President Donald Trump’s early efforts to court conservatives opposed to the GOP’s Obamacare replacement is backfiring in Congress — emboldening the far right to demand changes that could repel centrists critical to its passage.
While the president has given a full-throated endorsement of the bill, he’s also suggested he’s open to “negotiations.” The mixed signals have allowed hard-line conservatives and leadership to hear what they want to hear. Each side is taking Trump’s words and arguing he’s in their corner.
Take the president’s message to outside conservative groups during a Wednesday night meeting at the White House. The president indicated he might be willing to change the GOP health plan so that Obamacare’s Medicaid expansion is phased out a year or two more quickly. GOP critics in Congress took the president’s statement and ran with it, crafting an amendment to codify ending the Medicaid expansion at the end of this year rather than 2019.
The change would “go a long way toward getting conservatives to support the bill,” said Rep. Joe Barton (R-Texas), a member of the Republican Study Committee and the House Freedom Caucus.
But altering the bill in such a way would mean upsetting the delicate balance GOP leadership is trying to strike between centrist Republicans who hail from states that took the Medicaid expansion, and conservatives who have labeled the bill “Obamacare-Lite.” Senate Republicans immediately panned the idea Thursday morning, even as conservatives pressed House GOP leadership and the White House to adopt it.
“Bad idea,” said Sen. Rob Portman of Ohio, one of four GOP senators to warn the House to keep millions of low-income Americans in mind as the chamber considers the bill. “I hope it won’t be [adopted] because I think it’s moving backwards … It makes it harder for some of us.”
The split over Medicaid is just one of the complications threatening to scuttle the plans of Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker Paul Ryan (R-Wis.) to send the bill to Trump’s desk before the Easter congressional recess. Even if Ryan and his lieutenants believed the change could help them garner the 216 votes need to push the bill through the House, senators are almost certain to reverse it — sucking up more time.
While McConnell and his deputy, Whip John Cornyn of Texas, said on Thursday they still aim to push through the legislation before the two-week break starting April 7, the Senate rank and file are pushing back. In an interview, Sen. Tom Cotton of Arkansas said he wants the Senate to hold hearings and pursue a “stress-free” process for Americans who will be affected by repeal and replace.
“They’ve got a process that is not going to yield a good result,” Cotton said. “No American cares whether a health care bill passes before the Easter recess or the Memorial Day recess or any other recess.”
Conservatives and moderates in the Senate this week declared the House bill dead on arrival because it would defund Planned Parenthood and create tax credits that the right dislikes.
The more restrictive Medicaid provisions that House conservatives want would further imperil the bill’s chances in the upper chamber.
Two days ago, party leaders vowed that the bill would remain relatively intact in the form it was produced. But now, some on Capitol Hill and in the White House seem to be in deal-making mode.
How far the president is willing to bend, though, is not clear. Trump has been sufficiently vague to give hope to proponents who are reluctant to allow an unwieldy exercise of legislative logrolling — and critics who believe the measure is severely lacking and in need of bigger alterations.
“The president realizes this is our one chance to keep our promise and it’s this bill or it’s the status quo. And the status quo is melting down as we speak,” Cornyn said in an interview. “He’s wedded to successfully repealing and replacing. He understands that this legislative process is going to make some changes to the proposal.”
Trump has reassured the House GOP whip team that he’d do everything in his power to pass the repeal bill. He’s tweeted at Sen. Rand Paul (R-Ky.), one of the bill’s highest-profile opponents, urging him to fall in line. And the president invited conservative groups and lawmakers to meet with him about their objections.
But Trump and Vice President Mike Pence and Office of Management and Budget Director Mick Mulvaney also told conservatives they should try to amend the bill if they want changes rather than sink it outright.
House Majority Leader Kevin McCarthy told POLITICO that those comments more likely mean amending the bill in what leaders call the “third phase” of repeal: legislation that would be taken up perhaps later this year that would include reforms that can’t be adopted now via the fast-track budget reconciliation mechanism that sidelines Senate Democrats. The second phase would include regulatory changes that can be adopted administratively.
“Are they sure that’s what Trump said?” McCarthy asked. “When Trump says, ‘If you have better ideas,’ I think he’s thinking in the [later] phase they offer bills going forward,” the California Republican said.
The right flank of the House, however, seized on Trump’s negotiation remark.
“We’ve been told by the vice president and Mulvaney that he’s flexible,” Freedom Caucus Chairman Mark Meadows said Thursday. “I’ve been working with centrist senators to try and find the sweet spot. And I believe that we can.”
But the Medicaid amendment makes life very difficult for Republican centrists, who have nothing to gain politically by voting to remove hundreds of thousands of constituents from the Medicaid rolls. They worry that hundreds of thousands of people would cycle off the program after 2018, a transition too abrupt in their view.
Rep. Charlie Dent (R-Pa.), who heads the moderate Tuesday Group, told MSNBC that the change “would not be helpful” to the bill’s prospects of gaining centrist support. In the Senate, Republicans were baffled at the thought of moving the bill further right.
“We’d have a lot of people fall off” Medicaid, Portman said Thursday after he met with Vice President Mike Pence and Health and Human Services Secretary Tom Price to explain his concerns about Medicaid.
Sen. John Thune (R-S.D.), No. 3 in Senate leadership, said after meeting with Price and Pence that “there’s got to be an opportunity for the Senate to be heard on this” given the major gulf between the two GOP-controlled chambers.
“There are lots of ways you can fix and amend the bill. And that would have to go back to the House, obviously. I wouldn’t rule that out,” he added.
There’s another wild-card factor in the mix: Conservatives disagree about whether blocking new Medicaid users two years earlier than leadership’s proposal would actually win their votes.
Republican Study Committee Chairman Mark Walker (R-N.C.) told reporters Wednesday night that the group could potentially back the bill if the Medicaid phase-out period were shortened.
“If we can get some movement in those areas, I think the RSC steering committee as a whole is close to being able to move forward,” he said.
Other conservatives say they aren’t sure that will be enough.
By: Rachael Bade And Burgess Everett