President Trump went to Capitol Hill on Tuesday morning to sell the House GOP leadership’s plan to overhaul the health-care system as the legislation races toward an expected vote on the House floor by the end of the week. Assuring Republicans that they would gain seats if they passed the bill, the president told Rep. Mark Meadows (R-N.C.), the chairman of the House Freedom Caucus, to stand up and take some advice.
“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.”
But after the meeting, Meadows told reporters that the president had not made the sale, that the call-out was good-natured and that conservative holdouts would continue to press for a tougher bill.
“I’m still a ‘no,’ ” he said. “I’ve had no indication that any of my Freedom Caucus colleagues have switched their votes.”
Trump is putting his considerable weight behind a proposal crafted by House Speaker Paul D. Ryan (R-Wis.) that would represent a big win for the president and the speaker if the House approves it.
“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 played down the chance that Freedom Caucus members could band together to bring down the measure. He insisted that conservatives should be happy that many of their demands, such as limiting the expansion of Medicaid and including work requirements for those who do receive coverage from the program for the poorest Americans, were part of his legislation. Ryan insisted that conservatives will realize that pushing for more significant changes, such as ending payments to states that accepted the Medicaid expansion, could jeopardize the legislation’s chances of passing in the Senate.
“If you get 85 percent of what you want, that’s pretty darn good,” Ryan said. “We don’t want to put something in this bill that the Senate is telling us is fatal.”
But the House vote is still expected to be narrow, and the package faces skepticism from conservatives and moderates in the Senate 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 a 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 Steven K. Bannon, Chief of Staff Reince Priebus and senior policy adviser Stephen Miller.
After the meeting, he predicted that the legislation will pass the House.
“We’re gonna 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.
Opponents of the measure — Republicans and Democrats alike — called the deal a sordid giveaway on social media networks Monday night. Many compared it to the state-specific deals that were cut to pass the Affordable Care Act in 2009 and 2010 and panned by Republicans — such as the Medicaid reimbursement boost that then-Sen. Ben Nelson (D-Neb.) secured for his home state that Republicans mocked as the “Cornhusker Kickback.”
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 Trump’s Mar-a-Lago resort in Palm Beach, Fla., 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. No Democrats are expected to support the legislation, meaning Republican leaders can afford to lose no more than 21 of their members.
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 hold leverage to 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 to the Hill on Tuesday signals that GOP leaders and the president consider bigger talks with key blocs of House members to be essentially complete. The effort now turns toward persuading individual members to vote for the package.
Ryan credited Trump’s backing in a statement Monday: “With the president’s leadership and support for this historic legislation, we are now one step closer to keeping our promise to the American people and ending the Obamacare nightmare.”
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 conservative House members 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.
In an extreme case laid out in the Congressional Budget Office analysis of the bill, annual premiums for a 64-year-old earning $26,500 a year would rise from $1,700 under the ACA to $14,600 under the Republican plan.
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.
But it also means that the House members who pushed for the new aid will have to trust the Senate to carry out their wishes. And neither Meadows nor the Republicans marching in line behind Ryan took the president’s comments about the holdouts as a threat.
“I didn’t take anything he said as threatening anybody’s political future,” Meadows said.
“Oh, he was kidding around,” said Rep. Harold Rodgers (R-Ky.), a supporter of the bill. “I think.”
We Have a Fake President!