WASHINGTON — White House officials and House Speaker Paul Ryan told Republicans in a closed-door meeting Thursday that they are finished with negotiations on their health care bill and President Donald Trump wants a vote Friday.
The dramatic scene followed 24 hours of tense negotiations and hushed meetings with the conservative House Freedom Caucus and others that failed to produce a closing deal. GOP leaders had already put off their plan to vote to repeal and replace Obamacare Thursday.
Trump had previously told Republicans they could lose their seats if they don’t repeal the Affordable Care Act. Now, the White House is saying if they don’t pass the bill Friday, they may be “stuck with Obamacare,” according to a source inside the meeting.
The idea to end negotiations came from the White House, said a person with direct knowledge. Leadership and top White House aides spent the late afternoon “trying to grind them down,” the source said, referring to the Freedom Caucus.
The vote is expected Friday afternoon, said Rep. Chris Collins, R-New York.
Republicans can’t lose more than 21 of their caucus and still pass the bill, since no Democrats are expected to support it. According to CNN’s ongoing whip count, 26 House Republicans have said they will vote against the bill, and four more have indicated they are likely to oppose it.
The struggle to repeal Obamacare has highlighted both Trump’s and Ryan’s struggles to reconcile their own party’s deep and glaring internal divisions.
Both men have been furiously lobbying lawmakers to get behind the legislation, especially the Freedom Caucus, the group of conservatives that has tried to push the bill to the right but whose proposals have alienated moderate Republicans.
Meanwhile, the Congressional Budget Office came out with more bad news. Changes Republicans made earlier this week to the bill will actually only decrease federal deficits by $150 billion over 10 years, while the original measure would have lowered deficits by $337 billion.
The measure still would leave 24 million fewer people insured by 2026 than under Obamacare, CBO said.
After meeting directly with Trump at the White House Thursday, Freedom Caucus Chairman Mark Meadows said there were “30 to 40” votes against the bill.
“We have not gotten enough of our members to get to yes at this point,” Meadows said. “We are certainly trying to get to yes.”
Meadows also called the long-standing plan to vote on Thursday — the seven-year anniversary of President Barack Obama signing the Affordable Care Act — an “artificial deadline.”
Republican leadership aides threw up their hands, saying it was now up to the Freedom Caucus take it or leave it.
“This is the final offer,” chief deputy whip Patrick McHenry said. “We have a package, they have an offer, and they can accept or reject it.”
A senior administration official described the meeting with one word: “Intense.”
There was no clear movement, so in private conversations, even as the meetings were ongoing, the White House proposed this course of action. Leadership discussed it and agreed in short order. “There’s nothing more we want to — or really can — give them,” the source said.
Moderates are unhappy
The challenge for leaders as they count their votes is daunting: Give conservatives too much of what they want and risk losing the moderates, but keep the moderates on board and conservatives could walk.
On Wednesday and Thursday, non-Freedom Caucus Republicans began to turn their backs on the bill, saying it was not a plan they could back on behalf of their constituents.
The moderate Tuesday Group trekked to the White House Thursday afternoon after intense deliberations of their own and a meeting with Ryan. The group had seven boxes of pizza, as well as Doritos and Baked Lays, delivered to a room in the Capitol earlier in the day.
Trump is now experiencing firsthand what it is like to work with the Freedom Caucus, a top GOP source said — that they can be deeply frustrating because they don’t really want to get to yes and keep changing their demands.
Alabama GOP Rep. Bradley Byrne, emerging from a meeting with top House leaders, blasted the House GOP leadership’s move to continue talks with the hard right in the Freedom Caucus while leaving the bulk of other members in the dark.
“I think the window for making decisions is rapidly closing. We need a vote or go home,” said Byrne, a member of a large group of fiscal conservatives, the Republican Study Committee.
A key element of the negotiations between the Freedom Caucus and the White House revolves around the so-called “essential health benefits.” The White House is working to possibly include the repeal of Obamacare requirements that certain benefits — like mental health coverage, drug addiction coverage and maternity care — be required in insurance plans.
“A lot of people don’t realize what the implications of that are,” one lawmaker member said Wednesday night of stripping out Essential Health Benefits. “So we’re gonna railroad this thing through and there’s going to be even more people pissed off — our constituents, stakeholders.
What’s in the bill
The GOP health care bill, introduced earlier this month, would roll back many of the Obamacare taxes and eradicate the individual mandate. Instead of the subsidies available under Obamacare, officially known as the Affordable Care Act, the GOP plan provides Americans with refundable tax credits to purchase health insurance.
The bill also significantly restructures Medicaid and allows states to require able-bodied adults to work if they want to be eligible for the program. After 2020, states will no longer be able to expand Medicaid like they could under Obamacare and states that haven’t expanded the program at all are barred from doing so.
However, the GOP bill still includes 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, though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed.
The non-partisan CBO estimated that 24 million fewer Americans would be covered under this bill than under Obamacare by 2026 if the bill is becomes law in its current form.
This story will continue to be updated as developments warrant.