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Trump calls House health bill that he celebrated in the Rose Garden ‘mean’

President Trump and Sen. Joni Ernst (R-Iowa) talk Tuesday at a lunch with 13 Republican senators at the White House. (Jabin Botsford/The Washington Post)

President Trump told Republican senators Tuesday that the House GOP health-care bill was “mean” and he expects the Senate to “improve” the legislation considerably, according to several Republicans familiar with the gathering.

Trump’s comments, during a White House lunch with a group of 15 GOP senators from across the ideological spectrum, signaled that he may be willing to embrace a less-aggressive revision of the Affordable Care Act than Republicans have previously promised.

The meeting came as Senate Republicans were struggling to build support for their health-care rewrite among conservatives who are concerned that the legislation is drifting too far to the left.

Trump’s labeling of the House bill as “mean” was a significant shift of tone that followed months of private and public negotiations, during which he called the bill “great” and urged GOP lawmakers to vote for it. Following the House vote, Trump hosted an event in the Rose Garden to celebrate its passage.

Senate Republican Conference Chairman John Thune (R-S.D.), who attended the lunch, said Trump talked about “making sure that we have a bill that protects people with preexisting conditions” and how to design a tax credit for purchasing insurance that works for lower-income and elderly people in particular.

“I think he realizes, you know, our bill is going to move, probably, from where the House was and he seems fine with that,” Thune said. “He talked about making sure that we have a bill that protects people with preexisting conditions.”

Following the meeting, several top Republicans sought to temper expectations that leaders could produce a final health care draft by the end of the week, as had previously been expected. Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) told reporters that Trump was positive and the talks were productive, but he laughed when asked if he expected a bill would be complete by Friday.

“I don’t think so,” Hatch said.

Senate Majority Leader Mitch McConnell (R-Ky.) also declined to say whether the Senate would hold a vote on the bill before the July 4 recess, as some in Senate leadership have aspired to do.

“Our goal here is to move forward quickly,” McConnell told reporters. “The status quo is unsustainable. We all know something has to be done.”

Senate Republicans have struggled in recent weeks to reach consensus over how to cover more low-income people and protect people with preexisting conditions without driving up the cost of their health-care bill. Leaders have signaled that they are willing to expand tax credits and provide a longer transition for states that expanded Medicaid under the ACA.

But those changes risk alienating conservatives who are under intense pressure from voters and outside groups to demand a more forceful repeal of the law known as Obamacare. A growing number of conservatives, including Sens. Mike Lee (R-Utah), Ted Cruz (R-Tex.) and Rand Paul (R-Ky.) have been calling on Senate leaders to maintain House-passed reforms, including a waiver that could allow insurers to charge more for people with preexisting conditions. They argue that waiving those requirements would allow states to offer cheap, bare-bones plans and drive down the cost of premiums across the individual insurance markets.

Conservatives are also frustrated that Senate leaders are mulling plans to make tax credits for buying insurance more generous for low-income people. Leaders have openly discussed a plan to peg the value of the tax credit to the age and income of a person, a change from the House plan to adjust the credits based on age but not income.

A group of moderates, led by Sens. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio) are also demanding that the legislation include $45 billion over 10 years to help address opioid addiction. Capito told reporters Tuesday that the opioid fund is among her top priorities.

“It’s absolutely critical to my state, and we’ve got huge problems,” Capito said. “Obviously Sen. Portman’s been very forceful here — we’ve got the same issues, if not worse.”

Moderates, including Capito, have held great sway in the discussions as Senate leaders worked to secure the 50 votes necessary to pass a health-care bill. McConnell can afford to lose only two GOP votes on the bill.

Their push to extend coverage comes as the Office of the Actuary for the federal Centers for Medicare and Medicaid Services issued an analysis that predicted the House bill would cause nearly 13 million more Americans to become uninsured over the next decade. The forecast is bright news for the GOP following a more dire prediction three weeks ago from the Congressional Budget Office that 23 million more Americans would be uninsured as a result of the legislation.

The study estimates that the House bill would also reduce federal spending by $328 billion over 10 years, compared with $119 billion in the CBO analysis.

Amy Goldstein and Paige Winfield Cunningham contributed to this report.

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