hard to get the Mitch McConnell amendment passed.”
“I expect everyone in this arrangement to keep their word,” King said. “I’ll keep mine.”
White House press secretary Sean Spicer told reporters Wednesday the bill was picking up supporters and would pass the House, adding there is no “Plan B” if the proposal goes down.
“There is Plan A and Plan A,” said Spicer, who described Trump as “the closer” for the deal. “We’re going to get this done.”
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.”
Carlos Fuentes, legislative director for Veterans for Foreign Wars, said veterans want the issue resolved before any bill becomes law. “It would be a huge impact on veterans if this were not corrected,” he said.
Elsewhere in the Capitol, GOP leaders were working to clear the bill’s final procedural hurdle. House Rules Committee Chairman Pete Sessions, R-Texas, 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, D-Massachusetts, 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.”
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 a 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 on 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.
In interviews on Tuesday, more than two dozen lawmakers said they were either firmly opposed to the bill or leaning toward voting against it.
Addressing reporters Tuesday, Ryan played down the possibility that the bill could fail Thursday and argued that conservatives should be pleased that many of their demands would probably be in the legislation. Adding further changes, he said, could jeopardize the legislation’s chances in the Senate.
McConnell sounded a cautiously optimistic note Tuesday, promising that the Senate would forge ahead with plans for votes on the measure — if it passed the House first.
“If the House passes something, I will bring it up,” McConnell said. “We’ll try to move it across the floor next week.”
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, R-Texas, when asked about the issue by Rep. Tom Cole, R-Oklahoma. “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.
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, R-New York, 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, R-Pennsylvania, 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 and Lisa Rein contributed to this report.