Republicans are careening toward a House vote on repealing and replacing Obamacare in a moment that has huge implications for Donald Trump’s presidency and the GOP’s hopes of enacting an agenda that will change the face of American life.
House Speaker Paul Ryan went to the White House shortly after noon to brief Trump on the bill.
The vote, delayed to give Republican leaders a chance to eke out a majority for the bill, will go ahead following Trump’s huge gamble in warning he would walk away from health care reform if the GOP did not follow his desires.
The outcome of the vote is still unclear, and hinges on two questions. Will ultra-conservative Freedom Caucus members overcome their ideological objections to a bill they say does not go far enough in the wider cause of Republican unity?
And will moderate Republicans, worried a conservative bill will endanger their re-election chances, flee en masse?
The White House is effectively giving the Freedom Caucus a choice — vote for a bill they believe amounts to ‘Obamacare Lite’ or explain to their constituents why they killed a Republican crusade to repeal a law universally despised by Republicans.
A final vote is expected around 4 p.m.
GOP House Majority leader Kevin McCarthy said Friday he was “feeling good” about the prospects for the legislation. Asked whether the votes were there to pass the bill, he said, “Yeah. We’re going to get it done today. “
Though he said he’s done negotiating, Trump lobbied for a yes vote on Twitter on Friday morning.
“Disastrous #Obamacare has led to higher costs & fewer options. It will only continue to get worse! We must #RepealANDReplace. #PassTheBill.”
Trump is making last minute calls to members this morning and is “determined” to pass the bill, a senior administration official said.
A second senior administration official said there was “some movement” on Friday in support, but added: “I think the question is, is it enough?”
Ryan needs to get a simple majority in the House — around 216 votes depending on how many members show up to vote. He can probably afford to lose no more than 21 Republican votes.
There were also signs of frustration in the White House at the House Freedom Caucus, which has won a series of concession but is still holding out against the bill.
“We’ve emboldened them,” one White House aide said.
Freedom Caucus Chairman Mark Meadows, R-North Carolina, was mum about his plans. “I’m not making any comment,” he said.
The President is said to be “agitated” by the process, an aide said, which he thinks is all “political.”
There were also whispers against Ryan, suggesting that if the bill fails it will inflict a series blow to the relationship between the speaker and the President which will be vital to moving forward the Republican agenda.
Asked in the Oval Office by reporters what he would do if the bill goes down, Trump said “we will see what happens.”
Will moderates flee?
Rep. Leonard Lance, R-New Jersey, said that without a doubt, the decision to concede the repeal of essential health benefits to the Freedom Caucus definitely moved some of his colleagues to “no.”
“I suspect some became a no because of that,” Lance said. “That certainly didn’t help.”
The northeast Republicans are the ones to watch, he said.
“New York, New Jersey, Pennsylvania — that’s where you should count heads.”
What’s in the bill
The GOP health care bill would eliminate many of the taxes and eradicate the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan provides Americans with refundable tax credits based mainly on age to purchase health insurance.
The bill also significantly curtails federal support for Medicaid and allows states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults like they did under Obamacare, and states that haven’t expanded would be immediately barred from doing so.
However, the GOP bill doesn’t touch some of the most popular pieces of Obamacare, including letting children stay on their parents’ insurance plans until the age of 26 and including protections for people with pre-existing conditions. But it would end the requirement that insurers offer comprehensive policies that cover maternity, drugs, mental health and substance abuse.