President Trump the Capitol Hill dealmaker emerged Friday, playing hardball with uneasy GOP lawmakers as their leaders moved to push the Republican health-care plan through the House next week.
Trump won commitments of support from several members of the conservative Republican Study Committee after he endorsed two changes to the bill affecting Medicaid, the federal health program for the poor and disabled that would see $880 billion in cuts over the next decade under the pending GOP plan.
One would allow states to impose work requirements on childless adults receiving benefits under the program; another would allow them to accept a fixed “block grant” in lieu of the per-person reimbursement they now receive.
Trump declared his unequivocal support for the bill, the American Health Care Act drafted by House Speaker Paul D. Ryan (R-Wis.) and other GOP leaders, signaling that negotiations were coming to an end. House leaders are eyeing a Thursday floor vote.
“I want to let the world know: I am 100 percent in favor,” Trump said. “These folks were no’s, mostly no’s yesterday, and now every single one is a yes.”
At a news conference later in the day, Trump said the bill is “going to be passed” and indicated talks were wrapping up: “It’s coming together beautifully. We have conservative groups, other groups, everybody wants certain things.”
The morning meeting included signs that Trump was relishing a role as high-stakes “closer” as Congress debates his first major piece of legislation — a throwback to his previous careers as a real estate executive and reality-TV star. The stakes for the president are high: Rolling back the Affordable Care Act was a key campaign promise, and the outcome of this battle could affect momentum for his other legislative priorities.
Rep. Mark Walker (R-N.C.), the RSC’s chairman, said Trump asked each of the dozen members who gathered with him in the Oval Office to vote for the bill.
“The president asked us specifically: Would we support him on this American Health Care Act” if the changes were made, Walker said. “We all agreed, to a man.”
More than half of House Republicans belong to the RSC, and while the endorsement of those who attended the White House meeting Friday does not bind the entire group to supporting the bill, it is a sign that the measure is gaining support among rank-and-file Republicans.
“The core of the conference wants to get to yes,” said Rep. Phil Roe (R-Tenn.), a deputy whip. “We’re closer than we were a week ago, I’ll tell you that.”
The bill had been under attack by both conservatives and moderates in recent days, forcing Ryan to allow changes to the carefully crafted legislation to keep it on track for House passage next week. Some Republican senators have raised major concerns about the Medicaid cuts proposed in the bill. But House leaders first need to address rank-and-file conservatives who generally support further scaling back the program.
House Majority Whip Steve Scalise (R-La.), the top GOP vote-counter, would not say whether the changes Trump agreed to would be enough to persuade the necessary 216 Republicans to support the bill, and he acknowledged other tweaks were coming.
“These changes definitely strengthen our number but also show that President Trump’s all-in now,” he said. “Clearly we’re talking to other members about a few other changes that the president would like to add, and we’re going to work through those in the next couple days.”
But it remained far from clear Friday whether the alterations would win over a small but important group of hard-line conservatives who have engaged in a parallel negotiation with the White House in a bid to force more thorough revisions.
The chairman of the House Freedom Caucus said Friday that “there’s not anywhere close to the votes” for the legislation as it is now structured.
“I can assure you that this bill needs to be changed,” Rep. Mark Meadows (R-N.C.) said on C-SPAN’s “Newsmakers.”
But House leaders were heartened that one Freedom Caucus member, Rep. Gary Palmer (R-Ala.), was among those who pledged to support the bill to Trump on Friday. A day earlier, Palmer opposed the bill in a House Budget Committee vote.
Palmer said Friday that the Medicaid changes were enough to convince him: “This will be the most significant entitlement reform that we’ve seen, and I think it not only is going to help states manage their budgets better, but it’s going to allow the states to take care of people much more efficiently and much more effectively.”
Another Freedom Caucus member, Rep. H. Morgan Griffith (R-Va.), said Friday that he was “leaning yes” but also said he was an outlier for the roughly 30-member group. “I do think that they are mostly unified in opposition,” he said.
No Democrats are expected to support the bill, meaning it will fail if more than 21 Republicans oppose it.
It’s not only conservatives who have raised issues. Numerous Republicans across the ideological spectrum say they want changes to the system of tax credits offered to individuals buying insurance under the GOP plan.
Much of the concern was prompted by a Congressional Budget Office analysis issued this week that showed much higher costs for older and low-income Americans — including a roughly eightfold increase in premiums for a 64-year-old making about $25,000 a year.
Ryan told GOP lawmakers in a private meeting Friday that changes to the tax credits are forthcoming. Several other House members confirmed the matter is under review and is likely to be addressed before the measure hits the House floor.
Meadows suggested that the relatively minor changes backed Friday by Trump won’t placate the bill’s most strident critics. Earlier Friday, before Trump made his comments, Meadows said giving states the option of a Medicaid work requirement “doesn’t move the ball more than a couple yards” toward the caucus’s goal.
Nonetheless, conservatives have begun to back away from their urgent demands that House leaders scrap the legislation and start fresh.
Meadows declined to specify what his negotiations could ultimately yield, but the talks included efforts to eliminate specific minimum coverage requirements for insurers and to make Medicaid work requirements mandatory.
The bill cannot be formally changed until the House Rules Committee meets, probably on Wednesday, to consider how it will be presented and debated on the floor. House Majority Leader Kevin McCarthy (R-Calif.) signaled a final vote could come late Thursday.
One open question is whether the nonpartisan CBO analysis of any changes will be made available before final House action.
A CBO estimate issued Monday found that the original measure would reduce the budget deficit by $337 billion over 10 years but also lead to 24 million fewer people having coverage. The changes Trump endorsed Friday could potentially further reduce federal spending but also further increase the number of uninsured Americans.
Asked whether a CBO analysis of the changes would be available, House Rules Committee Chairman Pete Sessions (R-Tex.) said, “I am working off that assumption.” But a senior GOP aide and several other lawmakers said it might not be available.
“You know, sometimes, you just have to vote,” said Rep. Tom Cole (R-Okla.), who noted that the Senate is unlikely to pass the House bill without changes. “It’s an important vote, but it’s not a final vote. That’s the time to get serious.”
David Nakamura, Abby Phillip and Kelsey Snell contributed to this report.