Trump, GOP Leaders Try to Seal the Deal on Health Bill

House Republicans released a series of tweaks to their Obamacare-repeal legislation in hopes of wooing both moderate and conservative votes.

President Trump arrives to speak at a rally at the Kentucky Exposition Center in Louisville on Monday.
AP Photo/Andrew Harnik
Daniel Newhauser, Erin Durkin and Alex Rogers
Add to Briefcase
Daniel Newhauser and Erin Durkin and Alex Rogers
March 20, 2017, 8:49 p.m.

House Re­pub­lic­an lead­ers are count­ing on a vis­it by Pres­id­ent Trump and a last-minute policy re­write to push their health care le­gis­la­tion over the fin­ish line, but their mar­gin for er­ror will be razor-thin as scores of mem­bers have yet to com­mit to sup­port­ing the bill.

Re­pub­lic­an lead­ers re­leased a slate of changes Monday night aimed at draw­ing votes from mod­er­ate and con­ser­vat­ive Re­pub­lic­ans. But find­ing the le­gis­lat­ive “sweet spot” that House Speak­er Paul Ry­an has been seek­ing is prov­ing dif­fi­cult, as mem­bers on the Left and Right ex­pressed re­ser­va­tions about the be­lea­guered bill.

Mem­ber con­cerns seem to be cen­ter­ing on the in­ter­play between the House and the Sen­ate, with House mem­bers frus­trated that their bill can­not go farther to un­ravel Obama­care be­cause of Sen­ate rules or wary that the Sen­ate will strip out policies they con­sider must-haves.

House Free­dom Caucus Chair­man Mark Mead­ows said Monday even­ing that des­pite lead­ers’ pro­posed changes to the bill, he and sev­er­al of his HFC col­leagues will vote against it be­cause it does not go far enough. He said there are enough “no” votes in the con­ser­vat­ive Free­dom Caucus to keep the bill from passing.

“His­tory shows that it typ­ic­ally doesn’t get bet­ter in the Sen­ate,” he said.

The grous­ing from con­ser­vat­ives comes des­pite an over­ture from lead­er­ship in the form of a pro­posed change that would phase out Obama­care taxes a year earli­er than ori­gin­ally planned.

In­stead, con­ser­vat­ives want the House bill to re­peal the Af­ford­able Care Act’s es­sen­tial-health-be­ne­fit re­quire­ments, but lead­er­ship be­lieves that do­ing so would run afoul of Sen­ate rules. The le­gis­la­tion is be­ing brought to the floor un­der the so-called budget-re­con­cili­ation pro­cess, which al­lows Re­pub­lic­ans to pass their bill with a simple ma­jor­ity and without any Demo­crat­ic votes, but dis­cour­ages policy changes with a min­im­al im­pact on the budget.

The same Sen­ate pro­ced­ure, called the Byrd Rule, en­dangers a pro­vi­sion that would pro­hib­it tax cred­its from be­ing spent on plans that cov­er abor­tion. Mem­bers of the House Pro-Life Caucus met with Vice Pres­id­ent Mike Pence at the White House on Monday, but Rep. Trent Franks, a mem­ber of the Pro-Life Caucus and the Free­dom Caucus, said he still has con­cerns.

“The way to get me to ‘yes’ is to as­suage any con­cerns I have about the pro-life pro­vi­sions be­ing elim­in­ated … and in­clud­ing [the re­peal of] these Obama [reg­u­la­tions] in the bill be­cause if we don’t, the policy it­self will be at risk,” he said. “What we’re do­ing here, wheth­er we real­ize it or not, is we’re let­ting the Sen­ate rules sub­or­din­ate the policy dis­cus­sion here.”

House lead­ers are count­ing on an en­dorse­ment from the an­ti­abor­tion Na­tion­al Right to Life Com­mit­tee to help bring along some of those mem­bers. The group an­nounced it would key-vote the bill, mean­ing that any­one who votes against it would have a less-than-100-per­cent rat­ing on its score­card.

Lead­ers are also re­ly­ing heav­ily on Trump—who spent Monday even­ing ral­ly­ing with a friendly crowd in Louis­ville, Ken­tucky—and his ad­min­is­tra­tion to bring along con­ser­vat­ives. They are bet­ting that mem­bers from deep-red states don’t want to be on the wrong side of a pres­id­ent who ex­celled in their dis­tricts last Novem­ber.

Mean­while, lead­er­ship also plans to amend the le­gis­la­tion to cre­ate a $75 bil­lion re­serve fund to help low-in­come seni­ors pay their premi­ums, which would jump sig­ni­fic­antly un­der the Re­pub­lic­an bill. But the mech­an­ism to do so drew some ques­tions from mod­er­ates, whom it was cre­ated to ap­pease.

Rep. Charlie Dent, co­chair­man of the mod­er­ate Tues­day Group, said he is con­cerned that the House amend­ment would not ac­tu­ally set up the tax cred­its for low-in­come seni­ors, but rather in­struct the Sen­ate to do so, mean­ing House mem­bers would vote for the bill without be­ing cer­tain it will ad­dress their con­cerns.

“I would rather see the cred­its en­hanced in the House bill as op­posed to de­pend­ing on the gentle tender mer­cies of the U.S. Sen­ate,” Dent said.

Rep. Ileana Ros-Le­htin­en said she will vote against the bill be­cause no amount of budget­ary plus-ups could mit­ig­ate the dam­age that it would do to her dis­trict, which has the most re­cip­i­ents of Obama­care of any con­gres­sion­al dis­trict.

“It would be prac­tic­ally im­possible for the lead­er­ship to make the kind of changes that could ac­com­mod­ate the needs of my con­stitu­ents. They will be severely hit,” she said.

Still, some changes did flip some votes from “no” to “yes.” The lead­er­ship amend­ment, which is ex­pec­ted to be ad­ded to the bill in the Rules Com­mit­tee on Wed­nes­day, will in­clude pro­vi­sions that would in­sti­tute op­tion­al Medi­caid work re­quire­ments and block grants for states.

The pro­vi­sion is a con­ces­sion to mem­bers of the Re­pub­lic­an Study Com­mit­tee, who met with Trump last week and com­mit­ted to vote for the bill if its asks were met.

Even if the bill passes the House this week, it’ll need changes be­fore it could pass the Sen­ate, where enough Re­pub­lic­ans have already come out in op­pos­i­tion to sink the bill in its cur­rent form. Some sen­at­ors from states that ex­pan­ded Medi­caid un­der the Af­ford­able Care Act have cri­ti­cized the bill’s ef­forts to roll that back in 2020, as mil­lions few­er low-in­come people would have cov­er­age and state budgets take a hit without the en­hanced fed­er­al fund­ing.

Oth­er con­ser­vat­ives, such as Sens. Rand Paul and Mike Lee, want to start over, re­peal much of the ACA, and then be­gin the task of re­form­ing the health care sys­tem. Earli­er this year, the non­par­tis­an Con­gres­sion­al Budget Of­fice found that at least 18 mil­lion people would lose cov­er­age in the first year if Re­pub­lic­ans re­pealed the ACA without a re­place­ment. The CBO found that 24 mil­lion more people would be un­in­sured in the House bill than un­der Obama­care over a dec­ade, but it would re­duce the fed­er­al de­fi­cit by $337 bil­lion.

Sen­ate aides are prep­ping for a fight over the Byrd Rule. The par­lia­ment­ari­an’s in­ter­pret­a­tion of the rule could have ma­jor con­sequences. One seni­or Sen­ate aide said that about a dozen pro­vi­sions are be­ing de­bated as to what should or should not com­ply. An­oth­er Sen­ate aide said, “Demo­crats are very, very far from any de­cisions on this pro­cess.”

Re­ports sug­gest that two par­tic­u­lar pro­vi­sions are sus­pect: al­low­ing in­surers to charge the old­est en­rollees five times as much as the young­est, and the sur­charge for people who don’t main­tain con­tinu­ous cov­er­age.

What We're Following See More »
Yellen to Leave Fed Once Powell is Sworn In
1 hours ago

"Fed Chair Janet Yellen announced Monday that she will leave the Federal Reserve after her successor is sworn in," despite having seven years remaining on her term as governor. President Trump has nominated Jerome Powell to take over for Yellen. Her departure will leave four open seats for Trump to fill on the Fed's board. "As I prepare to leave the Board, I am gratified that the financial system is much stronger than a decade ago," said Yellen.

Former U.S. Rep. Donna Edwards Will Run for Prince George’s Exec
2 hours ago

Former Democratic Rep. Donna Edwards, who lost a primary to Maryland Sen. Chris Van Hollen in 2016, will run for the post of Prince George's County executive, she announced today. The current executive, Rushern Baker, is running for governor.

Keystone Pipeline Approved to Run Through Nebraska
2 hours ago

"Developers of the Keystone XL pipeline secured approval Monday for the pipeline to run through Nebraska, clearing a key hurdle in the years-long fight to build the project. The decision came after a rupture in TransCanada’s Keystone system spilled an estimated 210,000 gallons of oil in South Dakota last week, an incident that rankled opponents of the XL expansion. Nebraska regulators approved plans for Keystone XL to cross the state, though the approval didn't cover TransCanada's preferred route through the state. The commission voted 3-2 to move the project forward. The approval comes eight months after President Trump issued a presidential permit for the $8 billion, 860 barrel per day project."

Trump Places N. Korea Back on Terrorism List
2 hours ago

"President Trump plans to designate North Korea as a state sponsor of terrorism on Monday, years after the hermit nation was removed from the list during the George W. Bush administration. Speaking to members of his Cabinet, Trump said the designation "should have happened a long time ago." The White House expects the move to put further pressure on North Korean leader Kim Jong Un to abandon his nuclear and ballistic missile programs." Under the designation, North Korea will be subject to further penalties and sanctions.

Charles Manson Dead
8 hours ago

Manson "died Sunday of natural causes, according to the California Department of Corrections. He was 83. ...Manson served nine life terms in California prisons and was denied parole 12 times."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.