By
David Weigel, Kelsey Snell and Robert Costa
March
21, 2017
President Trump
stormed Capitol Hill on Tuesday to sell the House Republican leadership’s plan
to overhaul the health-care system, warning his party that not passing the
legislation would yield a political crisis and sweeping electoral defeats.
The president
addressed a closed-door meeting of House Republicans days before the measure is
expected to come to a vote on the House floor.
Trump used both
charm and admonishment as he made his case, reassuring skittish members that
they would gain seats in Congress if the bill passed — and singling out Rep.
Mark Meadows (R-N.C.), the chairman of the hard-line House Freedom Caucus, in
front of colleagues.
“I’m gonna come
after you, but I know I won’t have to, because I know you’ll vote ‘yes,’ ”
Trump said, according to several Republican lawmakers who attended the meeting.
“Honestly, a loss is not acceptable, folks.”
For Trump, who talked up the House
bill the previous evening at a raucous rally in Kentucky, the presentation was
the latest example of his mounting urgency to secure a major legislative
victory in the early months of his presidency and repeal the signature law of
President Barack Obama.
“That’s just the demeanor of this
president. He wants to get this bill done,” said Sen. David Perdue (R-Ga.), a
Trump ally. “I don’t hear that as a threat. It’s a statement of reality.”
“Read ‘The Art of the Deal,’ ”
Perdue said, referring to Trump’s book, when asked whether Trump thinks keeping
members on edge is effective.
But Trump’s ability to translate
his negotiation skills from the business world to the congressional realm — and
to rouse his party behind him — remained unclear by late Tuesday as Meadows and
other Republicans stayed firmly on the fence.
After the meeting, Meadows told
reporters that the president had not closed the sale, describing the call-out
as merely good-natured and insisting that conservative holdouts will continue
to press for a tougher package.
“I’m still a ‘no,’ ” Meadows
said. “I’ve had no indication that any of my Freedom Caucus colleagues have
switched their votes.” The group has about 30 members.
Meadows said he didn’t take Trump’s
remarks that he would “come after” him too seriously: “I didn’t take anything
he said as threatening anybody’s political future.”
Said Rep. Harold Rogers (R-Ky.), a
supporter of the bill: “Oh, he was kidding around. I think.”
White House press secretary Sean
Spicer said later in the day: “Mark Meadows is a long-time, early-supporter of
the president. He had some fun at his expense this morning during the
conference meeting.”
Asked whether Trump believed that
Republicans who opposed the bill would be damaged at the ballot box, Spicer
answered: “I think they’ll probably pay a price at home.”
Spicer explained that statement was
not a threat but “a political reality.”
Trump, who when angered has turned
on Republicans on numerous occasions in the past, is putting his considerable
political weight behind a proposal crafted by House Speaker Paul D. Ryan
(R-Wis.) that would represent a powerful if symbolic achievement for the
president and the speaker if the House approves it. Even if it passed, the
legislation would face an uphill battle in the Senate.
No Democrats are expected to
support the legislation, meaning Republican leaders can afford to lose no more
than 21 Republicans on the House floor. The House Rules Committee is slated to
meet at 10a.m.
“We made a promise and now it is
the time to keep that promise,” Ryan said. “If we keep that promise, the people
will reward us. If we don’t keep our promise, it will be very hard to manage
this.”
Ryan minimized the chance that
Freedom Caucus members could band together to bring down the measure and said
that conservatives should be pleased that many of their demands would likely be
in the legislation — such as limiting the expansion of Medicaid and including
work requirements for those who receive coverage from the program for the poorest
Americans.
Ryan said conservatives will
eventually realize that pushing for more extensive changes, such as ending
payments to states that accepted the Medicaid expansion, could jeopardize the
legislation’s chances in the Senate.
“If you get 85 percent of what you
want, that’s pretty darn good,” he said. “We don’t want to put something in
this bill that the Senate is telling us is fatal.”
Senate Majority Leader Mitch
McConnell (R-Ky.) took a cautiously optimistic tone Tuesday. He confidently
promised that the Senate would forge ahead with plans for votes on the health-
care legislation but left the immediate success of the venture in the hands of
House leaders.
“If the House passes something, I
will bring it up,” McConnell said. “We’ll try to move it across the floor next
week.”
McConnell also cautiously avoided
confronting mounting criticism of the bill from within Senate GOP ranks. He
instead dismissed the concerns as a natural part of the legislative process and
assured reporters that he would consider the legislation quickly to clear the
way for a vote on Supreme Court nominee Neil Gorsuch.
“We will reach a conclusion on
health care next week,” McConnell said. “Because we’re going to judge Gorsuch
the week after that.”
On Tuesday afternoon, several
Republican senators — including those from states that expanded Medicaid under
the Affordable Care Act — expressed reservations about the House bill and said
it would need to change significantly to win their support.
Sen. John Boozman (Ark.) said he
wasn’t sure what the House bill will ultimately contain.
“I don’t really know what the
American Health Care Act consists of right now. It’s constantly changing,” he
said.
“Arkansas and its governor would
very much like to keep the [Medicaid] expansion,” Boozman said. “So I think at
the end of the day, there will be some compromise.”
Sen. Tom Cotton, Boozman’s fellow
Arkansan, also said Tuesday that he “still cannot support” the House bill.
Sen. Lisa Murkowski (Alaska)
expressed reservations about the Medicaid revisions, saying she wants the
bill’s backers to “show me” how the legislation would be fair to her state.
Unlike some lawmakers such as Sen.
Ted Cruz (R-Tex.) — who recently visited Trump’s Mar-a-Lago resort in Palm
Beach, Fla., to talk health care with the president — Murkowksi said she hasn’t
been similarly wooed.
“I have not gone to Mar-a-Lago,”
she said, chuckling. “I did go to the White House last week — no, two weeks ago
— to talk about energy.”
Perdue said Trump was engaged in
selling the House bill to senators.
“A few votes get to be more
critical here,” he said. “He’s been having dinners. . . . He’s listening and trying to
probe what it will take to get this bill done and how to fix it right.”
Sen. Rand Paul (R-Ky.), who has
pressed Trump to abandon the bill, insisted that the legislation is fading in
the House.
“There are enough conservative
votes for it not to pass in its current form,” he said. “Negotiation begins in
real earnest in the next 24 hours or so once they discover they don’t have the
votes. My count is there are more than enough votes to stop the Ryan plan.”
Some GOP governors also have
weighed in.
In a letter Tuesday to every member
of Michigan’s congressional delegation, Gov. Rick Snyder (R) warned that the
House GOP bill “shifts significant financial risk and cost from the federal
government to states without providing sufficient flexibility to manage this
additional responsibility.” Individual letters were sent to each House member
detailing how many residents in their districts depend on both traditional
Medicaid and the expanded Medicaid program created by the Affordable Care Act.
The House vote is expected to be
narrow after a Congressional Budget Office study found that 14 million fewer
people would have insurance by 2018 under the GOP proposal.
Trump arrived on the Hill to
address the private meeting of House Republicans shortly after 9 a.m.
Tuesday, bringing with him many of his top White House aides. They included
senior adviser Stephen K. Bannon, Chief of Staff Reince Priebus and senior
policy adviser Steven Miller.
After the meeting, Trump was
confident that the legislation will pass the House.
“We’re going to have a real
winner,” he told reporters. “There are going to be adjustments but I think
we’ll get the vote on Thursday.”
Inside the room, however, Trump did
not get into much detail about what needed to be adjusted for the bill to win
approval. He focused more on the political risks and rewards of passage,
telling Republicans that they “kept passing and passing and passing” repeal
bills under President Obama and would be punished if they did not make good on
their campaign promises.
“We won’t have these crowds if we
don’t get this done,” he said, referring to his Monday night rally in Kentucky.
“If we get this done, and tax
reform, he believes we pick up 10 seats in the Senate and we add to our
majority in the House,” said Rep. Chris Collins (R-N.Y.), the first member of
Congress who endorsed Trump’s presidential bid. “If we don’t get it done, we lose
the House and the Senate.”
The president’s sales push comes
after Ryan and other House leaders released key proposed changes to the
legislation on Tuesday night that they hope will help secure the bill’s
passage.
The tweaks addressed numerous GOP
concerns, including the flexibility the package would give states to administer
their Medicaid programs and the amount of aid it would offer older Americans to
buy insurance. The changes are the product of two weeks of negotiations that
stretched from the Capitol to the White House to Trump’s Florida resort.
The bill’s proponents also appeared
to overcome a major obstacle Monday after a key group of hard-line
conservatives declined to take a formal position against the bill, known as the
American Health Care Act.
The House Freedom Caucus has
threatened for weeks to tank the legislation, arguing that it would not do
enough to undo the seven-year-old Affordable Care Act. Their neutrality gives
the legislation a better chance of passage: If the group of about three dozen
hard-right GOP members uniformly opposed the bill, it could block its passage.
Their decision not to act as a bloc
frees House leaders and White House officials to persuade individual Freedom
Caucus members to support the measure — a process that Meadows, the caucus
chairman, said is underway.
“They’re already whipping with a
whip that’s about 10 feet long and five feet wide,” he said Monday. “I’m trying
to let my members vote the way that their constituents would want them to vote.
. . . I think they’re all very aware of
the political advantages and disadvantages.”
Some of the changes announced
Monday were made to placate conservatives, such as accelerating the expiration
of the ACA’s taxes and further restricting the federal Medicaid program. But a
major push was made to win moderate voters, including a maneuver that House
leaders said would allow the Senate to beef up tax credits for older Americans
whose premiums could increase greatly under the GOP plan.
There were signs Monday that the
bill had growing support among the moderate wing of the House GOP. Rep. Tom
MacArthur (N.J.), who had voted against the leadership in an early procedural
vote on the health-care legislation, said that he was “satisfied enough that I
will support the bill.”
MacArthur said he was assured that
the measure would do more for older and disabled Americans covered under
Medicaid and that an additional $85 billion in aid would be directed to
those ages 50 to 65.
“That’s a $150 billion change
in this bill to help the poor and those who are up in years,” he said.
MacArthur told reporters Tuesday
that he is satisfied with the way the House amendment is structured and that he
trusts that the Senate will further refine the legislation. He also said he is
confident that the new changes will be enough to sway many of the approximately
50 members of the Tuesday Group, which he co-chairs.
“I believe the majority will vote
for the bill,” MacArthur said after the meeting with Trump.
Several House Republicans from
Upstate New York won an amendment that would allow counties in their state to
keep hundreds of millions of dollars of local tax revenue that they forward to
the state government to fund its Medicaid program. One member, Rep. Claudia
Tenney, told the Syracuse Post-Standard on Monday that her support of the bill
was conditioned on the amendment’s inclusion.
The Freedom Caucus had pushed for a
variety of alterations, including an earlier phaseout of the ACA’s Medicaid
expansion and a more thorough rollback of the insurance mandates established
under the law.
But for political and procedural
reasons, few of the group’s major demands stand to be incorporated into the
bill.
“It’s very clear that the
negotiations are over,” said Meadows, who met with White House officials at Mar-a-Lago
on Saturday.
Many Freedom Caucus members left
Tuesday’s meeting resolved to continue to oppose the bill.
“The president always does a good
job in these settings,” said Rep. Jim Jordan (R-Ohio), a co-founder of the
caucus. “But the legislation is still bad, and doesn’t do what we told voters
we would do.”
Under the group’s rules, it can
take a formal position to oppose the bill if 80 percent of its members
agree.
Meadows said after Monday night’s
meeting that taking a hard position against the bill “creates some dynamics
within the group that perhaps we don’t want to create,” hinting at tensions in
the group’s ranks.
One of its members, Rep. Gary
Palmer (R-Ala.), provided one of just three votes against the AHCA in the
budget committee. But he decided to support the bill last week when he met with
Trump in the Oval Office, emboldening House leaders who think that even
hard-liners will be hard-pressed to oppose Trump.
Said Meadows: “This is a defining
moment for our nation, but it’s also a defining moment for the Freedom Caucus.
There are core things within this bill as it currently stands that would
violate some of the principles of the Freedom Caucus.”
Attending the group’s meeting
Monday were three senators who oppose the House bill: Ted Cruz (R-Tex.), Mike
Lee (R-Utah) and Rand Paul (R-Ky.). They can block the bill in their chamber,
where Republicans hold a two-seat majority. Cruz said he told the House members
that the leadership strategy of pursuing distinct “phases” of legislation was a
dead end and that they need to push for changes in the present bill.
“The Senate Democrats are engaging
in absolute opposition and obstruction, and it is difficult to see that
changing anytime soon,” Cruz told reporters after leaving the meeting.
Trump’s visit Tuesday was his first
appearance at the weekly House Republican Conference meeting since he became
president. He last privately addressed Republican lawmakers as a group at the
party’s policy retreat in Philadelphia in late January and has met with small
groups of members on several occasions since.
Trump won the backing of Palmer and
several other conservatives Friday when he agreed to change the Medicaid
portion of the bill, including giving states the option to institute a work
requirement for childless, able-bodied adults who receive the benefit. Those
changes were included in the leadership-backed amendments that will be
incorporated into the bill before it comes to a final vote.
To address concerns expressed by a
broader swath of GOP lawmakers — conservatives and moderates alike — leaders
said they hoped to change the bill to give older Americans more help to buy
insurance.
House leaders said they intended to
provide an additional $85 billion in aid to those ages 50 to 64, but the
amendment announced late Monday did not do so directly. Instead, the leaders
said, it “provides the Senate flexibility to potentially enhance the tax
credit” for the older cohort by adjusting an unrelated tax deduction.
That workaround, aides said, was
done to ensure that the House bill would comply with Senate budget rules and to
ensure that the CBO could release an updated analysis of the legislation before
the Thursday vote.
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