WASHINGTON, D.C. — Hoping to shore up support for the revised GOP health care bill, President Donald Trump hit Capitol Hill on Tuesday, using his special blend of humor and hubris to get wary Republicans to rally around the troubled legislation.
With a full House vote scheduled for Thursday on legislation to repeal and replace Obamacare, Trump took nothing for granted, telling House Republicans in a closed-door meeting that their very jobs could be on the line if the repeal legislation doesn’t pass.
And if the president’s threat of a primary challenge in the 2018 midterm elections wasn’t enough to nudge defiant Republicans into compliance, Trump turned it up a notch, publicly confronting the bill’s main opposition leader, Rep. Mark Meadows, R-N.C., with a bit of presidential intimidation.
After asking Meadows to stand up at the meeting, Trump said, “I’m counting on you to vote for the bill,” according to Rep. Richard Hudson, R-N.C., who was there.
Trump later told Meadows: “I’m gonna come after you big time,” if the legislation falters.
House Speaker Paul Ryan, R-Wis., praised Trump’s pep talk. “The president just came here and knocked the ball out of the park,” Ryan told reporters afterward. “He knocked the cover off the ball.”
Meadows, the founder and leader of the House Freedom Caucus, wasn’t as awestruck by the public arm twisting.
“In terms of calling me out, the president and I have a good relationship,” Meadows said afterward … But “I’m no closer to ‘yes’ than I was yesterday because we haven’t made any changes,” Meadows added.
Meadows maintains that GOP leadership won’t have enough votes Thursday to pass the legislation. If 21 Republicans vote against Ryan’s plan, which he calls the American Health Care Act, the bill will fail. Democrats unanimously oppose the legislation.
While Trump’s attitude Tuesday was humorous and engaging, not stern or threatening, Republicans will feel heat from voters and possibly face primary challenges if they kill what many believe is their best shot at a quick repeal and replacement of the Affordable Care Act.
Last week, the Congressional Budget Office estimated the bill would cause 14 million people to lose health coverage in 2018 and 24 million over the next 10 years. The CBO is expected to release a similar analysis of the revised proposal before the scheduled House vote Thursday.
Ryan was optimistic Tuesday that new proposals to amend the legislation, announced late Monday night, would win over wary Republican moderates who feel the bill harms seniors and the poor, along with the more conservative members who say it’s too much like Obamacare.
The revised proposal offered sweeteners for both groups, but the enhancements may not go far enough to sway either.
In a nod to conservatives, the amendments allow states to require Medicaid enrollees to fulfill a work requirement in order to receive coverage. Single parents with children under age 6 or with a child with disabilities would be excluded from the requirement, said Elizabeth Lower-Basch, director of the income and work supports team at the liberal Center for Law and Social Policy.
In addition to employment, the work requirement could be satisfied under the GOP bill through skills training, education in pursuit of a job or community service. But Lower-Basch said states are unlikely to provide the training and education that would meet the requirement.
“There’s essentially no protections in this for people against states implementing this in terrible, terrible ways,” she said.
In a statement, seven female Democratic House members and Rep. Jerrold Nadler, D-N.Y., blasted the provision because states could block Medicaid benefits for new mothers who didn’t find work within 60 days of having a baby.
The criticism was leveled by Reps. Katherine Clark of Connecticut, Diana DeGette of Colorado, Jan Schakowsky of Illinois, Barbara Lee of Texas, Judy Chu of California, Suzan DelBene of Washington and Louise Slaughter of New York.
“Just when we thought this bill couldn’t get any worse for women and families, Republicans have found a new low,” the group’s statement said. “Their updated bill, released in the middle of the night, now includes a direct attack on new mothers right after childbirth. Their devastating bill would turn back the clock on women across our country by violating family leave protections for new mothers.”
Under the new amendments, states could also receive their federal Medicaid funding for traditional adults and children as lump-sum block grants. Funding for the elderly and disabled would be based on the number of enrollees.
The GOP bill shifts Medicaid, the state-federal health plan for the poor and disabled, from an open-ended entitlement program to one with capped funding.
The legislation would also increase Medicaid’s annual inflation-based funding rate for elderly and disabled beneficiaries.
In addition, the new amendments would also block new states from expanding eligibility for Medicaid under Obamacare. That would nix plans by North Carolina and Kansas to do so.
The new legislation would also repeal the Affordable Care Act taxes this year instead of in 2018, with most of the tax benefits going to wealthy individuals. Doing so would forego an estimated $40 billion in lost tax revenue, said Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget.
A new analysis by Democrats on the Joint Economic Committee found the Republican plan would provide the wealthy an average of $207,390 more per year in after-tax income while low-income families would lose $205 a year.
“The Republican plan would mean a restaurant worker pays more for their health care so that a hedge fund manager can get a six-figure tax break. That’s unconscionable,” said a statement from Sen. Martin Heinrich, D-N.M., the ranking member of the Joint Economic Committee.
To assuage moderate Republicans, the amended bill would provide more assistance for older Americans with higher health costs. The revised bill would allow people to deduct from their taxes all medical expenses that exceed 5.8 percent of their income. The current threshold is 10 percent.
Lowering the medical expense threshold would cost an estimated $85 billion in lost tax revenue, Goldwein said.
Senate negotiators could reverse both the $85 billion and $40 billion tax breaks in the House bill and reinsert the lost revenue — $125 billion — to boost tax credits for people age 50 to 64 years old, said a statement from House Ways and Means Committee Chairman Kevin Brady. People in that age group would face higher premiums under the GOP bill and get less government assistance for marketplace coverage.
Adding $125 billion to support coverage for older people would be an improvement on the current bill, Goldwein said, “but in my opinion, it’s not enough to fundamentally change the story for the elderly.”
Four hundred health care organizations sent a letter Tuesday to Ryan and House Minority Leader Nancy Pelosi of California, announcing their opposition to the bill because it reduces health coverage for vulnerable groups, particularly those with mental illness and substance abuse problems.
The Joint Economic Committee analysis found the numbers of uninsured in 2018 would increase most under the legislation in California, Texas, Florida, New York, Illinois, Pennsylvania, North Carolina, Ohio, Virginia and Michigan. Premium hikes would be greatest in Alaska, North Carolina, Arizona, Oklahoma, Alabama, Vermont, Wyoming, New York, South Dakota and Montana.
White House press secretary Sean Spicer said Trump’s outreach and the new proposals “have assuaged (Republican House) members who had concerns or wanted to see some additional tightening.”
But Spicer reiterated that Republicans who vote against the bill may pay a price politically. “I think there’s going to be a price to be paid. But it’s going to be with their own voters, and they’re going to have to go back and explain to them why they made a commitment to them, and then didn’t follow through,” he said.
Special interest groups are already stirring the pot.
On Wednesday, more than 800 advocates for people with disabilities will converge on Capitol Hill to lobby against the GOP bill’s proposed 10-year, $880 billion cut in Medicaid funding.
The conservative Club for Growth, although encouraged by the proposed changes in the bill, has launched $500,000 worth of TV and digital ads urging certain GOP House members to oppose the legislation.
“The RyanCare bill fails to keep President Trump’s promises of interstate competition and health insurance deregulation,” said a statement from Club for Growth President David McIntosh. “Republicans promised a bill that would stop Obamacare’s taxes and mandates, and replace them with free-market reforms that will increase health insurance competition and drive down costs. RyanCare fails on those counts.”
In addition, Mike Needham, CEO of Heritage Action For America, which opposes the bill, announced on Twitter that he would be monitoring how Republicans vote on the measure. Heritage Action opposes the legislation because it retains many of the Affordable Care Act’s insurance regulations.
The U.S. Chamber of Commerce sent a similiar “key vote alert” to House members in support of the legislation.
Some Republicans lawmakers aren’t happy that conservative opposition seems to be overshadowing the overall push for repealing Obamacare.
“I don’t think we can have a narrow view that it’s my way or the highway,” said U.S. Rep. Robert Pittenger, a Republican from Charlotte, N.C., who supports the bill.
After the president’s visit to Capitol Hill on Tuesday, Pittenger said he thinks there’s still time to bring enough “yes” votes on board this week to pass the bill.
Even if the measure passes the House, it faces an uphill struggle in the Senate where Sen. Tom Cotton, R-Ark., said Tuesday “I still cannot support the House health care bill, nor would it pass the Senate.”
In a statement, Cotton said the proposed amendments do little to address the core problem of Obamacare: rising premiums and deductibles, which make insurance unaffordable.
“The House should continue its work on this bill,” Cotton’s statement said. “It’s more important to finally get health care reform right than to get it fast.”