Health bill's supporters press for votes

GOP talks seen as ‘encouraging’

House Speaker Paul Ryan discusses the GOP health care plan Wednesday on Capitol Hill. In a radio interview that day, Ryan called opposition to the plan part of “the tempest of the legislative process.”
House Speaker Paul Ryan discusses the GOP health care plan Wednesday on Capitol Hill. In a radio interview that day, Ryan called opposition to the plan part of “the tempest of the legislative process.”

WASHINGTON -- The Republican health care overhaul spearheaded by House Speaker Paul Ryan and backed by President Donald Trump suffered another setback Wednesday as personal appeals by both the president and vice president failed to sway conservatives to back the bill.

In a last-ditch effort to persuade key GOP opponents of the bill to stand down, Vice President Mike Pence huddled with members of the conservative House Freedom Caucus in his office Wednesday morning, and Trump met with 18 House Republicans at the White House.

Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, said he had taken personal calls Wednesday from Trump seeking a resolution, though he said no formal offer had been extended by the White House.

"We are working very diligently tonight to try and get there," Meadows said Wednesday. "Tonight is an encouraging night, but I don't want to be so optimistic as to say the deal is done."

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Rep. Trent Franks, R-Ariz. said: "The president has been profoundly engaged. I think things are going in a very good direction right now."

At the same time, three more Republican moderates -- Reps. Frank LoBiondo of New Jersey, Daniel Donovan of New York and David Young of Iowa -- announced their opposition Wednesday, increasing pressure on leaders to win over the conservatives.

Late Wednesday night, Ryan, R-Wis., met with more than a dozen members of the moderate Tuesday Group in his office in an apparent bid to curb further defections.

Earlier in the day, Meadows warned of the Freedom Caucus' displeasure. After meeting with Pence in the Eisenhower Executive Office Building, Meadows said the vice president had offered the group "a couple of options" but there was "no official offers tendered on either side."

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For much of Wednesday, a Freedom Caucus spokesman said "more than 25" of the group's roughly three dozen members oppose the bill. And for much of the day, the caucus's message, spokesman Alyssa Farah tweeted, was to "start over."

Including vacancies and expected absentees, the bill would be defeated if 23 Republicans join all Democrats in voting no.

Several Freedom Caucus members leaving the meeting with the vice president said they would not accept the changes floated by Pence, because White House and leadership negotiators were offering to support future changes to the bill once it was considered in the Senate.

"There have been promises of hopes that something constructive might happen in the Senate, but that's after we vote, and that's not going to work," said Rep. Mo Brooks, R-Ala.

Rep. Randy Weber, R-Texas, said White House chief strategist Steve Bannon told them: "We've got to do this. I know you don't like it, but you have to vote for this."

Weber said Rep. Joe Barton, R-Texas, bristled.

"When somebody tells me I have to do something, odds are really good that I will do exactly the opposite," Barton said, according to Weber.

The comment from Bannon came after Trump told a group Tuesday that "many of you will lose your seats in 2018" if Republicans don't pass a health care bill.

"They know," said Rep. Steve Stivers of Ohio, head of the National Republican Congressional Committee, of the looming primary threats. Stivers said he has heard Trump "say things privately" about retaliating against those who oppose the measure. "Every member has their own calculations they have to look at," he said.

Conservatives want to eliminate more of the Patient Protection and Affordable Care Act's insurance mandates, known as "essential benefits," which require plans to include, among other things, mental health, prescription drug and preventive care coverage. That, they argue, is the only reliable way to force down premiums.

Moderates were daunted by projections of 24 million Americans losing coverage in a decade and higher out-of-pocket costs for many low-income and older people, as predicted by the nonpartisan Congressional Budget Office.

No 'Plan B'

Trump made a public pitch for the measure during a panel in the Roosevelt Room with the newly confirmed Centers for Medicare and Medicaid Services director, Seema Verma, and female medical professionals.

After praising the doctors, nurses and health care aides in the room, Trump declared, "Unfortunately Obamacare is making their lives so much more difficult, as you all know. And putting enormous barriers in the way of helping patients, who we are going to help and get this thing done, and get it figured out." Obamacare refers to the Affordable Care Act, signed into law by President Barack Obama in 2010

When a reporter asked whether he would keep trying to overhaul the Affordable Care Act if the House bill failed, the president replied, "We'll see what happens."

White House spokesman Sean Spicer told reporters Wednesday that the bill was picking up supporters and would pass the House, adding there is no "Plan B" if the proposal goes down.

"There is Plan A and Plan A," said Spicer, who described Trump as "the closer" for the deal. "We're going to get this done."

The group of lawmakers that met with Trump included Rep. Rick Crawford, R-Ark.

Crawford was the first member of the Arkansas congressional delegation to oppose the American Health Care Act, warning that the country can't afford another major entitlement program.

In an interview Tuesday, he said his party should be championing smaller government, adding, "Big government under Republicans vs. big government under Democrats is still big government."

Sen. Tom Cotton, R-Ark., also has repeatedly criticized the Republican health care bill since its introduction.

On Tuesday, he said he wouldn't vote for the legislation in its current form and warned that it would fail if brought to the Senate for a vote.

"The House should continue its work on this bill," Cotton said in a written statement. "It's more important to finally get health-care reform right than to get it fast."

Ryan, who hopes to bring the bill to the floor for a vote today, called opposition to the measure part of "the tempest of the legislative process" in a radio interview Wednesday morning with conservative host Hugh Hewitt. He did not rule out that further changes could be made to the bill to win additional votes. But the speaker warned that fulfilling those GOP demands would violate Senate budget rules and leave the bill vulnerable to a blockade by Democrats.

"Our whole thing is we don't want to load up our bill in such a way that it doesn't even get considered in the Senate," Ryan told Hewitt. "Then we've lost our one chance with this one tool we have."

Complications stemming from the bill's last-minute tweaks appeared to add yet another political headache Wednesday, as veterans' groups discovered that the latest draft might make them ineligible for a tax credit. A change made to ensure the measure would comply with Senate rules ensures that individuals can only qualify for the bill's tax credits if they "are not eligible" for other types of coverage, including that provided by the Veterans Health Administration.

In an email, House Ways and Means Committee spokesman Lauren Aronson said the matter would be fixed in subsequent legislation. "This amendment makes no change to veterans' healthcare. In working with the administration and the Veteran Affairs Committee, we will continue to ensure that America's veterans have access to the best care available."

Carlos Fuentes, legislative director for Veterans for Foreign Wars, said veterans want the matter resolved before any bill becomes law. "It would be a huge impact on veterans if this were not corrected," he said.

During the Rules Committee session Wednesday, Republicans acknowledged the legislation would undergo even more changes before it reaches Trump's desk.

"Look, this is a legislative process," said House Ways and Means Committee Chairman Kevin Brady, R-Texas, when asked about the issue by Rep. Tom Cole, R-Okla. "I assume the Senate will continue that improvement process as we hand this ball over to them."

Cole reiterated the point, saying lawmakers in both parties should keep in mind, "This isn't a once and forever bill, or vote, or anything of the kind. ... What we do today isn't going to be the final word.

Information for this article was contributed by Mike DeBonis, Juliet Eilperin, David Weigel, Abby Phillip and Lisa Rein of The Washington Post; by Alan Fram, Ricardo Alonso-Zaldivar, Kenneth Thomas, Vivian Salama, Erica Werner, Matt Daly, Kevin Freking, Jonathan Lemire and Andrew Taylor of The Associated Press; and by Frank E. Lockwood of the Arkansas Democrat-Gazette.

A Section on 03/23/2017

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