Conservatives Threaten to Sink Republican Health-Care Bill

With GOP leaders in need of votes, Trump reopened negotiations with the House Freedom Caucus to save the Obamacare repeal.

Updated on March 22 at 7:19 p.m. ET

When President Trump summoned Representative Ted Yoho and about a dozen other lawmakers to the White House on Wednesday to hear a direct, presidential pitch for the House Republican health-care bill, the Florida conservative told Trump what he wanted: a “100 percent repeal” of the Affordable Care Act.

Like most of his fellow members of the hardline House Freedom Caucus, Yoho believes the party leadership’s American Health Care Act doesn’t go far enough in dismantling the law former President Barack Obama signed seven years ago this week. The group is now playing a game of high-stakes chicken with the White House and Speaker Paul Ryan, vowing they have the votes to defeat the Trump-endorsed plan and hand the new president an embarrassing loss in his first major legislative push.

The bill guts Obamacare’s insurance mandates and repeals most of its tax increases, but it leaves key parts of its architecture in place. As the GOP plan barrels toward a House vote on Thursday, conservatives are urging Speaker Paul Ryan to agree to changes that would strip out Obamacare’s requirement that insurance plans cover certain “essential health benefits,” which include maternity and newborn care, mental health treatment, and preventive services.

“As long as that’s there, we do not have a repeal of the Affordable Care Act,” Yoho told me at the Capitol on Wednesday. He told Trump that if GOP leaders repealed the essential health benefits provision as part of their bill, it would be “really close” to getting his vote.

The president smiled, Yoho recalled. “We’ll see what we can do,” Trump told the congressman.

When he returned to the Capitol, Yoho was still a no.

So were the bulk of the roughly two dozen members of the Freedom Caucus who left a separate White House meeting with Vice President Mike Pence empty-handed and defiant. They were unmoved both by Trump’s warning of political fallout on Tuesday and by the vice president’s more policy-focused plea on Wednesday.

Pence, along with several senior Trump aides at the meeting, rejected the conservatives’ push either to “start over” on repealing Obamacare or a least to add language stripping out the law’s essential health benefits. “They steeled our resolve by their unwillingness to lower premiums on hard-pressed American families,” Representative Mo Brooks of Alabama told reporters afterward. “If they want to bring it up for a vote, we’ll vote it down.”

Yet by the late afternoon, it appeared the conservatives’ message had gotten through to Trump, who called members of the Freedom Caucus and told them he was now on board with adding a provision targeting the essential health benefits. Negotiations restarted by phone, with the Freedom Caucus holed up in their makeshift war room in one of the House office buildings. Popping out of the ralks shortly after 6 p.m., Representative Mark Meadows struck a notably more optimistic note. “I can tell you we’re making great progress,” Meadows, the Freedom Caucus chairman, told reporters. “We’re not there yet, but I’m hopeful.”

Just how many votes there were for the leadership’s bill was a source of debate throughout the Capitol on Wednesday. Brooks and other conservatives declared early in the afternoon there were plenty more than the 21 or 22 Republican defections they needed to defeat the measure and, they hoped, force the leadership back to the bargaining table. “Right now, you’re seeing a gain in the no votes and a subtraction from the yes votes as more and more Republican congressmen communicate with their constituents back home,” Brooks said.

Allies of the speaker claimed the opposite. They said that over the course of a flurry of meetings on both ends of Pennsylvania Avenue, they were getting closer and closer to a majority of the House. Depending on absences on Thursday, Ryan will need either 215 or 216 Republicans to back the bill, given the unified Democratic opposition. “We’re pretty close,” said Representative Richard Hudson of North Carolina, a member of the leadership’s whip team. “We’re seeing a lot of folks who are getting comfortable enough to say yes or getting close.”

In an appearance on Fox News, Ryan said GOP leaders were “adding votes, not losing them,” and he claimed that Trump had personally persuaded 10 members to support the bill. Yet the speaker notably stopped short of predicting the plan would pass on Thursday, as he had done in previous weeks.

Ryan has resisted the conservative demands to repeal the essential health benefits as part of the House bill because he and other leaders fear that the provision could sink the bill in the Senate, where strict budget reconciliation rules limit how much Republicans can change in Obamacare without the measure being subject to the 60-vote filibuster threshold. As it stands, the current bill is unlikely even to get the 51 votes it would need to pass the Senate without major changes. Republicans can only use the reconciliation process once in a single fiscal year.

“Our whole thing is we don’t want to load up our bill in such a way that it doesn’t even get considered in the Senate and it’s killed in the Senate, and then we lost our one chance with this one tool we have,” the speaker told the radio host Hugh Hewitt on Wednesday morning.

With Trump’s endorsement, however, Ryan came under to soften his position. “We’re hearing one thing from the president and another thing from our own leadership,” Representative Louie Gohmert of Texas told reporters early Wednesday evening. Gohmert said members of the Freedom Caucus were pushing not just to remove the essential health benefits but to knock out a much wider chunk of Obamacare, including the broadly popular provisions banning discrimination based on preexisting conditions and allowing young adults to stay on their parents’ insurance plans.

House leaders appeared unlikely to go that far, however. They have vowed to maintain those protections in any new health-care plan, and a senior GOP aide warned that moving the bill that far to the right would cost too many votes among less conservative members. It’s a “not-too-hot, not-too-cold situation,” the aide said, describing the effort to satisfy both wings of the Republican conference in the House.

Ryan and administration officials had earlier tried to assuage conservatives by promising that Senate Republicans would try to add more repeal provisions once the House passes its version. “That’s unsatisfying,” Brooks said. It was enough, however, to win the support of at least one conservative critic: Representative Steve King of Iowa. King announced in a Facebook video on Wednesday that after meeting with Trump, he had agreed to support the bill in exchange for a firm commitment that Senate Majority Leader Mitch McConnell will try to beef it up in the Senate next week. “In the end, we have the best chance to get a package that is the closest thing we can get to a full repeal within this political environment,” King explained. Another opponent, Representative Lou Barletta of Pennsylvania flipped his vote after securing a promise that the House will pass a separate bill to ensure that undocumented immigrants won’t have access to the new tax credits in the GOP plan.

Yet for every new supporter of the leadership’s bill, another new opponent seemed to emerge. Moderate Representatives Dan Donovan of New York and Frank LoBiondo announced they would vote no. LoBiondo said the proposal was “not as good or better than what we currently have,” while Donovan said an amendment added to benefit officials in upstate New York would disproportionately hurt his constituents in New York City.

It was the conservatives, however, who appeared to have the numbers to defeat the bill without more changes, and just over 24 hours before the vote, the White House seemed to blink first. As negotiations restarted, leadership allies and GOP aides said that Ryan planned to call up the bill on Thursday regardless of whether it would pass.

“If we don’t have the votes,” Hudson told me, “it’s going down tomorrow.”