WASHINGTON -- The Senate Republican plan for a scaled-back overhaul of the Affordable Care Act was headed for a cliffhanger vote when House Republican leaders said late Thursday that they were willing to use the proposal as a basis for negotiating a broader rollback of the law.
After a two-hour standoff, House Speaker Paul Ryan, R-Wis., issued a measured statement expressing openness to a House-Senate conference that many rank-and-file Republican senators have demanded as a condition for backing "skinny repeal" legislation that has little substantive appeal to them.
Ryan's statement came as the Senate prepared for a marathon session of votes on health-care legislation that was expected to begin late Thursday and extend into Friday morning. The speaker also scheduled a pivotal meeting with his House caucus Friday to hash out the Senate's demands.
"If moving forward requires a conference committee, that is something the House is willing to do," Ryan said. "The House remains committed to finding a solution and working with our Senate colleagues, but the burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise."
Although the statement could ease tensions, it remained to be seen whether it will be enough to win over a bloc of Senate Republicans who earlier had declared the proposal "terrible."
"I would like to have the kind of assurances he didn't provide," Sen. John McCain, R-Ariz., told reporters.
Sen. Lindsey Graham, R-S.C., left open the possibility that he could be swayed by further talks, telling reporters he did "not yet" support the measure.
Earlier, McCain, Graham and Sen. Ron Johnson, R-Wis., convened a news conference as part of an extraordinary spectacle that highlighted the extent to which Republicans are struggling to reconcile their desire to tear down President Barack Obama's landmark 2010 law with their inability to unite behind a replacement.
Republicans have been promising for seven years to repeal the Affordable Care Act (ACA) but never had a Republican in the White House to carry out their demands - until President Trump began urging lawmakers via speeches and tweets to send him something to sign.
McCain, Graham and Johnson - who could collectively defeat the Senate plan - said their support for a skinny repeal must not be used to trigger a hasty House vote before members head home for their August recess.
The commitment from Ryan alone wasn't enough for McCain or Graham. McCain said Ryan's statement did not go far enough to ensure that the legislation under consideration by Senate leaders would never pass the House.
"If I don't get those assurances, I'm a 'no,' because I'm not going to vote for a pig in a poke," Graham said. "I'm not going to vote for a bill that is terrible policy and horrible politics, just because we have to get something done."
Many conservatives in both chambers object to the measure, which would remove key insurance mandates and make a handful of other changes, because they say it wouldn't go far enough in repealing the ACA.
But, with lawmakers unable to agree on anything broader, it has become a last resort for Senate Majority Leader Mitch McConnell, R-Ky., to keep alive a longtime GOP promise. McConnell sent an email to Republican senators Thursday outlining the details of a skinny repeal.
The legislation would eliminate the law's requirement that Americans obtain insurance or pay a tax penalty, and would suspend the mandate that companies employing 50 or more workers provide coverage for at least five years.
The measure also would eliminate funding for preventive health care provided under the 2010 law and block Medicaid recipients from being reimbursed for Planned Parenthood services. Finally, it would provide states more flexibility in how they administer their Medicaid programs under the law's waiver program.
While the revamped health-care bill is more modest than earlier versions, it still would have a major effect on the individual insurance market. Eliminating the ACA's individual mandate could transform the makeup of those buying coverage, causing the premiums for those remaining in the system to rise significantly.
Sara Rosenbaum, a health law and policy professor at George Washington University, said the bill would make "enormous" changes to both private and public insurance.
A preliminary Congressional Budget Office estimate has found that 16 million people would lose coverage and that premiums would rise 20 percent if Republicans enacted a handful of the policies included in the pared-down repeal bill.
Major insurers are warning that the proposal could destabilize the individual insurance market. Blue Cross Blue Shield Association criticized it on Wednesday, and on Thursday the industry's largest trade group suggested it was unacceptable.
"We would oppose an approach that eliminates the individual coverage requirement, does not offer continuous coverage solutions, and does not include measures to immediately stabilize the individual market," America's Health Insurance Plans wrote in a letter to Senate leaders.
Senate Republicans, however, framed the bill as just a vehicle to keep alive their ACA repeal efforts.
"My sense is people aren't so much focused on the substance as they are this being the lifeline to get to a conference and expanding the bill," said Sen. Bob Corker, Tenn.
And Sen. Rob Portman, Ohio, tweeted, "I will support legislation to move this process to a House-Senate conference because I believe we need to repeal and replace Obamacare."
Before Ryan issued his statement, the prospect of an immediate up-or-down vote in the House raised alarms in the Senate. House Republican leaders instructed their members not to leave town for their month-long summer recess just yet.
"Members are advised that - pending Senate action on health care - the House schedule is subject to change. All Members should remain flexible in their travel plans over the next few days," said the office of House Majority Leader Kevin McCarthy, R-Calif.
Key House conservatives said they would not back a skinny repeal in its current form. Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus, said that he wouldn't vote for such a measure and that he didn't think other conservatives would, either.
"My nose would say that there's enough that it would lack the support," he told reporters.
Speaking on the Senate floor Thursday, McConnell emphasized that the votes this week would not reverse the ACA even if they culminate in the passage of a bill.
"One phase of that process will end when the Senate concludes voting this week, but it will not signal the end of our work. Not yet," he said.
Democrats, meanwhile, decided to save their political ammunition until Republicans revealed the substance of the skinny repeal measure.
Senate Minority Leader Charles Schumer, N.Y., said Thursday morning that Democrats will offer no more amendments until that point to prevent Republicans from claiming that their final bill was the product of extensive Senate deliberations.
Schumer said that if a skinny repeal passes, the Senate should be prepared for "numerous" Democratic amendments, which could force Republicans into politically tough votes.
In an effort to muster enough votes for a narrow bill, GOP leaders suggested that even some proposals that have died in the Senate could resurface once senators enter negotiations with the House. And some members tried to add a few more provisions to the skinny bill, using their leverage to try to strengthen their negotiating positions in conference.
Portman was pushing for the inclusion of $45 billion to treat opioid addiction, Republicans familiar with the talks said Thursday. It was unclear whether the funding would be included, given the bill's budget constraints.
While McConnell has led the negotiations over health-care legislation for weeks, Trump has sought to drum up support by pressing wavering Republicans.
Interior Secretary Ryan Zinke called Sens. Dan Sullivan and Lisa Murkowski, both Alaska Republicans, separately Wednesday to warn them that the administration may change its position on several issues, according to people briefed on the conversations, given Murkowski's vote against proceeding with health-care legislation this week.
Since Trump took office, Interior has indicated that it is open to constructing a road through the Izembek National Wildlife Refuge and drilling in the Arctic National Wildlife Refuge while expanding energy exploration elsewhere in Alaska. But now these policy shifts may be in jeopardy.
Speaking to reporters Thursday, Sullivan said the Trump administration has previously been cooperative on Alaska issues with Murkowski, who chairs the Senate Energy and Natural Resources Committee.
"From my perspective, the sooner we can get back to that kind of cooperation between the administration and the chairman of the ENR Committee, the better for Alaska and the better for the country," he said. Sullivan said he is not telling Murkowski how to respond.
The Alaska Dispatch News first reported the calls; Interior officials did not respond to a request for comment.
As Republican senators prepared to plow ahead toward a final vote on the skinny repeal plan, the divides that have plagued their effort for months were still present Thursday, leaving open the possibility that new roadblocks could still emerge.
"I think there's a lot of debate going on," said Sen. Orrin Hatch , R-Utah.
The Washington Post's Paul Kane, Dino Grandoni, Mike DeBonis and Tory Newmyer contributed to this report.
WASHINGTON - The cinematic infighting that has consumed the White House in recent days was pushed into public view on Thursday, exposing the West Wing as the political equivalent of a New York-accented reality television show that runs on a raucous mix of drama, machismo and suspicion.
The new communications director - Anthony Scaramucci, a flashy New York financier who brags that he and Trump "started out as friends" - has been trying to oust White House Chief of Staff Reince Priebus in a foul-mouth campaign fueled by months of brewing animus. Scaramucci accused Priebus of leaking to the media about behind-the-scenes maneuverings and his own personal finances, but his broader intent is to purge senior advisers and low-level staffers who he suspects are not adequately loyal to President Donald Trump.
In an interview with The New Yorker published Thursday, Scaramucci called Priebus a "f----- paranoid schizophrenic, a paranoiac" and claimed that the former Republican Party chairman will "be asked to resign very shortly" in a sweep that he warned could eventually involve much of the staff.
The New Yorker interview gave voice to the profane intensity of the warring West Wing factions that has defined much of Trump's early administration - but the level of candor and raging frustration Scaramucci expressed yet again stunned a Washington political class that has become increasingly inured to the unorthodoxy of this White House.
At one point in the interview, Scaramucci switched to speaking in the third-person while trying to make his mission clear.
"O.K., the Mooch showed up a week ago," he said. "This is going to get cleaned up very shortly, O.K.?"
Scaramucci's anger toward Priebus was burning long before he joined the White House this week.
After the election, he sold his company, investment fund SkyBridge Capital, in preparation for a job in the White House, only to be blocked by Priebus. Scaramucci was later shuffled into a position at the Export-Import Bank, where he plotted his next move. Last week, Trump surprised Priebus, Bannon and others by announcing that Scaramucci would become the next White House communications director - news that prompted press secretary Sean Spicer, Priebus' closest ally, to resign.
Priebus is considered an establishment figure in a sea of nontraditional White House staffers, and he has long faced criticism from some of Trump's staunchest allies who view him as ill-prepared for the job and too concerned about his own reputation. But the attacks that had been quietly waged against him for months in behind-the-scenes trash talk are now being spoken aloud by Scaramucci, who claims he has the president's blessing to do so.
In the expletive-filled interview with the New Yorker, Scaramucci presented himself as someone who is fully dedicated to the president. He accused Stephen Bannon, Trump's chief strategist, of trying to build his "own brand off the f------ strength of the president."And he angrily lashed out at Priebus for blocking him from the White House for six months and accused him of leaking the details of a Wednesday night dinner with Fox News personality Sean Hannity at the White House to a reporter.
"What I want to do is I want to f------ kill all the leakers, and I want to get the president's agenda on track so we can succeed for the American people," Scaramucci said.
After the article was published, Scaramucci sought to shrug off the controversy with a tweet: "I sometimes use colorful language. I will refrain in this arena but not give up the passionate fight for @realDonaldTrump's agenda. #MAGA."
The White House at first seemed unfazed by the article or unsure of how to respond. Incoming press secretary Sarah Huckabee Sanders pointed reporters to Scaramucci's tweet and said "we're working on health care."
Spicer, who will soon leave the White House, walked by reporters staking out his office and passed on the opportunity to comment.
But by early Thursday evening, Sanders spoke to reporters outside the West Wing saying Scaramucci has "made pretty clear he's a passionate guy. I think he might sometimes let that passion get the better of him. I think maybe that happened and he used some colorful language that I don't anticipate he'll do again."
Asked if Trump needs to step in to referee the infighting on his staff, she touted the president's business career and said, "I think he knows when he needs to play a role and when he does, he will."
Scaramucci took over the communications job on Wednesday, even though he wasn't supposed to start until Aug. 15 - a move that a White House official said was designed to thwart any attempt by Priebus to derail Scaramucci yet again.
Scaramucci and his allies are compiling a diagram of the news organizations that they suspect received leaked information from Priebus, and they plan to present it to the president on Friday, according to a White House official who asked for anonymity to discuss the secret plan of attack.
"If Reince wants to explain that he's not a leaker, let him do that," Scaramucci said in an interview with CNN early Thursday morning.
On Fox News that same morning, Kellyanne Conway, a senior counselor to the president, described the leaks that Scaramucci was ranting about as "people using the press to shiv each other in the ribs."
As all of this was playing out, few came to Priebus' defense. House Speaker Paul Ryan, a longtime friend and fellow Republican from Wisconsin, said at a news conference on Thursday that "Reince is doing a fantastic job at the White House, and I believe he has the president's confidence."
Former House speaker Newt Gingrich, who has informally advised Trump on his feud with Attorney General Jeff Sessions this week, was one of the few Trump allies to come to Preibus' defense on Thursday.
"My advice to Reince is just do your job," Gingrich said. "Ignore the noise. Assume it's noise. He's the chief of staff, and he's the chief of staff until he isn't."
At the White House press briefing on Thursday afternoon, reporters asked Sanders three times if the president still has confidence in his chief of staff. She would not directly answer.
"We all serve at the pleasure of the president, and if he gets to a place where that isn't the case, he'll let you know," Sanders said.
A Republican who is in close contact with those at the White House rated Priebus's job security in this way: "On a scale of 1 to 10, it's a 2."
Priebus attended a medal of valor ceremony at the White House Thursday where he was seen smiling broadly and applauding as Trump entered East Room. When the president left the event he appeared to briefly shake hands with his chief of staff who clasped Trump's right shoulder with his left hand.
Since being named the new communications director last week, Scaramucci has taken a very Trumpian approach to the job - blowing a kiss during a press briefing on Friday, sparring with a BBC reporter over whether the president is elitist, threatening to fire his entire staff, cursing and unexpectedly calling into a morning talk show. While this might appear out of control, it creates the sort of must-watch drama that delights the president.
On Wednesday night, Scaramucci had dinner at the White House with the president, first lady, Hannity and former Fox News executive Bill Shine to discuss how best to overhaul the West Wing staff. New Yorker's Ryan Lizza tweeted about the dinner, prompting an angry call from Scaramucci, who wanted to know Lizza's source.
"You're an American citizen, this is a major catastrophe for the American country. So I'm asking you, as an American patriot, to give me a sense of who leaked it," Scaramucci said to Lizza.
Scaramucci was also angry that Politico reported on the financial disclosure form he filed while at the Export-Import Bank, which showed that he stood to continue to receive profits from his former company. Politico reporter Lorraine Woellert, who wrote the article, said she obtained the document - which is considered a public record - by simply requesting it from the agency.
Scaramucci told Lizza that he thought Priebus had leaked it and that he had called the FBI and the Department of Justice.
"Are you serious?" Lizza asked.
Soon after their conversation, Scaramucci made his suspicions public in a tweet and tagged Priebus: "In light of the leak of my financial disclosure info which is a felony. I will be contacting @FBI and the @TheJusticeDept #swamp @Reince45."
In an unusual move, the spokeswoman for the Department of Justice and Attorney General Jeff Sessions - whom Trump has repeatedly attacked this week for not investigating reports of leaks - released a late-night statement pledging that Sessions "will aggressively pursue leak cases wherever they may lead."
Two hours after Scaramucci posted the tweet, he deleted it.
The next morning, Lizza appeared on CNN's "New Day" to share some details from the night before - and he was suddenly cut short by a call from Scaramucci, who wanted to explain himself.
"Yeah so, when I was speaking to you last night, Ryan, I said it was unpatriotic that you weren't telling me who the leakers were . . . And so you may have caught it the wrong way," Scaramucci said, as if having a private conversation with Lizza. "I was teasing you, and it was sarcastic. It was one Italian to another."
Chris Cuomo, one of the show's hosts, tried to take the interview back over, and Scaramucci acknowledged that the financial disclosure was actually a public record - but he repeatedly railed against those in the White House he believes are leaking information.
"I told the president this morning, 'When the iceberg hits the boat, the rats are flying up from steerage.' Right? Because the water comes in steerage," Scaramucci said, comparing the White House to a sinking ship. "So when you mention the FBI and the Department of Justice, you watch how the rats lift in the boat."
Scaramucci claimed that he tagged Priebus in the late-night tweet so that he could investigate the leak, but he also said that journalists assumed he was blaming Priebus because they "actually know who the leakers are."
"So if Reince wants to explain that he's not a leaker, let him do that," Scaramucci said.
Scaramucci also said that he doesn't know if his relationship with Priebus, which last week he insisted was just fine, can ever be repaired.
"We have had differences. When I said we were brothers . . . that's because we're rough on each other. Some brothers are like Cain and Abel, other brothers can fight with each other and then get along," Scaramucci said, referencing the biblical brothers without mentioning that Cain murdered Abel. "I don't know if this is repairable or not - that will be up to the president."
Later in the morning, The Washington Post asked Scaramucci if Trump had authorized him to call into CNN to discuss Priebus and the leaks, and Scaramucci responded: "He did, yes."
The Washington Post's Abby Philip contributed to this report.
Video: Newly appointed White House communications director Anthony Scaramucci is trying to "undercut" leaks coming out of the divided camps within the Trump administration, and turned his ire on chief of staff Reince Priebus on July 27. (Jenny Starrs/The Washington Post)
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