House leaders postpone vote on their health-care plan
By Mike DeBonis, Juliet Eilperin and David Weigel
March 23 at 3:37 PM - The Washington Post
House leaders postponed a vote Thursday on their plan to overhaul the
nationfs health-care system, as they and President Trump struggled to meet
demands of conservative lawmakers who said they could not support the bill.
House Republicans planned to meet behind closed doors later Thursday to
figure out their next steps. Leaders have told the rank and file to be available
Friday in the event a vote can be scheduled then.
White House Deputy Press Secretary Sarah Huckabee Sanders confirmed the delay
but said that she expected debate on the bill to begin Thursday night, with the
expectation of a vote early Friday.
gWefre very confident that the bill will pass tomorrow morning,h she
Earlier Thursday, conservative House Republicans had rebuffed an offer by
Trump on Thursday to strip a key set of mandates from the nationfs current
health-care law, raising doubts about whether House Speaker Paul D. Ryan
(R-Wis.) had the votes.
Trump met at the White House with the most conservative House Republicans,
hoping to close a deal that would help ensure passage of the partyfs health-care
plan by shifting it even further to the right. But the session ended with no
clear resolution, and some lawmakers said they needed more concessions before
they would back the bill.
Rep. Justin Amash (R-Mich.), asked whether the White House had made its
final negotiating offer, said that if thatfs the case, gTheyfre not going to
pass the bill.h
Talks continued, however, and White House press secretary Sean Spicer said he
still anticipated a vote on the measure by dayfs end. Asked whether there was an
alternative plan to the current bill, Spicer replied: gNo. itfs going to pass.
So thatfs it.h
The chairman of the conservative Freedom Caucus, Rep. Mark Meadows (R-N.C.),
also said that resolution could gpossiblyh be resolved Thursday. His spokesman,
Ben Williamson, later tweeted that Meadows gremains hopeful and will continue
workingh to reach a deal.
That appears to have changed, according to several lawmakers who confirmed
The session came after more than a day of almost nonstop negotiations, as
Trump and Ryan have worked to mollify members of the conservative House Freedom
Caucus while simultaneously trying to minimize defections by GOP moderates.
As of midafternoon Thursday, 37 House Republicans — mainly Freedom Caucus members — had
announced their opposition to the bill, known as the American Health Care
Trump will also meet Thursday with members of the moderate gTuesday Group,h
Spicer said. On Wednesday, four Republican moderates — Reps. Charlie Dent (Pa.),
Frank A. LoBiondo (N.J.), Daniel Donovan (N.Y.) and David Young (Iowa) —
announced their opposition, increasing pressure on leaders to win over
GOP leaders appeared to be making some headway in bringing the measure to the
floor for a vote Thursday. The price for doing so, however, may be striking
popular provisions in former president Barack Obamafs Affordable Care Act that
could make it even more difficult to pass legislation in the Senate. This
high-wire balancing act, in which Republicans are catering to conservatives in
the House with the knowledge that they still must woo moderates to get
legislation to Trumpfs desk, could not only reshape the nationfs health-care
system but could also have uncertain electoral repercussions for the new
But with failure not a viable option, Ryan and Trump have been working
furiously to win over the large voting bloc of conservatives who control the
House billfs fate. Conservative lawmakers have asked to eliminate much of the
measurefs Title I, which not only mandates which benefits participating insurers
must cover — such as mental health treatment, wellness visits, and maternity and
newborn care — but also bars companies from setting insurance rates based on a
personfs sex, medical condition, genetic condition or other factors.
The only existing mandates conservatives are open to preserving are ones that
bar insurers from denying coverage based on preexisting conditions and allow
children to stay on their parentsf plans until age 26.
Passage of the bill would represent a major political victory for both the
White House and House leaders, although the ultimate fate of the legislation
hinges on the Senate. There are at least a dozen skeptics of the bill among
Senate Republicans, who maintain a slim 52-to-48 advantage, and many of them
want to maintain some of the current lawfs more generous spending
If Republicans fail this initial test of their ability to govern, Trump and
Capitol Hill Republicans may face a harder time advancing high-priority
initiatives on infrastructure, tax reform and immigration. They might also find
themselves navigating strained relationships among themselves.
White House officials expressed optimism Thursday that a deal remained within
reach. Cliff Sims, director of White House message strategy, tweeted a photo of the president walking in to meet with
Freedom Caucus members, along with the line, gLengthy standing ovation from the
Freedom Caucus when @POTUS walked into the Cabinet Room just now. Big momentum
GOP leaders can afford only 22 defections, given that one Democrat was
expected to be absent Thursday. A Freedom Caucus spokeswoman said that gmore
than 25h members of the group oppose the bill.
The flurry of activity Thursday represented a profound shift from GOP
leadersf previous strategy, under which they insisted that the changes sought by
hard-right members would render the bill unable to pass the Senate.
Thursday is the seventh anniversary of the Affordable Care Act, and
Republican leaders are eager to mark it with a historic vote demonstrating that
its evisceration has begun. In a sign of how high the stakes are for both
parties, Obama issued a statement noting that more than 20 million
Americans have gained coverage since he signed the law, while the rise in
health-care costs has slowed.
gSo the reality is clear: America is stronger because of the Affordable Care
Act,h Obama said, adding that Republicans are welcome to work with Democrats to
improve the law. gBut we should start from the baseline that any changes will
make our health care system better, not worse for hard-working Americans. That
should always be our priority.h
House Democrats have urged their GOP counterparts to slow down. Just before
11:35 p.m. Wednesday, the House Rules Committee voted along party lines to
waive a rule prohibiting the panel from forwarding a bill to the floor for
same-day consideration. The move, colloquially known as gmartial lawh in the
House, will allow GOP leaders to make further changes to the legislation and
still hold a final vote Thursday.
Democrats questioned why lawmakers would move it to the floor when the
Congressional Budget Office had not issued a new analysis of the bill. The
additional effects on coverage and federal spending of the provisions still
being negotiated Wednesday were also unknowns.
gYoufre going to own this, just like we owned the Affordable Care Act,h Rep.
Alcee L. Hastings (D-Fla.) warned shortly before the panel adjourned for the
night. gYoufll rue the day that you did it this way.h
Republicansf current strategy is based on a new interpretation of Senate
rules had raised the possibility that acceding to the Freedom Caucusfs request
might not threaten Senate consideration of the whole bill. But both aides said
the provision could still be stripped out once the bill reaches the Senate.
Democratic Senate aides insisted that would be the case. gWhat the proponents
arenft telling conservative House Republicans is that the plan to repeal
essential health benefits will almost certainly not be permissible under Senate
reconciliation rules,h said Matt House, a spokesman for Senate Minority Leader
Charles E. Schumer (D-N.Y.).
In fact, the new negotiations late Wednesday raised the possibility that the
challenge would only grow at the other end of the Capitol. Republicans can
afford to lose the votes of only two senators, assuming Pence would step in to
cast a vote for the health-care rewrite in the case of a tie.
An additional potential hurdle facing the bill is the updated analysis still
to come from the Congressional Budget Office, which will reflect changes to the
measure that were issued Monday. That analysis could be rendered inaccurate if
further changes are made before the vote.
Complications stemming from the billfs last-minute tweaks appeared to add yet
another political headache Wednesday, as veterans groups discovered that the
latest draft might make them ineligible for a tax credit. A change made to
ensure that the measure would comply with Senate rules created a separate
consequence — that individuals would qualify for the billfs tax credits only if
they gare not eligibleh for other types of coverage, including those provided by
the Veterans Health Administration.
In an email, House Ways and Means Committee spokeswoman Lauren Aronson said
the issue would be fixed in subsequent legislation. gThis amendment makes no
change to veteransf health care. In working with the administration and the
Veteran Affairs Committee, we will continue to ensure that Americafs veterans
have access to the best care available.h
In another example of last-minute changes,
Illinoisf GOP delegation announced late Wednesday night that Centers for
Medicare and Medicaid Services Director Seema Verma had assured them that
gIllinois will have the opportunity to accurately report its 2016 Medicaid
payment information to CMS.h The state ghas long been disadvantaged by below-
average Medicaid reimbursements,h the lawmakers said, and this adjustment will
ensure that the state would receive more federal funds when the government
shifts to allocating Medicaid dollars on a per capita basis under the bill.
Many recent changes made to the bill were aimed at placating conservatives,
including giving states the option to take a fixed Medicaid block grant and to
impose work requirements on childless, able-bodied adults covered under the
program. Others responded to broader concerns about the sufficiency of the tax
credits offered to help Americans purchase insurance.
One revision was more narrowly targeted — added at the behest of Republicans
from Upstate New York who wanted to end their statefs practice of commandeering
local tax revenue to fund state Medicaid benefits.
That concerned Donovan, who said a day after meeting with Trump in the Oval
Office that he would oppose the bill.
In an op-ed for the Staten Island Advance, he said the change ggives our
district short shrifth and also said the GOP bill would disproportionately harm
Paul Kane, Abby Phillip, Lisa Rein, Kelsey Snell and John Wagner contributed
to this report.