Less than 48 hours ahead of Thursday’s House floor vote on the GOP bill to repeal the Affordable Care Act, some Republican lawmakers were openly worrying about what would happen if the bill goes down in flames.
“It will really make us look bad in the eyes of the public, and this unity we have now—the House, Senate, and presidency—could be hurt in 2018,” warned a still-undecided Rep. Peter King (R-NY) following a meeting with President Trump in the basement of the Capitol Tuesday morning. “It’s bad for the whole Republican agenda if we can’t make it on this one. It’ll hurt us on everything going forward. It makes us look like we can’t get our act together.”
King and other lawmakers said Trump made an even more direct warning in the meeting, telling House members that they would be “ripe for a primary” challenge in 2018 if they did not fall in line and back the bill. The Trump administration and GOP leadership offered carrots as well as sticks to wavering and dissenting members, unveiling a package of amendments Monday night designed to assuage the concerns of both moderates and conservatives.
Still, the gambit may fail. Several Republicans publicly declared their opposition to the bill even after Trump’s sales pitch, and members of the hardline Freedom Caucus say they have the votes to bring the repeal effort to a screeching halt.
Leading up to what is likely a nail-biter of a House vote on Thursday, many Republicans expressed concern about the potential fallout of failing to pass a health care bill while in control of both chambers of Congress.
“We know we have a historic opportunity to get stuff done, and we can’t blow it,” Rep. Blake Farenthold (R-TX), who supports the bill, told reporters. “I’d hate to go back home to Texas and say I had the opportunity to repeal Obamacare and I didn’t.”
Others worried for the fate of their party as well as their own careers.
“If we’re not successful in delivering on what we said we would do, we could lose the majority,” fretted Rep. Gary Palmer (R-AL), who was initially opposed to the bill but has come around to support it.
The combination of pressure from the White House and congressional leaders and the introduction of amendments aimed at pleasing both ends of the ideological spectrum—Medicaid work requirements for conservatives and more generous tax credits for moderates—has been somewhat successful in eroding the opposition. Several former critics of the bill, like Palmer, have flipped.
Still, Freedom Caucus chair Mark Meadows (R-NC), a leading critic of the bill, is hanging tough in his opposition. After meeting with Vice President Mike Pence Tuesday afternoon, Meadows told C-SPAN he and dozens of others remain unmoved.
Rep. Mark Meadows (R-NC), second from left, speaks about health care during a March 7 news conference on Capitol Hill.
“He understands how desperately the members of the Freedom Caucus and especially myself want to get to a yes,” Meadows said of President Trump. “But at the same time, our primary objective remains unchanged, and that is lowering premiums. Until we can be convinced that it will do that, we are still a no.”
Meadows and other members of the Freedom Caucus claim they have the votes to kill the bill, unless efforts are made to repeal Obamacare’s 10 Essential Health Benefits mandate, which dictates what basic services insurance plans must cover. The current GOP bill maintains this rule, though the Trump administration has promised to make changes to it in a future “phase” of their health care overhaul.
Administration efforts to woo right-wing dissenters on the Senate side have been similarly unsuccessful. Trump hosted six Republican senators at the White House on Monday to persuade them to support the bill. On Tuesday, two of those lawmakers broadcast on social media that their minds remained unchanged.
— Mike Lee (@SenMikeLee) March 21, 2017
Despite the proposed amendments, I still cannot support the House health-care bill, nor would it pass the Senate. https://t.co/agIcxONXao
— Tom Cotton (@SenTomCotton) March 21, 2017
Others present at that White House meeting did not give a firm no, but said their concerns have not yet been fully addressed.
Sen. Bill Cassidy (R-LA), when asked for his thoughts on the proposed Medicaid changes, said: “It begins to help a little bit, but I don’t know if it’s adequate. I just don’t know: Is it a Band Aid or does it really accomplish something?”
Sen. James Lankford (R-OK) was similarly skeptical of the changes unveiled Monday night: “They’ve altered the bill but not improved it,” he told reporters.
Another factor adding to the anxiety gripping Capitol Hill ahead of the vote is the uncertainty around when the Congressional Budget Office will issue a report on the impact of the proposed changes to the revised health care bill and what that report will contain. It’s not clear how much the revisions to the bill will change the CBO’s projections of its cost, of its effect on premiums or of how many people will lose coverage.
The CBO’s report on the original bill was brutal, laying out how the legislation would sharply raise health insurance premiums for older Americans and cause a whopping 24 million people to lose their coverage altogether. The only good news for Republicans in the original CBO report—a projection that the bill would reduce the federal deficit by more than $300 billion dollars, mainly by gutting Medicaid—is likely to be eroded by the revisions to the bill, which boost federal spending on both tax credits and Medicaid reimbursements.
A new analysis from the New York Times released Tuesday painted an even grimmer picture: The GOP plan would cause more people to be uninsured than simply a straight repeal of the Affordable Care Act would.
Adding to the pressure ahead of the votes are demands from powerful conservative groups—including Heritage Action, Club for Growth, and Americans for Prosperity—that lawmakers oppose the bill. And congressional offices continue to receive a flood of phone calls from constituents concerned about the impact of the bill on their families.
Sen. Shelley Moore Capito (R-WV) told TPM she has received an earful from her constituents over the past couple weeks. “They’re concerned about the possibility of losing coverage,” she said. “And I’m concerned about that, too.”
Still, the Senate’s Republican leadership is plowing ahead, operating on the assumption that the bill will pass the House on Thursday and land in their laps next week. Against the protests of many Democrats and a few Republicans, Senate Majority Leader Mitch McConnell (R-KY) suggested Tuesday that he plans to bring the bill straight to the Senate floor without holding any hearings.
“We are in a reconciliation context,” he said, referencing the special Senate rule for budget bills that eliminate the possibility of a Democratic filibuster. “There’s a time limit to it, and it comes to an end. This is not a bill that we have to file cloture on, wait two days, and all the rest.”
Asked about the continued dissent within his own party on the legislation, McConnell echoing his counterparts’ message in the House, telling reporters that passing the bill is “a pretty strong obligation to the American people.”
“We have an obligation to the American people to do what we called for in ’10, ’12, ’14 and ’16,” he said. “[We said] if we had the opportunity, if the American people gave us a president who will sign a repeal and replace bill, we would do it.”
Sen. Orrin Hatch (R-UT) had his own take the prospect of the bill’s failure: “It might embolden the Democrats if they can win on this issue,” he told reporters. “We gotta make sure they don’t win on it.”