'No deal' yet for Republican healthcare bill as House prepares to vote

Lauren Gambino in Washington
Mark Meadows, chairman of the House Freedom Caucus, said he was ‘hoping to get to a yes before 7 o’clock tonight’. Photograph: Eric Thayer/Reuters

Donald Trump has not yet reached a deal with conservatives rebelling against the plan to repeal the Affordable Care Act, as eleventh-hour negotiations continue with the White House confident there will be enough support of the legislation to pass the bill on Thursday.

The president invited members of the Freedom Caucus, a coalition of hard-right conservatives who are opposed to the plan on ideological grounds, to the White House for another round of negotiating on Thursday morning. After the meeting, the caucus chairman said there was “no deal” – yet.

“There are not enough votes as of 1.30 today,” North Carolina congressman Mark Meadows, chairman of the House Freedom Caucus, told reporters after the meeting with the president. He added: “I’m hoping to get to a yes before 7 o’clock tonight.”

The Freedom Caucus members believe the bill doesn’t go far enough in undoing the ACA, also known as Obamacare, and lowering premiums. They want the Republican plan to strip away the ACA’s essential benefits, the 10 benefits an insurer must offer in their health plan, including maternity care, mental health services and prescription drugs.

The White House called the meeting between the president and more than 30 members of the Freedom Caucus a “positive step” toward repealing and replacing the Affordable Care Act. Trump will meet with members of the moderate Tuesday Group on Thursday afternoon.

During the daily press briefing, the White House press secretary, Sean Spicer, said that he expected the House to press ahead with a vote by the end of the day. “It’s gonna pass – so that’s it.”

Barack Obama on Thursday defended his signature domestic policy achievement, the Affordable Care Act, on its seventh anniversary, as Republicans’ attempt to repeal the law which expanded healthcare for millions of Americans teetered in the balance.

“America is stronger because of the Affordable Care Act,” Obama said in a statement marking the seventh anniversary of its passage.

Obama did not mention the Republican plan to undo the law, which introduced the greatest expansion of healthcare coverage in more than a generation, but urged lawmakers to work together to “make our healthcare system better, not worse for hardworking Americans”. It was one of his most significant interventions in US politics since he left office.

The House is poised on Thursday to vote on the Republican healthcare proposal despite widespread criticism and opposition from a coalition of hard-right conservatives who say that they have the votes to block its passage. A new Quinnipiac University poll showed that Americans disapprove of the healthcare overhaul by a margin of 56% to 17% – with support among Republicans hovering at just 41%. The same poll showed 20% felt Obamacare should be repealed in total and 50% in part.

The stakes for Trump and the House speaker, Paul Ryan, who is spearheading the bill, are high. For seven years – and over the course of three election cycles – Republicans have run in and won elections on the promise to repeal the Affordable Care Act.

Its passage is also the first major legislative test for Trump, who campaigned as the brilliant negotiator behind The Art of the Deal. On the campaign trail, crowds thrilled to Trump’s promise to repeal Obamacare “on day one” and replace it with “something terrific”. Failure to pass this law could jeopardize Trump’s broader legislative agenda, which includes tax reform and border security.

In a private meeting on Capitol Hill on Tuesday, the US president reportedly warned Republicans that there could be political backlash if they fail to uphold their promises to repeal the ACA, with Spicer saying: “I think there’s going to be a price to be paid but it’s going to be with their own voters.”

“One of the reasons I don’t want this bill to fail is because I don’t want Paul to fail,” Mike Simpson, a Republican representative from Idaho, told reporters on Wednesday. “I want him to be successful.”

The embattled plan faces opposition from across the political spectrum and has been criticized by influential conservative groups, patient advocacy organizations and almost every corner of the healthcare industry.

A group of conservative donors, led by the powerful industrialists Charles and David Koch, announced on Wednesday that it was putting together a new fund for Republican re-election races in 2018 – excluding candidates who voted for the healthcare overhaul. They oppose the bill because they feel it does not scale back enough of Obamacare.

The negotiations are also complicated by a non-partisan Congressional Budget Office report that estimated that 14 million people would lose their healthcare coverage in the first year under the Republican plan, and that insurance premiums for older Americans would rise dramatically. The forecast makes it difficult to see how Trump will keep the promise he made as president elect to create a plan that offers “insurance for everybody”.

The Republican plan, known as the American Health Care Act, removes ACA taxes, eliminates the requirement that all Americans have insurance and dramatically restructures Medicaid, the healthcare program for low-income Americans. Instead of subsidies, the plan would offer tax credits to help people purchase health insurance.

Eleventh-hour negotiations continued late on Wednesday night and into Thursday morning as the White House and the Republican leadership signaled an openness to changes that would placate conservative members, but almost certainly would not pass the narrowly divided Senate.

A number of Senate Republicans have already objected to the bill, from the Kentucky libertarian Rand Paul, who has rallied with the Freedom Caucus, to the Maine moderate Susan Collins, who was rattled by the CBO’s findings that millions could lose coverage. With the party’s slim two-vote majority in the Senate, finding a plan that satisfies Republicans across the political spectrum is a difficult – if not impossible – task.

“We’re not there yet, but I’m hopefully we can get this done,” Meadows said.

Trump reached out to Meadows and members of the Freedom Caucus directly on Wednesday, with concerns centering on the ACA’s insurance mandates, which the Republican plan carries over.

Ryan, the most senior Republican in Congress, had been reluctant to introduce these measures to the House proposal out of concern that it would violate a budget rule and trigger the 60-vote threshold to pass, at which point Democrats could block it.

“We don’t want to load up our bill in such a way that it doesn’t even get considered in the Senate, and it’s killed in the Senate,” Ryan told the conservative radio show host Hugh Hewitt on Wednesday. “Then we’ve lost our one chance with this one tool we have.”

Late on Wednesday night, that view appeared to shift when a Republican leadership source said a new understanding of the budget rule meant incorporating the Freedom Caucus’s demands might not violate the rule, allowing the bill to pass with a simple majority.

While the changes might win conservative support, they could also drive away more moderate Republicans.

On Wednesday night, the Pennsylvania representative Charlie Dent, the chairman of the moderate Tuesday Group who attended a White House meeting with the president on Monday, called on his party leaders to “step back from this vote and arbitrary deadline”.

“We have an important opportunity to enact reforms that will result in real healthcare transformation – bringing down costs and improving health outcomes,” Dent said in a statement. “This legislation misses the mark.”

Dent is one of a handful of moderate Republicans to recently come out against the legislation, putting even more pressure on leadership to win over conservatives.

Congressman Frank LoBiondo, a moderate from New Jersey, announced on Wednesday that he too is against the bill. In a statement, LoBiondo said he supports overhauling Obamacare but the Republican plan is simply “not as good as or better than what we currently have”.

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