House passage would represent a powerful, if symbolic, achievement for both men — and failure would send leaders back to the drawing board on a key issue that Trump and congressional Republicans promised voters they would address. Even if the House approves the package, the legislation faces an uphill battle in the Senate.
The holdouts are mainly hard-line conservatives who believe that the bill, known as the American Health Care Act, does not do nearly enough to undo the Affordable Care Act passed by Democrats in 2010. But they also include moderates who fear that the bill will imperil their constituents and their party’s prospects at the ballot box.
In a morning address to a closed-door meeting of House Republicans, Trump used both charm and admonishment as he made his case, reassuring skittish members that they would gain seats in Congress if the bill passed.
He singled out Rep. Mark Meadows (R-N.C.), the chairman of the House Freedom Caucus, which has led the right-wing opposition to the bill.
“I’m gonna come after you, but I know I won’t have to, because I know you’ll vote ‘yes,’ ” Trump said, according to several lawmakers who attended the meeting. “Honestly, a loss is not acceptable, folks.”
Trump’s remarks — which Meadows said he took as good-natured ribbing — reflected his mounting urgency to secure a major legislative victory in the early months of his presidency and fulfill a central campaign promise by repealing the signature domestic achievement of President Barack Obama. Passing a health-care measure is key to unlocking momentum for the president’s other legislative priorities, such as tax reform and infrastructure spending.
“He wants to get this bill done,” said Sen. David Perdue (R-Ga.), a Trump ally. “I don’t hear that as a threat. It’s a statement of reality.”
In interviews, more than two dozen lawmakers said they were either firmly opposed to the bill or leaning toward voting against it. Ryan can lose only 21 members of his party for the bill to succeed, as no Democrats have pledged to support the package.
Several Republicans privately said Tuesday that the Thursday vote could be postponed if leaders are unable to secure enough firm votes for passage beforehand.
One top Republican not authorized to speak about the whipping process said the leadership remained confident that it would collect enough support but was weighing scheduling options.
“The White House is engaged, the leadership is engaged, everyone is working together,” the Republican said. “But this is the House GOP, and you can’t assume that it’s going to go perfect. You leave options,” meaning a vote on Friday or even the weekend.
A second Republican, also not authorized to discuss internal deliberations, said others in the leadership orbit were eager to bring the bill to the floor, even if the count is narrow, because they would like opponents to take ownership of their position and the consequences of what it would mean for the president.
Addressing reporters Tuesday, Ryan played down the possibility that the bill could fail Thursday and argued that conservatives should be pleased that many of their demands will probably be in the legislation. Adding further changes, he said, could jeopardize the legislation’s chances in the Senate.
“If you get 85 percent of what you want, that’s pretty darn good,” he said. “We don’t want to put something in this bill that the Senate is telling us is fatal.”
Senate Majority Leader Mitch McConnell (R-Ky.) sounded a cautiously optimistic note Tuesday, promising that the Senate would forge ahead with plans for votes on the measure — if it passed the House first.
“If the House passes something, I will bring it up,” McConnell said. “We’ll try to move it across the floor next week.”
On Tuesday afternoon, Trump hosted more than a dozen members of the Tuesday Group, a moderate House faction, in the Oval Office for a lower-key lobbying session that involved the president asking each person to relay their concerns about the bill.
On Friday, a similar meeting helped Trump win converts among members of the Republican Study Committee, a key conservative bloc. But on Tuesday, he found more resistance.
Going into the White House meeting, Rep. Leonard Lance (R-N.J.) described himself as “a strong lean no,” citing a variety of concerns. “My views are based on fundamentals in the legislation,” he said. “I don’t see the lower premiums in this bill.”
After the meeting, he said his views had hardened: “I’m a no,” he told reporters.
The meeting came less than 24 hours after GOP leaders released changes to the bill that they believe are sufficient to win a House majority.
Many of the changes were made to placate conservatives, including giving states the option to take a fixed Medicaid block grant and to impose work requirements on childless, able-bodied adults covered under the program. Others responded to broader concerns about the sufficiency of the tax credits offered to help Americans purchase insurance.
One revision was more narrowly targeted — added at the behest of a group of Upstate New York Republicans who wanted to end their state’s practice of commandeering local tax revenue to fund state Medicaid benefits.
That compounded the concerns of Rep. Daniel Donovan (R-N.Y.), a Tuesday Group member who represents parts of New York City that would be hurt by the change.
“I have four hospital systems in my district; they are my biggest employers,” he said. “All of them have grave concerns about how they are going to survive if this gets passed.”
After the White House session, Donovan said he welcomed the meeting with Trump but had not reached a final decision: “We’ll know on Thursday. Some of these things have to be addressed.”
One surprising holdout was Rep. Lou Barletta (R-Pa.), who was among the first House members to endorse Trump and has emerged as one of his most stalwart backers. But he is a hard-liner on illegal immigration and cited the issue Tuesday in opposing the bill.
The tax credits offered under the GOP plan, he said, could be claimed by individuals who are not “lawfully in this country and eligible to receive them.”
“I would have a hard time explaining to families in the 11th District . . . why they should be helping to pay for the health expenses of someone who broke the law to get here and has no right to those federal dollars,” he said.
But it was Trump’s warning to Meadows that sent the sharpest message Tuesday. “He was kidding around — I think,” said Rep. Harold Rogers (R-Ky.), a bill supporter.
White House press secretary Sean Spicer said later in the day: “Mark Meadows is a longtime, early supporter of the president. He had some fun at his expense this morning during the conference meeting.”
Asked whether Trump believed that Republicans who opposed the bill would be damaged at the ballot box, Spicer answered: “I think they’ll probably pay a price at home.”
Spicer explained that statement was not a threat but “a political reality.”
Meadows told reporters that he had a “sincere and deep friendship” with Trump and appreciated the many hours of negotiation that were involved in the package. But he remained firmly against the bill absent major changes that Trump and Ryan have now ruled out.
“This is not a personality decision; this is a policy decision,” Meadows said. “It won’t lower premiums, and until it does, I’m going to be a no, even if it sends me home.”
The Freedom Caucus has not taken a formal position to oppose the bill, but it appeared Tuesday that the bulk of the caucus’s roughly three dozen members stood ready to vote it down.
Two caucus members who said they could support the bill — Rep. David Schweikert (R-Ariz.) and Rep. H. Morgan Griffith (R-Va.) — both serve on the committees that wrote it.
The others insisted that the Freedom Caucus would hold fast. “I personally know of more than 21 House members who are pretty strong no’s,” said Rep. Rod Blum (R-Iowa). “So when [GOP leaders] say they’ve got the numbers, they don’t have the numbers.”
Blum said he was not concerned by Trump’s implied threat that he could face an electoral challenge next year if he opposed the bill: Trump won his northeastern Iowa district by three points, but Blum won it by eight points.
“I outperformed the president, so I’m not worried about that,” he said. “They know who I am, and they know that I care about them, and they know I’ll stand up to my own leadership. I’ll stand up to the president of the United States, I’ll stand up for what I think is right.”
David Nakamura, Juliet Eilperin and David Weigel contributed to this report.