House leaders postpone vote on their health-care plan

By Mike DeBonis, Juliet Eilperin and David Weigel
March 23 at 3:37 PM - The Washington Post

House leaders postponed a vote Thursday on their plan to overhaul the nation’s health-care system, as they and President Trump struggled to meet demands of conservative lawmakers who said they could not support the bill.

House Republicans planned to meet behind closed doors later Thursday to figure out their next steps. Leaders have told the rank and file to be available Friday in the event a vote can be scheduled then.

White House Deputy Press Secretary Sarah Huckabee Sanders confirmed the delay but said that she expected debate on the bill to begin Thursday night, with the expectation of a vote early Friday.

“We’re very confident that the bill will pass tomorrow morning,” she said.

Earlier Thursday, conservative House Republicans had rebuffed an offer by Trump on Thursday to strip a key set of mandates from the nation’s current health-care law, raising doubts about whether House Speaker Paul D. Ryan (R-Wis.) had the votes.

Trump met at the White House with the most conservative House Republicans, hoping to close a deal that would help ensure passage of the party’s health-care plan by shifting it even further to the right. But the session ended with no clear resolution, and some lawmakers said they needed more concessions before they would back the bill.

Rep. Justin Amash (R-Mich.), asked whether the White House had made its final negotiating offer, said that if that’s the case, “They’re not going to pass the bill.”

Talks continued, however, and White House press secretary Sean Spicer said he still anticipated a vote on the measure by day’s end. Asked whether there was an alternative plan to the current bill, Spicer replied: “No. it’s going to pass. So that’s it.”

The chairman of the conservative Freedom Caucus, Rep. Mark Meadows (R-N.C.), also said that resolution could “possibly” be resolved Thursday. His spokesman, Ben Williamson, later tweeted that Meadows “remains hopeful and will continue working” to reach a deal.

That appears to have changed, according to several lawmakers who confirmed the delay.

The session came after more than a day of almost nonstop negotiations, as Trump and Ryan have worked to mollify members of the conservative House Freedom Caucus while simultaneously trying to minimize defections by GOP moderates.

As of midafternoon Thursday, 37 House Republicans — mainly Freedom Caucus members — had announced their opposition to the bill, known as the American Health Care Act.

Trump will also meet Thursday with members of the moderate “Tuesday Group,” Spicer said. On Wednesday, four Republican moderates — Reps. Charlie Dent (Pa.), Frank A. LoBiondo (N.J.), Daniel Donovan (N.Y.) and David Young (Iowa) — announced their opposition, increasing pressure on leaders to win over conservatives.

GOP leaders appeared to be making some headway in bringing the measure to the floor for a vote Thursday. The price for doing so, however, may be striking popular provisions in former president Barack Obama’s Affordable Care Act that could make it even more difficult to pass legislation in the Senate. 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. Conservative lawmakers have asked to eliminate much of the measure’s Title I, which not only mandates which benefits participating insurers must cover — such as mental health treatment, wellness visits, and maternity and newborn care — but also bars companies from setting insurance rates based on a person’s sex, medical condition, genetic condition or other factors.

The only existing mandates conservatives 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.

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.

White House officials expressed optimism Thursday that a deal remained within reach. Cliff Sims, director of White House message strategy, tweeted a photo of the president walking in to meet with Freedom Caucus members, along with the line, “Lengthy standing ovation from the Freedom Caucus when @POTUS walked into the Cabinet Room just now. Big momentum toward #RepealAndReplace.”

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.

The flurry of activity Thursday represented a profound shift from GOP leaders’ previous strategy, under which they insisted that the changes sought by hard-right members would render the bill unable to pass the Senate.

Thursday is the seventh anniversary of the Affordable Care Act, and Republican leaders are eager to mark it with a historic vote demonstrating that its evisceration has begun. In a sign of how high the stakes are for both parties, Obama issued a statement noting that more than 20 million Americans have gained coverage since he signed the law, while the rise in health-care costs has slowed.

“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.”

House Democrats have urged their GOP counterparts to slow down. Just before 11:35 p.m. Wednesday, the House Rules Committee voted along party lines to waive a rule prohibiting the panel from forwarding a bill to the floor for same-day consideration. The move, colloquially known as “martial law” in the House, will allow GOP leaders to make further changes to the legislation and still hold a final vote Thursday.

Democrats questioned why lawmakers would move it to the floor when the Congressional Budget Office had not issued a new analysis of the bill. The additional effects on coverage and federal spending of the provisions still being negotiated Wednesday were also unknowns.

“You’re going to own this, just like we owned the Affordable Care Act,” Rep. Alcee L. Hastings (D-Fla.) warned shortly before the panel adjourned for the night. “You’ll rue the day that you did it this way.”

Republicans’ current strategy is based on a new interpretation of Senate rules had raised the possibility that acceding to the Freedom Caucus’s 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 E. Schumer (D-N.Y.).

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.

An additional potential hurdle facing the bill is the updated analysis still to come from the Congressional Budget Office, which will reflect changes to the measure that were issued Monday. That analysis could be rendered inaccurate if further changes are made before the vote.

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.

Paul Kane, Abby Phillip, Lisa Rein, Kelsey Snell and John Wagner contributed to this report.