When members of Congress return to Washington next week after their long spring recess, both parties plan to focus on passing a spending bill to keep the federal government running past April 28. When Congress returns next week, President Trump wants House Republicans to take up the American Health Care Act again, with a new amendment, so he will be able to point to a concrete accomplishment in his first 100 days in office; his 100th day is April 29.
"Congress usually cannot take on two big things at once," The New York Times says. Five days to pass a spending bill, The Washington Post adds, is "a tight timeline under the most generous of circumstance that would be nearly impossible to meet if House leaders also try to force a vote on the repeal legislation." In theory, Democrats and Republicans could pass a very short-term stopgap spending bill, but a new GOP push to pass the AHCA, which repeals large parts of the Affordable Care Act, would not put Democrats in a very cooperative mood.
The first attempt to pass the AHCA failed very publicly last month. But at a news conference on Thursday, Trump said "the plan gets better and better and better, and it's gotten really, really good, and a lot of people are liking it a lot," adding he thinks the House can pass that as well as a spending bill. "We have a good chance of getting it soon," Trump said of the AHCA. "I'd like to say next week, but it will be — I believe we will get it."
Hopes of passing the health-care bill rest on an amendment negotiated by relative moderate Rep. Tom MacArthur (R-N.J.) and Freedom Caucus chairman Rep. Mark Meadows (R-N.C.). The draft plan would allow states to seek waivers to requirements that insurers offer essential health benefits and not charge more to people with pre-existing conditions, if the state maintained a high-risk pool. (Jeff Spross has more details at The Week.)
Even if House Republicans get the plan translated into legislative language and get it scored by the Congressional Budget Office, there's no guarantee it would pass. The amendment "really doesn't address the concerns that I had," Rep. Dan Donovan (R-N.Y.) told The New York Times. Fellow moderate Rep. Charlie Dent (R-Pa.) agreed it "does nothing to change my views," criticizing any focus "on an arbitrary 100-day deadline." Peter Weber
President Trump has said on several occasions that Republicans would be smart to let the Affordable Care Act just collapse on its own so Democrats would be forced to help negotiate a deal to replace or radically change the law. Now, he's threatening to push ObamaCare over the cliff himself. Trump wants to use billions in subsidies to help low-income people afford health care as leverage to drag Democrats to the negotiating table, Politico says, citing "three administration officials with knowledge of Trump's thinking." Trump told The Wall Street Journal the same thing in a 70-minute interview on Wednesday.
Former President Barack Obama approved the estimated $7 billion in cost-sharing subsidies, which help insurance companies pay customers' medical bills. Scrapping the subsidies would likely crash the ObamaCare individual marketplaces. "ObamaCare is dead next month if it doesn't get that money," Trump told The Wall Street Journal. "I don't want people to get hurt," he added. "What I think should happen and will happen is the Democrats will start calling me and negotiating." Senate Minority Leader Chuck Schumer "should be calling me and begging me to help him save ObamaCare, along with Nancy Pelosi," the House minority leader, Trump said.
Schumer criticized Trump's "cynical strategy" of "threatening to hold hostage health care for millions of Americans ... to achieve a political goal of repeal that would take health care away from millions more." Pelosi said Trump's "appalling threat" is aimed at trying to "manufacture a crisis," using "millions of families" as a bargaining chip.
House Speaker Paul Ryan backs continuing the subsidies for now, although House Republicans sued to block Obama from paying them out; a federal judge agreed last year that the payments are improper but allowed them to continue on appeal. On Monday, the Health and Human Services Department told The New York Times that the Trump administration may continue paying the subsidies, drawing a rebuke from the HHS that was, two administration officials tell Politico, "personally ordered by an incensed Trump, who feared that the Times story hurt his negotiating position."
In a Kaiser Family Foundation poll released last week, 75 percent of Americans said they want the Trump administration to make ObamaCare work rather than make it fail, and 61 percent said they would hold Trump and the GOP responsible for any problems with the law. "I don't think Trump really wants to cut the subsidies, because he'd get blamed for people losing insurance," a White House official told Politico. "But right now, it might be his biggest way to force people to do something." Peter Weber
After a flurry of negotiations this week, the Republican "Zombie TrumpCare" bill is "dead, killed off by House Republicans who never actually read the legislation — because in fact, it never actually existed," The New York Times reports. House Republicans leave for a two-week Easter break on Thursday afternoon, and despite a last-ditch push by Vice President Mike Pence to sell a new set of proposals to hard-right Republicans this week, there was no breakthrough.
"There's no suggestion we should be changing our flights," Rep. Chris Collins (R-N.Y.) told The Associated Press. "We're going home ... without a deal." House Republicans are still considering an emergency House Rules Committee meeting on Thursday, Politico reports, but expectations are very low and there is no health-care vote on the schedule. On Wednesday night, Republicans and conservative groups were mostly blaming other GOP factions for the new failure to come up with a workable compromise. The first bill, the American Health Care Act, was pulled before a vote it was certain to lose. The health-care fight has highlighted fractures in the GOP coalition, but it has apparently given a sizable boost to the law the AHCA seeks to replace, the Affordable Care Act, which is hitting new highs in opinion polls. Peter Weber
For the first time since Gallup started asking about general approval or disapproval of the Affordable Care Act in November 2012, the 2010 health-care overhaul is viewed favorably by a majority of Americans, Gallup reported Tuesday. And the 55 percent approval number is all the more dramatic because just five months ago, only 42 percent of Americans approved of ObamaCare, versus 53 percent who disapproved.
Wow: Obamacare approval surges to 55% in favor, 41% against amid Republican repeal efforts, per new Gallup poll. pic.twitter.com/FcqMLTPR27
— Sahil Kapur (@sahilkapur) April 4, 2017
The rise in approval comes from Democrats, Republicans, and especially independents, whose approval rose 17 points since President Trump's election, to 57 percent from 40 percent. So what changed in five months? "Trump vehemently attacked the Affordable Care Act during his presidential campaign — and in the days immediately following his election, the public appeared to agree with him," Gallup said. "However, in the five months since, as Republicans' efforts to replace the law with one of their own have failed to get off the ground, enough Americans have changed their minds about the ACA to create a majority favoring it for the first time."
Trump and House Republicans have started meeting again this week to try and reach agreement on their ObamaCare replacement bill, which House leaders pulled from an imminent vote when it became clear it would fail. According to a Kaiser Family Foundation survey released Tuesday, a 63 percent majority thinks it's a "good thing" that the bill, the American Health Care Act, crashed. Almost half of those people said it's good because the ACHA did not fully repeal ObamaCare, but 75 percent of respondents — including majorities of every group polled — said that given the choice, Trump and the GOP should try to make ObamaCare work rather than make it fail, as Trump has threatened to do.
— Kaiser Family Found (@KaiserFamFound) April 4, 2017
The Kaiser Family Foundation found opinions about ObamaCare split evenly, with 46 percent in favor and opposed, and there's a pretty broad consensus on who is responsible for the Affordable Care Act going forward: A 61 percent majority say Trump and the GOP are responsible for any problems with the law, while 31 percent say former President Barack Obama and his party still own ObamaCare. You can find more results at the Kaiser Family Foundation. Peter Weber
Vice President Mike Pence, White House Chief of Staff Reince Priebus, and White House budget director Mick Mulvaney met behind closed doors with members of the House Freedom Caucus on Monday night, after meeting with more moderate House GOP members earlier in the day, in the latest sign that President Trump hasn't given up on House Speaker Paul Ryan's health-care bill. Rep. Mark Meadows (R-N.C.), the Freedom Caucus leader, told The Associated Press that the White House made an informal offer but "there is no deal in principle" yet and his group is waiting to see details, in writing, before committing support.
The changes, Meadows said, center on allowing governors to apply for waivers to some big ObamaCare requirements, including that all health-care plans offer a set of essential health benefits and that insurers have to charge the same prices to everybody in the same age group, a mechanism called community rating. Scrapping both requirements, but especially community rating, would effectively negate ObamaCare's ban on discriminating against sick people and those with pre-existing conditions, Margot Sanger-Katz explains at The New York Times:
A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn't do her much good if that plan was not required to cover chemotherapy drugs.... Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted. If both of the ObamaCare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up. [The New York Times]
Trump ally Rep. Chris Collins (R-N.Y.) told Politico that the moderates said they would tentatively be fine with the changes if the Freedom Caucus signed on, and White House legislative liaison Marc Short reportedly told attendees at Ryan's donor retreat late last week that outside conservative groups that opposed the AHCA have indicated a willingness to negotiate. Ryan pulled the deeply unpopular bill two weeks ago when it became clear it wouldn't pass, and it still faces long odds in the Senate if it manages to pass in the House. Peter Weber
Maybe rumors of the American Health Care Act's death were exaggerated a bit. After House Speaker Paul Ryan (R-Wis.) pulled the bill on Friday because his broadly unpopular health-care overhaul plan didn't have enough Republican votes to pass, he called ObamaCare "the law of the land" for the visible future and the White House said it is ready to move on to tax reform and other issues. On Monday afternoon, however, Ryan told a group of donors that he will continue to push forward on health care "on two tracks," as the GOP pursues other parts of its agenda, according to The Washington Post, which obtained a copy of the call.
House Republicans have sent mixed messages as to whether they will try to tinker with the AHCA or start over, and Ryan did not divulge any details to his political operation's donors. But he said he plans to outline his plans to Republican donors at a retreat in Florida on Thursday and Friday. "When we're in Florida, I will lay out the path forward on health care and all the rest of the agenda," Ryan said. "I will explain how it all still works, and how we're still moving forward on health care with other ideas and plans.... It will be good to look at what can feasibly get done and where things currently stand. But know this: We are not giving up."
Ryan laid blame for the AHCA's defeat on members of the far-right House Freedom Caucus, not mentioning at least 25 other House GOP members who said they would vote no, too. He said he met with President Trump on Monday and separately with Vice President Mike Pence, Health and Human Services Secretary Tom Price, and White House Chief of Staff Reince Priebus, describing his relationship with the White House as closer than ever. "We're not going to just all of a sudden abandon health care and move on to the rest," he said. "It's just that valuable, that important." Ryan had counted on the AHCA tax cuts to allow him to cut taxes deeper and more permanently later in the year. Peter Weber
House Republicans plan to hold a vote on the American Health Care Act on Friday, probably in the late afternoon, and they are apparently still tinkering with the legislation. On Thursday night, President Trump sent White House budget director Mick Mulvaney to Capitol Hill with an ultimatum: He would agree to no more changes, the dealmaking is done, and House Republicans can take it or live with ObamaCare. House Freedom Caucus chairman Rep. Mark Meadows (R-N.C.) wasn't buying it. "Anytime you don't have 216 votes, negotiations are not totally over," he said.
So what will be in the final bill? House Republicans already started amending the original bill on Monday, agreeing to moderate-wooing sweetheart deals for upstate New York and Illinois, a quicker end to the Medicaid expansion, an option to let states require able-bodied Medicaid recipients to work in order to get benefits, $85 billion set aside to possibly help people 50 to 64 afford insurance, and other changes to win over holdouts.
The House Rules Committee is meeting Friday morning to discuss more amendments, notably one filed Thursday night by House Speaker Paul Ryan (R-Wis.). According to Catherine Reynolds at CBS News, the four-page amendment would scrap ObamaCare's 10 "essential health benefits" that every insurance plan must offer — a key demand of the Freedom Caucus — and let states decide what insurance companies have to cover for individual plans; add $15 billion more to a "stability fund" that will help states subsidize coverage for benefits dropped by insurers, most likely maternity care, substance abuse treatment, and mental health services; and delay the repeal of a 0.9 percent Medicare tax for wealthy Americans until 2023.
The heart of the bill remains — repealing the individual mandate that all adults have health care, scrapping subsidies that help most individual insurance buyers for less-generous tax credits, making significant cuts and changes to Medicaid, allowing insurers to charge older people more, pulling funding for Planned Parenthood, and repealing taxes on health companies. "In my district right now, there's a lot of misunderstanding about what it is we're doing, and once we get it done," Rep. Chris Collins (R-N.Y), one of Trump's biggest backers in the House, told MSNBC on Thursday, "then we can have the chance to really explain it." Peter Weber
Considering the grief and political attacks congressional Democrats have weathered over ObamaCare from their Republican colleagues for seven years, perhaps a little schadenfreude is to be expected now that Republicans are rushing headlong into the health-care buzzsaw. The Democrats on the House Ways and Means Committee seem to have taken the lead in rubbing it in on Thursday.
They started with a dig at the GOP disarray, using the old throwback Thursday hashtag to remind Republicans of the "UNITY" they had all the way back in November:
— Ways and Means Dems (@WaysMeansCmte) March 23, 2017
Then there was the alternative acrostic for American Health Care Act:
— Ways and Means Dems (@WaysMeansCmte) March 24, 2017
And what internet trolling session would be complete without animated GIFs?
— Ways and Means Dems (@WaysMeansCmte) March 23, 2017
— Ways and Means Dems (@WaysMeansCmte) March 24, 2017
The House Republicans wanted to repeal ObamaCare on the seventh anniversary of it being signed into law, and failed, even after trying to borrow tactics they ascribed to the Democrats. They may push through the latest version of the ACHA on Friday. But on Thursday, a little mockery seems fair. Peter Weber