Obamacare repeal in jeopardy as Trump offers 11th-hour concessions

'Everybody's frustrated,' says one lawmaker.
From: Politico

The Republican plan to replace Obamacare — backed vehemently by President Donald Trump and House Speaker Paul Ryan — continued to bleed support from moderate House members Thursday morning just hours before an expected vote.

An effort to woo conservatives, hatched late Wednesday, appeared to backfire with other factions in the House Republican Conference, and the growing rebellion threatens to derail Trump's guarantee that he will repeal and replace the seven-year-old health care law.

“After careful deliberation, I cannot support the bill and will oppose it,” Rep. Charlie Dent (R-Pa.) announced after he joined moderates for a two-hour meeting with Ryan and House leaders late Wednesday. “I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”

Defections continued Thursday, as Rep. Jaime Herrera Beutler (R-Wash.) declared her own opposition to the bill, the American Health Care Act.

The fate of the bill appeared to hinge on a White House meeting Thursday between Trump and members of the hard-line conservative House Freedom Caucus, a bloc of about three dozen Republicans who have long threatened to tank the bill because of what they say are inadequate measures to repeal Obamacare and reduce health care premiums for constituents.

"If this goes down, we're all screwed," said one Republican lawmaker who requested anonymity.

The meeting appeared to be a last-ditch bid to win the support of conservatives, who failed to commit support for the bill despite winning a crucial concession a day earlier. Bowing to pressure from the Freedom Caucus, the White House pressed House leaders to gut minimum health insurance requirements imposed by Obamacare, a key demand of the GOP's right flank. But Freedom Caucus members demanded additional changes. They want to cut even more Obamacare regulations, including its popular provision requiring insurers to offer coverage for people with pre-existing conditions.

One senior House Republican lamented that House leaders had essentially ceded final negotiations on the health care bill to the White House.

"Every single part of this is being negotiated at the White House," said Rep. Pete Sessions of Texas. He added, "the White House — they’re the ones that know the art of the deal. I don’t yet. So I’m counting on them to put it together.”

Even if Trump can persuade most Freedom Caucus members to reverse course and back the bill, it's still in danger of failing. More than a dozen Republican House members outside the Freedom Caucus have taken positions against the bill. Because they expect no Democrats to back their measure, House leaders can afford to lose only 22 of their 237 members and still pass the bill.

Moderates were infuriated that the Freedom Caucus would not guarantee its support for the bill despite winning concessions, causing them to reconsider their own position.

“Obviously the Freedom Caucus has presented what it will take for them to get some yeses, and I think there are now members who will have to now evaluate things a little bit further,” said Rep. Ryan Costello (R-Pa.) after exiting the meeting in Ryan's office.

A Thursday morning meeting of the full 237-member House Republican Conference was canceled at the last minute as members awaiting the outcome of a final meeting between the Freedom Caucus and Trump. The fate of the whole effort could hinge on Trump's ability to clinch an agreement with these hard-line members.

In the marathon meeting with moderates Wednesday, Ryan laid out the changes to the bill that the White House negotiated with the Freedom Caucus. A source in the room said many attendees found the concessions to the right-wing caucus hard to swallow, especially because leadership told them Freedom Caucus members hadn’t yet promised to support the measure — even if they won the changes.

Moderates said they need to learn more about what the White House proposal would mean for their constituents and providers they represent. Many expressed worry that the leadership would force swing-district members to take a risky vote when the Senate would likely strip out the provision anyway because it might run afoul of the Senate's arcane rules.

And some moderates were especially aghast that leadership couldn’t tell them how many votes this proposal would win them from the Freedom Caucus.

“Everybody’s frustrated,” said one lawmaker in the meeting. “Some moved; some stayed the same.”

When asked whether by “moved” he meant away from the bill, the source added: "Nobody goes closer to the bill on that one.”

Among the attendees: Ryan, Majority Leader Kevin McCarthy (R-Calif.), Majority Whip Steve Scalise (R-La.), Chief Deputy Majority Whip Patrick McHenry (R-N.C.) and Conference Chairwoman Cathy McMorris Rodgers (R-Wash.).

Centrist and Tuesday Group attendees included Will Hurd (R-Texas), Elise Stefanik (R-N.Y.) Bill Johnson (R-Ohio), Adam Kinzinger (R-Ill.), Susan Brooks (R-Ind.), Rodney Frelinghuysen (R-N.J.), Charlie Dent (R-Pa.), Ryan Costello (R-Pa.), Martha McSally (R-Ariz.), Bruce Poliquin (R-Maine), David Joyce (R-Ohio), Carlos Curbelo (R-Fla.) and Pat Tiberi (R-Ohio).

Trump and Ryan allies spent all day Wednesday attempting to build a fragile coalition in support of their proposal, and they appeared, at times, to be making inroads. House leaders, who still say they will bring the bill up for a vote Thursday, expressed optimism that they can still cobble together support to pass the bill. They’re hoping for another boost from Trump, who is expected to meet one-on-one with a slew of GOP holdouts throughout the day. He met with the Freedom Caucus on Thursday morning.

After a day of ferrying between the Capitol and the White House, conservatives secured a commitment from House leaders to consider a proposal that would eliminate Obamacare’s “essential health benefits” — a set of regulations that requires insurers to cover a broad array of benefits. Conservatives have argued that these requirements drove up the cost of health insurance and restricted consumer choice.

Yet after House leaders signaled they were open to that measure, Freedom Caucus members pushed for even more: a repeal of all the Obamacare regulations, including protections for people with pre-existing conditions — a nonstarter with most Republican lawmakers.

Even before the blow-up over the concession to conservatives, moderate GOP members began peeling off.

Reps. Frank LoBiondo and Chris Smith of New Jersey both announced their opposition to the bill. So did Reps. Dan Donovan of New York and David Young of Iowa.

Sessions, who chairs the Rules Committee — the panel charged with making the final negotiated changes to the health care bill before it comes to the floor — said he's not sure whether Republicans are committing the same sins they accused Democrats of in 2010: making last-minute changes to get their health care plan through.

“My sin-level at this point is probably not something I’ve thought about. Getting this done to where we deliver a good product is where I am," Sessions said.

But he added: "The sins of how you get there, how fast you are, do matter. It does matter that the public knows what we’re doing. The public needs to see and have confidence what we’re doing. I have to assure myself that that’s the right thing also. I’m not going to fall victim to just doing something to do it. You need to do it openly and fairly and honestly. But we need to do it when we’ve got a deal, not when we don’t have a deal.”