WASHINGTON—For the House Republicans who have never served under a Republican president—roughly two-thirds of them—the vote scheduled for Thursday on a measure that would replace President Barack Obama’s signature health-care law with their own party’s version is a legislative fantasia, the culmination of seven years of campaign promises impeded by Obama’s veto pen.
But weeks of backroom machinations to bring a disparate group of lawmakers on board have left many Republicans with an excruciating choice: Pass a bill with an extremely limited constituency that could well wreak havoc with their own voters, and with Republicans’ reelection prospects, or vote it down, undermining President Donald J. Trump’s agenda.
House Speaker Paul Ryan said on Wednesday that he was confident the House would pass the bill. But as of late Wednesday, roughly 30 Republicans had said they either would vote against the measure or had not made up their minds. That left the bill’s sponsors short of the 216 votes needed, and on Wednesday night Ryan held a meeting in the Capitol to try to win over skeptics.
If House Republicans reject the measure, the working relationship between the White House and Republican leaders in Congress, still in its infancy, will suffer a powerful blow.
In Washington failure often begets more failure, as opposition forces strengthen, alliances fragment and the thin foam of bipartisanship evaporates.
“How do we have any momentum to do anything else?” asked Rep. Richard Hudson, Republican-North Carolina. “Without this bill, I don’t know how you do tax reform,” he said. If the bill fails, “it’s going to have negative repercussions for all of us.”
Trump, a man who rushes to hang his name in gold anywhere he can, has rejected the nickname that some have given the House bill: Trumpcare.
But he has begun a last-minute campaign to both sweet talk and vaguely threaten fellow Republicans into supporting the leadership’s hastily written bill, though the measure, which would replace the Affordable Care Act’s health insurance mandate and generous subsidies with tax credits to buy insurance, has been criticized by the right and the left.
Trump met with a group of the most conservative House members at the White House on Wednesday, and Republican leaders are depending on him to finish the job. Indeed, this week many Republicans have begun to acquiesce to his and the House leadership’s desires, accepting that the bill, however flawed, is the best they are going to get.
At least for now, though, too many have not.
“The bill maintains Obamacare’s overall structure and approach, an approach that cements the federal government’s role in health insurance,” said Rep. Rick Crawford, Republican-Arkansas, an opponent of the bill who represents the concerns of the conservatives.
Other more moderate members expressed opposite objections. “Under the current proposal, many South Jersey residents would be left with financial hardship or without the coverage they now receive,” said Rep. Frank A. LoBiondo, Republican-New Jersey. “Our seniors on Medicare already struggle to make each dollar stretch.”
Some Republican leaders and those charged with drumming up votes suspect that some of the more conservative members are simply trying to force Ryan to cancel a vote on the bill so they do not have to go on record against Trump. But moderates may feel the pressure of voters: Large protests against the bill are planned for Thursday.
Further hampering them, House Republicans failed to do the grueling work of building a coalition outside Washington as Democrats did with the Affordable Care Act in 2009.
While anti-abortion groups have warmly embraced the bill, which could restrict coverage of the procedure, it lacks other advocates. Doctors, nurses and hospitals have come out strongly against the measure, and insurance companies have been largely skeptical.
Even if Ryan manages to secure the bare minimum of votes required, the bill that would pass the House would not become law. The Senate expects to make significant changes in the legislation, dragging out the process deep into the spring, if it can pass any version at all.
Senate Republicans, largely those from states that chose to expand their Medicaid programs under the Affordable Care Act, so far have not seemed susceptible to pressure from leaders and Trump, listening instead to governors and constituents concerned about significant reductions in benefits.
Part of the bill’s problem is time itself. Much has changed in the years since the Affordable Care Act passed, with millions of Americans, many in red states, now getting health insurance as a result of the law, as well as treatment for the prescription drug addictions that have plagued scores of communities.
“My goal for this whole process was to help the people the law harmed and not harm the people it helps,” said Rep. Dan Donovan, Republican-New York. At the same time, a fair number of conservatives would like to see those benefits greatly reduced, the central tension of the Republican debate.
As a result, it remains difficult to imagine a bill that could find its way out of the Capitol to Trump’s desk, given the broad disparities in what Republicans now seek.
Image credits: Gabriella Demczuk/The New York Times