Trump and his team did not outright reject changes on at least three components of the GOP’s American Health Care Act, said some of the meeting’s attendees, speaking on the condition of anonymity. One idea was accelerating the timetable for key changes to Medicaid under the House GOP plan from 2020 to 2018.
Thirty-one states plus the District of Columbia accepted Medicaid expansion under the Obama administration’s Affordable Care Act. The House GOP plan would restrict Medicaid payments starting in 2020.
Another change that some of the conservative leaders want to see take effect more swiftly — in 2018 instead of 2020 — is a proposal in the House GOP plan to allow insurance companies more freedom in the types of coverage they can offer Americans. One of the meeting’s attendees said Trump and his team seemed open to this idea.
Leaders of the Club for Growth, the Heritage Foundation, Heritage Action for America, Americans for Prosperity, Tea Party Patriots, and FreedomWorks all participated in the meeting, joined by White House staff including Chief of Staff Reince Priebus, White House Budget Director Mick Mulvaney, chief strategist Steve Bannon, senior adviser Kellyanne Conway and legislative affairs director Marc Short.
The White House did not comment directly the content of the meeting, but noted generally that it is reaching out to various coalitions as it works with Congress to repeal and replace the ACA. Shortly after the meeting ended, Trump’s social media manager tweeted out a black-and-white photo.
A third tweak Trump and his team seemed at least open to, attendees said, was raising the cap on how much money people can put into tax-exempt savings accounts for health-care costs, going further than the House GOP proposal. And as he’s done in public, Trump stressed that the bill represented the first in three phases to “repeal and replace,” followed by regulatory changes from the Department of Health and Human Services and legislation passed through the Senate’s normal legislative process.
One element of the House bill that Trump and his team appeared unwilling to overhaul are the age and income-based tax credits in the House proposal designed to replace federal insurance subsidies in the Affordable Care Act. Some conservatives have said they amount to a new and unnecessary entitlement program.
Mulvaney gave an “impassioned” explanation in the meeting for why the credits are necessary in the context of the repeal-and-replace strategy Republicans have adopted, one attendee said.
David McIntosh, president of the Club for Growth, said Trump used the 45-minute meeting to convince conservatives that a real strategy for repealing the ACA was in place. The Club had denounced the AHCA, saying it did nothing to legalize the purchase of insurance plans across state lines; Trump emphasized that such deregulation could only be done in a stand-alone bill.
“The president asked us: ‘Don’t be doom and gloom, and against getting this done,'” said McIntosh. “He emphasized that there will be three phases to this, and he said ‘I wish they’d done a better job; then maybe you’d have realized some of your issues are being taken care of.'”
The “they,” in that case, were House Republicans who had rolled out a bill that alienated not just the conservative groups but the AARP, the AMA and a small constellation of retirement and insurance coalitions.
“I‘m most optimistic that they’re actually pushing back in the House and ultimately in the Senate to improve the bill,” said McIntosh. “They’re not saying that in public, but they’re negotiating.”
But the meeting, said attendees, did not end with any of the critics dropping their previous worries about the bill. “It was cordial,” said TPP’s Jenny Beth Martin. “I left encouraged because the president is listening to us, [but] I don’t believe we left that room with any order from him to do anything.”
Trump also mentioned centrist Democratic senators from red states up for reelection in 2018. Their support might be key in future changes to the law — the “third phase” — though none are inclined to support the AHCA. Trump noted that he performed well in the Democrats’ states and was up to the task of swaying them to come around on health-care reform, the attendees said. And Trump returned to an argument he made at the Conservative Political Action Conference, that the failure of a Republican bill could and would allow the ACA’s problems to be blamed on Democrats.
So far this week, conservative groups have not embraced that argument — or let Republicans off the hook. By Tuesday, FreedomWorks was already running social media ads attacking the bill as “RyanCare,” illustrated with a doctored photo of the speaker of the House getting cozy with former president Barack Obama.
But as of Wednesday afternoon, Republican vote-counters were confident that there was not enough genuine conservative opposition to the bill to grind it down. One staffer suggested that FreedomWorks et al needed to remain in opposition mode, or they’d lose their argument to activists and donors — a common Republican gripe about the outside groups.
Also among the critics: Breitbart News. The site, run by White House political strategist Steve Bannon until 2016, has gone all-in against the AHCA, describing it as “Ryancare” and leading for much of Wednesday with an interview with AHCA critic Sen. Rand Paul (R-Ky.).
“Many Republican offices outside the House Freedom Caucus privately tell Breitbart News that as many as 70 or more House Republicans are opposed to Ryan’s plan,” wrote reporter Matt Boyle, who reportedly was on the receiving end of a rant from Bannon last month. “Leadership knows this too, they say, as all the “hard no” votes have told the Speaker’s office or the whip teams they cannot vote for this bill.”