GOP Leaders Not Confident They Have Votes to Pass Health Bill

  • Speaker Ryan heading to White House to brief president
  • House vote is scheduled to be held on Friday afternoon

Former Aetna CEO Weighs in on Health Care Vote

House GOP leaders aren’t confident they have enough votes to pass their embattled health-care bill, according to a senior congressional aide, and are already considering what to do if the measure is blocked before a do-or-die vote hours away.

House Speaker Paul Ryan went to the White House Friday to brief President Donald Trump ahead of the vote. Vice President Mike Pence canceled a trip to Arkansas to be in Washington for the vote, a White House official said.

The Trump administration is doubling down on its demand that House Republican leaders hold a vote Friday on their embattled health-care bill without any changes. White House Press Secretary Sean Spicer said the vote will proceed as scheduled Friday afternoon.

“It’s not a question of negotiating any more, it’s understanding the greater good,” Spicer said at a news conference. “This is it.” The president, he added, has “made it clear this is our moment.”

But an influential GOP member said he’s not sure they have the votes.

"I’m not sure we’ve landed it," Mark Walker of North Carolina, chairman of the conservative Republican Study Committee of House members, said Friday morning. "I’m hopeful that we can get there today but at this point I don’t know how many we’re short."

Stocks retreated in afternoon trading, adding to the worst weekly slide since the election, while Treasuries rose as prospects for the Republican health-care bill worsened. The S&P 500 Index fell to session lows, and bank shares headed for the worst week in 14 months as investors speculated the GOP infighting could delay efforts to implement pro-growth policies and financial revisions.

Tensions among House Republicans were high, said Chris Collins of New York, the first House member to endorse Trump last year.

"There’s some divisiveness within our conference now that’s not healthy," Collins said. "I’ve never seen this before. People are just refusing to talk to each other. They’re storming past each other. This is not good."

‘Currently Unacceptable’

House Appropriations Chairman Rodney Frelinghuysen of New Jersey announced his opposition to the measure, writing on Facebook that the bill was "currently unacceptable as it would place significant new costs and barriers to care" on his constituents.

If the high-stakes gamble works and the House manages to pass the Obamacare replacement bill, it will be an important win for Trump and Ryan who have formed an uneasy alliance to repeal former President Barack Obama’s signature health-care law.

If the measure is blocked, it will be an embarrassing setback that casts doubt on Trump and Ryan’s ability to deliver on their ambitious agenda, including taxes and infrastructure, both of which are being closely watched by Wall Street.

“After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!” Trump tweeted Friday morning.

Referring to the conservative House group that has several members holding out on the plan, Trump added, “The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!” Planned Parenthood, which offers reproductive health services such as birth control and abortions at U.S. clinics, has long been a Republican target for defunding.

“He wants to do this and he wants to do it now,” White House budget director Mick Mulvaney said of Trump on ABC Friday morning. “He also wants to move on to things like tax reform, infrastructure, restructuring the government, putting people back to work. He’s not willing to wait the several months an ordinary president would.”

Mulvaney said the White House was still unsure whether it had enough votes to pass.

Societe Generale Global Strategist Kit Juckes discusses how Trump’s health care overhaul could impact markets.

Source: Bloomberg

The Trump administration made a last-minute deal with House conservatives to change the bill -- by removing Obamacare’s requirements that certain essential benefits be covered by insurance -- in an effort to win over holdouts, who had forced GOP leaders to delay a vote originally scheduled for Thursday.

Then Trump aides, including senior strategist Steve Bannon, went to Capitol Hill to deliver a message in person to House leaders and the Republican caucus that the president has run out of patience: Trump wanted a vote Friday, win or lose, even if that means leaving Obamacare in place.

‘No More Negotiations’

“We have to have a vote tomorrow. He expects it to pass,” Collins said Thursday, speaking about Trump. “We are done negotiating, there are no more negotiations.”

“If it loses, we just move on to tax reform,” added Collins, a Trump ally.

Conservatives, including Freedom Caucus Chairman Mark Meadows, emerged from the meeting saying they were still leaning against the bill but evaluating the final package.

Meadows said late Thursday “I’m a no” for now, but said members had been given “a binary choice” and that he would talk with other members before making a final decision.

GOP leaders didn’t agree to a core demand of the Freedom Caucus to eliminate other insurance regulations, according to a senior Republican aide.

Representative Thomas Massie of Kentucky, who opposes the bill, said Republican leaders are taking a risky bet.

“If they bring this to the floor and it doesn’t get to 216 quickly, the momentum could go in the other direction and they could come way short,” he said. “Because you don’t want to be the person who fell on your sword and voted yes for a piece of legislation that never passes.”

‘Leaning the Other Way’

Other House conservatives said they were getting the sense that enough of their colleagues would end up backing it.

"I’m still a no, but it looks like it’s leaning the other way," Freedom Caucus member Ted Yoho of Florida said. Representative Mark Sanford of South Carolina agreed, saying he was picking up that the “sentiment” of most of the conference was now to pass the bill.

The bill has struggled to win over far-right members who have demanded a more complete repeal of Obamacare, but it’s also unnerved moderates concerned about projections that millions of Americans will lose coverage. A number of moderates came out against the bill this week, giving Republican leaders little room to negotiate changes.

Ryan put a brave face on the upcoming test of whether he and Trump can deliver the votes.

“For seven-and-a-half years, we have been promising the American people that we will repeal and replace this broken law because it is collapsing and hurting families,” he said Thursday. “Tomorrow we will see that.”

The GOP bill, H.R. 1628, would reverse massive gains in health coverage under the Affordable Care Act, which brought the uninsured rate to a record low. The proposal would pull hundreds of billions of dollars out of the health system by winding down Obamacare’s expansion of Medicaid and limiting its subsidies, threatening revenues for hospitals, doctors and insurance companies.

Some Changes

Meadows and other conservative Freedom Caucus members demanded a provision in the bill -- agreed to by Trump and GOP leaders -- that would scrap the essential benefits portion of the Affordable Care Act, which requires insurers to cover 10 categories of services, for the individual market. Those services include hospitalization, ambulance services, maternity
care, pediatric services, mental health and substance abuse treatment, prescription drugs, rehabilitative care and laboratory services.

Other new provisions described by lawmakers Thursday night include a $15 billion boost to a new state flexibility fund and six more years of a 0.9 percent Medicare tax on high earners.

That last bit is needed to pay for what is expected to be a surge of people buying lower-cost insurance products, triggering tax credits that run from $2,000 to $4,000 per person for eligible people.

If the bill makes it to the Senate, it is expected to undergo significant changes there as well, including boosts to tax credits for people ages 50 to 64 who are hit with massive premium spikes under the bill.

Outdated CBO Score

The last-minute changes mean that Republicans will be voting on the measure without a final estimate from the Congressional Budget Office about how many millions of Americans will lose coverage or how much the measure will cost.

In another development that could unease conservatives, the CBO issued a new estimate Thursday to account for changes made to the bill earlier in the week. The nonpartisan agency cut its estimate of how much the bill would shrink the federal budget deficit, saying the updated measure would reduce the deficit by $150 billion over the next decade, $186 billion less than the initial forecast of $337 billion.

— With assistance by Arit John, Terrence Dopp, Steven T. Dennis, Jennifer Epstein, and Jennifer Jacobs

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