Maybe rumors of the American Health Care Act's death were exaggerated a bit. After House Speaker Paul Ryan (R-Wis.) pulled the bill on Friday because his broadly unpopular health-care overhaul plan didn't have enough Republican votes to pass, he called ObamaCare "the law of the land" for the visible future and the White House said it is ready to move on to tax reform and other issues. On Monday afternoon, however, Ryan told a group of donors that he will continue to push forward on health care "on two tracks," as the GOP pursues other parts of its agenda, according to The Washington Post, which obtained a copy of the call.
House Republicans have sent mixed messages as to whether they will try to tinker with the AHCA or start over, and Ryan did not divulge any details to his political operation's donors. But he said he plans to outline his plans to Republican donors at a retreat in Florida on Thursday and Friday. "When we're in Florida, I will lay out the path forward on health care and all the rest of the agenda," Ryan said. "I will explain how it all still works, and how we're still moving forward on health care with other ideas and plans.... It will be good to look at what can feasibly get done and where things currently stand. But know this: We are not giving up."
Ryan laid blame for the AHCA's defeat on members of the far-right House Freedom Caucus, not mentioning at least 25 other House GOP members who said they would vote no, too. He said he met with President Trump on Monday and separately with Vice President Mike Pence, Health and Human Services Secretary Tom Price, and White House Chief of Staff Reince Priebus, describing his relationship with the White House as closer than ever. "We're not going to just all of a sudden abandon health care and move on to the rest," he said. "It's just that valuable, that important." Ryan had counted on the AHCA tax cuts to allow him to cut taxes deeper and more permanently later in the year. Peter Weber
House Republicans plan to hold a vote on the American Health Care Act on Friday, probably in the late afternoon, and they are apparently still tinkering with the legislation. On Thursday night, President Trump sent White House budget director Mick Mulvaney to Capitol Hill with an ultimatum: He would agree to no more changes, the dealmaking is done, and House Republicans can take it or live with ObamaCare. House Freedom Caucus chairman Rep. Mark Meadows (R-N.C.) wasn't buying it. "Anytime you don't have 216 votes, negotiations are not totally over," he said.
So what will be in the final bill? House Republicans already started amending the original bill on Monday, agreeing to moderate-wooing sweetheart deals for upstate New York and Illinois, a quicker end to the Medicaid expansion, an option to let states require able-bodied Medicaid recipients to work in order to get benefits, $85 billion set aside to possibly help people 50 to 64 afford insurance, and other changes to win over holdouts.
The House Rules Committee is meeting Friday morning to discuss more amendments, notably one filed Thursday night by House Speaker Paul Ryan (R-Wis.). According to Catherine Reynolds at CBS News, the four-page amendment would scrap ObamaCare's 10 "essential health benefits" that every insurance plan must offer — a key demand of the Freedom Caucus — and let states decide what insurance companies have to cover for individual plans; add $15 billion more to a "stability fund" that will help states subsidize coverage for benefits dropped by insurers, most likely maternity care, substance abuse treatment, and mental health services; and delay the repeal of a 0.9 percent Medicare tax for wealthy Americans until 2023.
The heart of the bill remains — repealing the individual mandate that all adults have health care, scrapping subsidies that help most individual insurance buyers for less-generous tax credits, making significant cuts and changes to Medicaid, allowing insurers to charge older people more, pulling funding for Planned Parenthood, and repealing taxes on health companies. "In my district right now, there's a lot of misunderstanding about what it is we're doing, and once we get it done," Rep. Chris Collins (R-N.Y), one of Trump's biggest backers in the House, told MSNBC on Thursday, "then we can have the chance to really explain it." Peter Weber
Considering the grief and political attacks congressional Democrats have weathered over ObamaCare from their Republican colleagues for seven years, perhaps a little schadenfreude is to be expected now that Republicans are rushing headlong into the health-care buzzsaw. The Democrats on the House Ways and Means Committee seem to have taken the lead in rubbing it in on Thursday.
They started with a dig at the GOP disarray, using the old throwback Thursday hashtag to remind Republicans of the "UNITY" they had all the way back in November:
— Ways and Means Dems (@WaysMeansCmte) March 23, 2017
Then there was the alternative acrostic for American Health Care Act:
— Ways and Means Dems (@WaysMeansCmte) March 24, 2017
And what internet trolling session would be complete without animated GIFs?
— Ways and Means Dems (@WaysMeansCmte) March 23, 2017
— Ways and Means Dems (@WaysMeansCmte) March 24, 2017
The House Republicans wanted to repeal ObamaCare on the seventh anniversary of it being signed into law, and failed, even after trying to borrow tactics they ascribed to the Democrats. They may push through the latest version of the ACHA on Friday. But on Thursday, a little mockery seems fair. Peter Weber
Republicans say they still plan to put the American Health Care Act up for a vote on Thursday, even as the White House and House Republican leaders worked through the night to whip up enough votes to ensure passage. "There is no Plan B," White House Press Secretary Sean Spicer said Wednesday. "There's Plan A and Plan A. We're going to get this done."
Late Wednesday, the White House and the conservative House Freedom Caucus reportedly reached a deal to strike ObamaCare's requirement that insurance plans cover 10 "essential health benefits" — including hospitalization, maternity and newborn care, mental health, emergency services — and the Freedom Caucus will press their other demands in a meeting with President Trump on Thursday morning. They want to scrap at least some of ObamaCare's Title One provisions, which include prohibitions against denying coverage due to pre-existing conditions and annual or lifetime coverage limits. Even with the changes, many members of the caucus would not commit to voting yes on the bill.
After news of the Freedom Caucus deal spread, House GOP moderates met with House Speaker Paul Ryan and his leadership team and balked at the changes. The House moderates say they are concerned that the AHCA will cause people to lose health insurance and raise costs for the poor and elderly, and the fact that Freedom Caucus members wouldn't sign on even with the hard-to-swallow changes made them even worse. "Everybody's frustrated," one lawmaker in the meeting told Politico. "Some moved; some stayed the same.... Nobody goes closer to the bill on that one."
The changes demanded by House Freedom Caucus members aren't opposed by most Republicans, but they would make passage in the Senate, already facing long odds, even more difficult, as they could render the bill ineligible for the filibuster-proof "reconciliation" process. Mike DeBonis explains the situation at The Washington Post: "The White House and GOP congressional leaders have told the Freedom Caucus that meeting their demands would essentially kill the American Health Care Act before it is born, but the Freedom Caucus, egged on by several conservative Republican senators, refuses to believe that is the case." House Republicans can't lose more than 22 votes. Peter Weber
House Republican leaders say they plan to hold a floor vote on the American Health Care Act on Thursday, regardless of the outcome, despite conceding late Tuesday that they currently lack the votes. With all Democrats opposed, Republicans can lose 21 votes and still push the ObamaCare replacement through, but according to The Hill's tally and House Freedom Caucus leaders, there are at least 22 firm no votes, plus six more House Republicans leaning toward voting against the legislation; The New York Times, citing a GOP aide, says as many as 36 Republicans are opposed to the bill or not yet swayed in its favor.
President Trump has thrown himself into flipping enough votes to ensure passage, spending much of Tuesday encouraging, cajoling, and horse-trading with reluctant House Republicans in public and private. Even if the bill does squeak by in the House, six Senate Republicans have said they oppose the legislation as written; three voting no would kill the bill. One of those no votes, Sen. Mike Lee (R-Utah), urged House Speaker Paul Ryan (R-Wis.) on Tuesday to cut his losses, saying on Fox News he is "strongly, strongly persuaded that it is not going to pass" and thinks "they should cancel the vote because they don't have the votes."
Republicans leaders are still predicting that reluctant members will come around, especially with Trump's ramped-up involvement. "A lot of folks are holding out because they think there will be a better offer," said Rep. Richard Hudson (R-N.C.). "I think he's got to make the case and the point that this is the final offer — take it or leave it." "We're not there yet," a top House Republican tells Politico. "I think we'll get there, especially with Trump working it, but we're not there right now." Trump's approval rating hit 37 percent in Gallup's daily tracking poll on Monday, The New York Times notes, and the AHCA is even less popular at 34 percent, per a recent Fox News poll. Peter Weber
President Trump spent much of Tuesday on Capitol Hill trying to rally Republicans around the American Health Care Act, the House Republican plan to replace the Affordable Care Act. His closed-door outreach included carrots and sticks, and at a National Republican Congressional Committee fundraiser Tuesday night, Trump urged Republicans to push forward with the "serious action" he said America voted for in November. "The House bill ends the ObamaCare nightmare," he said. "These are the conservative solutions we campaigned on, and these are the conservative solutions the American people asked us as, a group, to deliver. We are keeping our promises."
The GOP health-care plan is actually deeply unpopular, according to polls, and according to the Congressional Budget Office analysis, it will leave 24 million fewer people with insurance by 2026 versus ObamaCare. Especially hard-hit is the Affordable Care Act's Medicaid expansion, which will be phased out, along with taxes on the wealthy used to pay for federal subsidies and the individual mandate. In 2014, CNN notes, 25 percent of Americans treated for drug addiction were on Medicaid. That helps explain why Trump's push for the GOP plan finally cost him the support of Kraig Moss.
Moss wasn't a casual Trump fan — he sold his construction equipment for his upstate New York business and followed Trump to 45 campaign rallies, literally singing Trump's praises on a Trump-emblazoned guitar, CNN says. The GOP health-care bill "is an absolute betrayal of what Trump represented on the campaign trail," Moss told CNN. "I feel betrayed."
Moss' son, Rob, died of a heroin overdose in 2014 at age 24, and Trump frequently said on the campaign trail that he would work to help addicts through expanded treatment programs. The ACHA does the opposite, slashing funding for addiction treatment. "I did a lot to promote his candidacy," Moss said. "Now, I wish I had never sold my equipment." You can learn more about Moss and his story in the CNN report below. Peter Weber
President Trump is headed to Capitol Hill on Tuesday to try and rally House Republicans around the health-care bill they are expected to vote on this week, with uncertain prospects of passage. To win the support of conservative holdouts, House Speaker Paul Ryan released 43 pages of amendments to the bill on Monday night, including instant repeal of ObamaCare's taxes on high earners and certain medical companies, allowing states to attach work requirements to Medicaid, adding more restrictions on Medicaid's future growth, and allowing the Senate to increase tax credits for people 50 to 64, if it chooses.
Trump and House conservatives had hammered out many of those provisions in direct negotiations, but one specific amendment is aimed at a handful of Republican moderates from upstate New York. The provision would bar New York from making smaller counties pay for part of the state's Medicaid costs, potentially saving upstate counties some $2.3 billion a year, out of New York's roughly $27 billion Medicaid bill; New York City would still have to pay in. The amendment, which only affects New York, was pushed by Reps. John Faso and Chris Collins, Republicans from upstate New York districts.
"I suggested we put this in," Collins told The New York Times, "and the question that came back was, 'If we do it, can we get the New York votes?'" He said with the amendment, he believes eight of nine members of New York's Republican House delegation will vote yes. "If they did not have the New Yorkers, I'm not sure they could get it over the finish line," Collins said.
It's unclear if those extra votes will push the American Health Care Act over the finish line, or how those changes would be received in the Senate. Republicans sharply criticized Democrats in 2009 and 2010 for secret dealing and targeted provisions to win over on-the-fence members on the Affordable Care Act, with the most infamous example being the Cornhusker Kickback for Nebraska. The Huffington Post has come up with some similarly cutesy nicknames for the New York carveout: "The Buffalo Buyout ― or the Tammany Haul, or the Empire State Earmark, or whatever you may want to call it ― is a recognition that leaders are close, but can't afford to lose votes from moderates." Peter Weber
Hoping to appeal to more conservative members of Congress, House Speaker Paul Ryan (R-Wis.) submitted amendment packages to the Republican health-care plan on Monday night, three days before the scheduled vote on the House floor.
The changes include sharper cuts to Medicaid, including giving states the ability to impose work requirements for recipients; repealing tax increases this year instead of in 2018; and letting the Senate approve tax credits for people between the ages of 50 and 64. While Ryan's camp believes this will help him get to the 216 votes needed to pass the bill to the Senate, several conservatives in the House Freedom Caucus say there still are not enough votes. Catherine Garcia