Trump digs in heels on gambit for GOP to vote on health bill
(Bloomberg) – The Trump administration doubled down on its demand that House Republican leaders hold a vote Friday on their embattled healthcare bill without any changes and with lingering uncertainty about whether they have enough support to pass the measure.
“After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!” President Donald Trump tweeted Friday morning.
Referring to the conservative House group that has several members holding out on the plan, Trump added, “The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!” Planned Parenthood, which offers reproductive health services such as birth control and abortions at U.S. clinics, has long been a Republican target for defunding.
If the high-stakes gamble works and the House manages to pass the ACA replacement bill, it will be an important win for Trump and House Speaker Paul Ryan who have formed an uneasy alliance to repeal former President Barack Obama’s signature healthcare law.
If the measure is blocked, it will be an embarrassing setback that casts doubt on Trump and Ryan’s ability to deliver on their ambitious agenda, including taxes and infrastructure, both of which are being closely watched by Wall Street.
“He wants to do this and he wants to do it now,” White House budget director Mick Mulvaney said of Trump on ABC Friday morning. “He also wants to move on to things like tax reform, infrastructure, restructuring the government, putting people back to work. He’s not willing to wait the several months an ordinary president would.”
Mulvaney said the White House was still unsure whether it had enough votes to pass.
The Trump administration made a last-minute deal with House conservatives to change the bill -- by removing the ACA’s requirements that certain essential benefits be covered by insurance -- in an effort to win over holdouts, who had forced GOP leaders to delay a vote originally scheduled for Thursday.
Then Trump aides, including senior strategist Steve Bannon, went to Capitol Hill to deliver a message in person to House leaders and the Republican caucus that the president has run out of patience: Trump wanted a vote Friday, win or lose, even if that means leaving the ACA in place.
“Nothing’s going to change at this point with this piece of legislation,” Health and Human Services Secretary Tom Price told MSNBC Friday morning.
‘No More Negotiations’
“We have to have a vote tomorrow. He expects it to pass,” Representative Chris Collins of New York said Thursday, speaking about Trump. “We are done negotiating, there are no more negotiations.”
“If it loses, we just move on to tax reform,” added Collins, a Trump ally.
Conservatives, including Freedom Caucus Chairman Mark Meadows, emerged from the meeting saying they were still leaning against the bill but evaluating the final package.
Meadows said late Thursday “I’m a no” for now, but said members had been given “a binary choice” and that he would talk with other members before making a final decision.
GOP leaders didn’t agree to a core demand of the Freedom Caucus to eliminate other insurance regulations, according to a senior Republican aide.
Representative Thomas Massie of Kentucky, who opposes the bill, said Republican leaders are taking a risky bet.
“If they bring this to the floor and it doesn’t get to 216 quickly, the momentum could go in the other direction and they could come way short,” he said. “Because you don’t want to be the person who fell on your sword and voted yes for a piece of legislation that never passes.”
‘Leaning the Other Way’
Other House conservatives said they were getting the sense that enough of their colleagues would end up backing it.
"I’m still a no, but it looks like it’s leaning the other way," Freedom Caucus member Ted Yoho of Florida said. Representative Mark Sanford of South Carolina agreed, saying he was picking up that the “sentiment” of most of the conference was now to pass the bill.
Freedom Caucus member Scott DesJarlais of Tennessee held out hope that there was still room for compromise. “We’ve been told that this is it, this is the deal, but we’ve been told that three or four times since last week,” he said.
The bill has struggled to win over far-right members who have demanded a more complete repeal of the ACA, but it’s also unnerved moderates concerned about projections that millions of Americans will lose coverage. A number of moderates came out against the bill this week, giving Republican leaders little room to negotiate changes.
Ryan put a brave face on the upcoming test of whether he and Trump can deliver the votes.
“For seven-and-a-half years, we have been promising the American people that we will repeal and replace this broken law because it is collapsing and hurting families,” he said Thursday. “Tomorrow we will see that.”
The GOP bill, H.R. 1628, would reverse massive gains in health coverage under the Affordable Care Act, which brought the uninsured rate to a record low. The proposal would pull hundreds of billions of dollars out of the health system by winding down the ACA’s expansion of Medicaid and limiting its subsidies, threatening revenues for hospitals, doctors and insurance companies.
Meadows and other conservative Freedom Caucus members demanded a provision in the bill -- agreed to by Trump and GOP leaders -- that would scrap the essential benefits portion of the Affordable Care Act, which requires insurers to cover 10 categories of services, for the individual market. Those services include hospitalization, ambulance services, maternitycare, pediatric services, mental health and substance abuse treatment, prescription drugs, rehabilitative care and laboratory services.
Other new provisions described by lawmakers Thursday night include a $15 billion boost to a new state flexibility fund and six more years of a 0.9 percent Medicare tax on high earners.
That last bit is needed to pay for what is expected to be a surge of people buying lower-cost insurance products, triggering tax credits that run from $2,000 to $4,000 per person for eligible people.
If the bill makes it to the Senate, it is expected to undergo significant changes there as well, including boosts to tax credits for people ages 50 to 64 who are hit with massive premium spikes under the bill.
Outdated CBO Score
The last-minute changes mean that Republicans will be voting on the measure without a final estimate from the Congressional Budget Office about how many millions of Americans will lose coverage or how much the measure will cost.
In another development that could unease conservatives, the CBO issued a new estimate Thursday to account for changes made to the bill earlier in the week. The nonpartisan agency cut its estimate of how much the bill would shrink the federal budget deficit, saying the updated measure would reduce the deficit by $150 billion over the next decade, $186 billion less than the initial forecast of $337 billion.
Representative Kevin Cramer of North Dakota said he fears that even if the Freedom Caucus succeeds at getting its wish and delivers the votes for the bill to pass to the House, the provisions they demand won’t pass muster under Senate rules.
“It seems that they want more inclusion on the essential benefits and some of those things that the speaker and others believe” will violate Senate rules, Cramer said. “And for some, I think they’re spoiling for a fight. They want to challenge the Senate.”