WASHINGTON — House leaders postponed a vote Thursday on their plan to overhaul the nation’s health-care system, casting doubt on whether President Trump and House Speaker Paul Ryan, R-Wis., can deliver on one of the GOP’s central promises to the voters who placed Republicans in power.
Lawmakers and White House officials continued to express confidence that the revisions to the Affordable Care Act would pass by week’s end, and talks resumed soon after leaders announced the postponement. As evening came, members of the conservative House Freedom Caucus filed into the office of Speaker Paul Ryan, R-Wisconsin, as did White House Chief of Staff Reince Preibus and Trump’s chief strategist, Steve Bannon.
Lawmakers also said they expected to begin floor debate Thursday night, and a White House spokeswoman predicted a vote by Friday morning.
The frenzy of activity Thursday laid bare the reality that Trump’s and Ryan’s plan for a vote on Thursday had unraveled over the course of the day, after Freedom Caucus members had rejected Trump’s offer to strip a key set of mandates from the nation’s current health care law.
Meanwhile, a new analysis by the Congressional Budget Office released Thursday evening showed that changes House leaders made to the bill on Monday don’t 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 reforms to the Medicaid program and language directing that $85 billion be used to help Americans aged 50 to 64 obtain coverage.
It was unclear how the new CBO score would affect legislative support for the bill.
Speaking to reporters Thursday afternoon, the Freedom Caucus chairman, Mark Meadows, R-North Carolina, said House leaders were still seeking another 30 to 40 votes in order to pass the bill.
“I’m desperately trying to get to yes,” said Meadows. “I think we need to make sure that it lowers health care costs.”
House leaders confirmed that they still lacked sufficient support. But White House deputy press secretary Sarah Huckabee Sanders framed the delay as being “for scheduling purposes, so nobody has to be up at 3 o’clock in the morning for a vote.”
“We’re very confident that the bill will pass tomorrow morning,” she said, adding that while the White House remains open to tweaking the measure, “this is the bill, this is the vote.”
Trump devoted much of his day to personally lobbying members, meeting with conservatives Thursday morning and offering to remove “essential benefits” include mental health treatment, wellness visits, and maternity and newborn care from the proposal. lawmakers who support that proposal say it would reduce premium costs for Americans.
But Freedom Caucus members have asked to eliminate more — including language that bars companies from setting insurance rates based on a person’s sex, medical condition, genetic condition or other factors. The only existing mandates they are open to preserving are ones that bar insurers from denying coverage based on preexisting conditions and allow children to stay on their parents’ plans until age 26.
At least 80 percent of the group voted Thursday afternoon to reject the latest offer from GOP leadership and the White House.
“The ball is in their court,” said Freedom Caucus member Rep. Andy Harris, R-Maryland. “Our position has not changed.”
The president continued to work on cajoling lawmakers throughout the day, meeting at 5 p.m. with members of the moderate “Tuesday Group.” Meanwhile, Ryan and House Majority Leader Kevin McCarthy, R-California, huddled with about a half-dozen conservatives in the speaker’s office in an effort to win them over.
Trump, who spoke to a group of trucking executives and employees at a White House event aimed at showing how the ACA had driven up the industry’s costs, joked that he didn’t have much time to mingle.
“I’m not going to make it too long, because I have to get votes,” Trump said, sparking laughter. “I don’t want to spend too much time with you. I’m going to lose by one vote and then I’m going to blame the truckers.”
As of Thursday afternoon, 37 House Republicans — mainly conservatives — had announced their opposition to the bill, known as the American Health Care Act.
On Wednesday, four Republican moderates — Reps. Charlie Dent of Pennsylvania, Frank LoBiondo of New Jersey, Daniel Donovan of New York and David Young of Iowa — announced their opposition, increasing pressure on leaders to win over conservatives.
This high-wire balancing act, in which Republicans are catering to conservatives in the House with the knowledge that they still must woo moderates to get legislation to Trump’s desk, could not only reshape the nation’s health-care system but could also have uncertain electoral repercussions for the new majority.
But with failure not a viable option, Ryan and Trump have been working furiously to win over the large voting bloc of conservatives who control the House bill’s fate.
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-to-48 advantage, and many of them want to maintain some of the current law’s more generous spending components.
If Republicans fail this initial test of their ability to govern, Trump and Capitol Hill Republicans may face a harder time advancing high-priority initiatives on infrastructure, tax reform and immigration. They might also find themselves navigating strained relationships among themselves.
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-Illinois. “Now, here we are — they don’t have it, again. They’re looking for a sweet spot and they won’t find one.”
Former President Barack Obama, for his part, issued a statement noting that more than 20 million Americans have gained coverage since he signed the law in 2010, while the rise in health-care costs has slowed. The statement came on the seventh anniversary of the passage of the Affordable Care Act — a day that Republicans had hoped to mark by dismantling it.
“So the reality is clear: America is stronger because of the Affordable Care Act,” Obama said, adding that Republicans are welcome to work with Democrats to improve the law. “But we should start from the baseline that any changes will make our health care system better, not worse for hard-working Americans. That should always be our priority.”
Republicans’ current strategy is based on a new interpretation of Senate rules that raised the possibility that acceding to the Freedom Caucus’ request might not threaten Senate consideration of the whole bill. But both aides said the provision could still be stripped out once the bill reaches the Senate.
Democratic Senate aides insisted that would be the case. “What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” said Matt House, a spokesman for Senate Minority Leader Charles Schumer, D-New York.
In fact, the new negotiations late Wednesday raised the possibility that the challenge would only grow at the other end of the Capitol. Republicans can afford to lose the votes of only two senators, assuming Pence would step in to cast a vote for the health-care rewrite in the case of a tie.
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 that the measure would comply with Senate rules created a separate consequence — that individuals would qualify for the bill’s tax credits only if they “are not eligible” for other types of coverage, including those provided by the 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’ health care. 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.”
In another example of last-minute changes, Illinois’ GOP delegation announced late Wednesday night that Centers for Medicare and Medicaid Services Director Seema Verma had assured them that “Illinois will have the opportunity to accurately report its 2016 Medicaid payment information to CMS.” The state “has long been disadvantaged by below- average Medicaid reimbursements,” the lawmakers said, and this adjustment will ensure that the state would receive more federal funds when the government shifts to allocating Medicaid dollars on a per capita basis under the bill.
Many recent changes made to the bill were aimed at placating 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 Republicans from Upstate New York who wanted to end their state’s practice of commandeering local tax revenue to fund state Medicaid benefits.
That concerned Donovan, who said a day after meeting with Trump in the Oval Office that he would oppose the bill.
In an op-ed for the Staten Island Advance, he said the change “gives our district short shrift” and also said the GOP bill would disproportionately harm older Americans.