GOP Health Care Plan Faces Day of Reckoning
Republican leaders appear short on votes to replace Obamacare ahead of crucial House test
On the eve of the most significant congressional vote of Donald Trump’s young presidency, House GOP leaders appear to lack the support needed to pass a bill to replace the Affordable Care Act.
The House is supposed to vote later Thursday on the American Health Care Act, but The New York Times counts 27 GOP representatives as “no” votes, and another 15 as expressing concerns or leaning against. CNN’s tally is 22 against and four likely nos.
“I came into the meeting being a no and I left being a no.”
Opposition spans the ideological spectrum of the party, from members of the conservative House Freedom Caucus, who believe the replacement health system is too much like Obamacare, to moderates who fear too many of their constituents would lose insurance.
Trump has worked hard to lobby fellow Republicans, spending time on Capitol Hill and inviting small groups of Republicans to the White House. The efforts appear to have paid off in at least one case. Rep. Lou Barletta (R-Pa.) tweeted Wednesday, “Met w Trump/Ryan & got guarantee that House will vote in April on my bill to deny tax credits to illegal immigrants. Will now vote for AHCA.”
But Rep. Ted Yoho (R-Fla.) said that while he appreciates the president's efforts, they have not changed his mind.
"I came into the meeting being a no and I left being a no," he told CNN.
The maneuvering comes amid signs that the bill is losing popularity among the American people. House leaders can afford to lose no more than 21 Republicans to ensure passage. But Speaker Paul Ryan (R-Wis.) appeared upbeat during an interview on Fox News Wednesday.
"There was a claim that there's 24 votes against," he said. "We're getting a lot of Freedom Caucus members to support this bill. We've been adding Freedom Caucus votes to this all week."
Ryan declined to say whether the vote might be delayed. He said the bill has undergone revisions as members of Congress have negotiated and brokered deals. He praised Trump, calling him "a fantastic closer" who has been winning support.
"We're not losing votes," he said. "We're adding votes."
White House press secretary Sean Spicer also expressed optimism.
"Member by member, we're seeing tremendous support flow in our direction, and the count keeps getting stronger for us," he said during his daily briefing.
But the bill is the subject of an enormous opposition effort by conservative interest groups. Club for Growth announced Wednesday that it would count the vote in its congressional scorecard rating members of Congress, following a similar decision this week by Heritage Action for America.
Rep. Jim Jordan (R-Ohio), a member of the House Freedom Caucus, said on "The Laura Ingraham Show" Wednesday that he does not believe the bill will pass. Members of the group contend they have 25 votes against the bill.
Heritage Action spokesman Dan Holler said at least five Democratic members of the House may miss the vote for various reasons. That would reduce the number of votes Ryan needs for passage. But Holler told LifeZette the Freedom Caucus' 25-vote estimate is in the ballpark.
"I don't think the votes are there," he said.
Holler said there is still a chance that sufficient changes could be made to win over conservatives. He said he would like to see more language striking down the mandates and regulations on insurance companies that drive up the cost of health care.
Ryan argues those changes must be made in a separate bill. The first legislation must be related to the budget in order to avoid a Senate filibuster.
"You can get at some of these provisions, or all of them, without changing the overall structure … That doesn't require a blank sheet of paper," he said.
But Seth Chandler, a University of Houston law school professor and visiting scholar at George Mason University's Mercatus Center, said he believes some parts of he current bill might run into a challenge that the Senate parliamentarian would have to resolve. For instance, the bill would require insurance companies to impose a 30-percent surcharge on customers who let their policies lapse and then try to sign back up.
"That's classic insurance regulation," he said, which might be impermissible to pass with 51 votes.
Holler is more optimistic. He noted the same process was used to pass welfare reform in 1996.
Kyle Kopko, a political science professor at Elizabethtown College in Pennsylvania, said the House vote should be the easy part for Republicans.
"I think it will get through the House. The big question is the Senate," he said. "This would be such a major defeat for Speaker Ryan and President Trump … I would imagine he would view this as a major defeat and damage his political image, or to use a better word, he brand."
Pennsylvania is home to a number of wavering Republican representatives. Kopko said they must worry about angering conservatives who long have hated Obamacare while at the same time keeping an eye on the broader electorate that might not see immediate benefits, even if the health reform ultimately proves successful at restraining costs.
"This is a really tricky position for a lot of lawmakers, to tell the truth," he said.