Updated on March 23 at 2:13 p.m. ET
House Republicans on Thursday plan to mark the seventh anniversary of the signing of the Affordable Care Act by voting to dismantle the law and reshape the American health-care system.
Well, that’s the plan, at least.
Hours before the scheduled evening roll call, neither party leaders nor rank-and-file lawmakers know exactly what they’ll be voting on. They haven’t posted the final text of the American Health Care Act, they don’t have an updated projection of how it will impact the deficit or the millions of people currently insured under Obamacare, and they haven’t agreed to the rules governing a House debate.
But most ominously for President Trump and Speaker Paul Ryan, Republicans don’t appear to have the votes to pass whatever they put on the floor.
The White House and GOP leaders are still scrambling to assemble a majority, hoping to woo the defiantly conservative House Freedom Caucus with last-minute changes without hemorrhaging support of party moderates. By late Wednesday, leading conservative critics were voicing optimism that Trump would lean on Ryan to broaden the repeal of Obamacare by removing provisions requiring insurance companies to cover maternity care, mental-health treatment, preventive services, and a host of other “essential health benefits” defined in the law. Republican leaders postponed a meeting of their full conference on Thursday morning so the Freedom Caucus could return to the White House for another round of negotiations with Trump. But that meeting yielded no deal, Representative Mark Meadows, the group’s chairman, said afterward, according to the Associated Press. During his briefing Thursday afternoon, Press Secretary Sean Spicer said the White House is nevertheless “very pleased” with the direction Trump’s talks with lawmakers are taking. Asked if there’s a plan in place in case the bill fails, Spicer replied: “It’s gonna pass. So that’s it.”
Lawmakers had hoped to vote by around 7 p.m. on Thursday, but now it may not happen until much later in the evening—if it happens at all. The GOP leadership was meeting early Thursday afternoon inside Ryan’s office to plot their next move.
“Donald Trump seems to be doing everything he can to make this work. He seems to be working a lot harder to get an agreement than leaders in our party,” grumbled Representative Louie Gohmert of Texas, a member of the Freedom Caucus. The group spent most of Wednesday afternoon and evening holed up in an office in the Capitol complex, where Trump phoned in to bargain with Representative Mark Meadows, the caucus chairman.
Yet the leadership’s negotiations with conservatives threatened the support of moderates. Ryan spent more than two hours Wednesday night meeting with more than a dozen members of the centrist Tuesday Group and lawmakers representing swing districts. The pow-wow was inconclusive. The Republicans slipped out of the Capitol without speaking to reporters, and immediately after he left, Representative Charlie Dent of Pennsylvania, a co-chairman of the Tuesday Group, instructed his staff to release a statement formally opposing the leadership’s bill.
“I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals,” Dent said. “We have an important opportunity to enact reforms that will result in real health-care transformation—bringing down costs and improving health outcomes. This legislation misses the mark.” On Thursday morning, another blue-state Republican, Representative Jaime Herrera Butler of Washington state, also pulled her support, citing the bill’s cuts to Medicaid.
The GOP bill, which would replace the ACA’s subsidies with less generous tax credits while repealing its insurance mandates, has run into opposition from across the political spectrum. Aside from the Chamber of Commerce, most industry groups have lined up against it. And despite the president’s hearty support, conservative activists and the billionaire Koch brothers say it falls far too short of a full repeal and have vowed to punish Republicans who support it.
Perhaps the biggest challenge for Republicans is that the bill as written appears to lack any defined constituency in their districts. A Quinnipiac University poll released on Thursday found just 17 percent of respondents supported the American Health Care Act based on what they had heard about it, and opponents outnumbered those in favor by a three-to-one margin. That would make the plan far more unpopular than Obamacare was even at its lowest point. But it jibes with what conservative critics in Congress have reported: For every call they receive in support of the bill, hundreds of constituents are urging them to vote it down. “The people back home are not sold on what we’re doing yet,” Representative Pete Sessions of Texas, chairman of the House Rules Committee, said Wednesday on CNN.
Depending on how many lawmakers vote, Republicans can lose no more than 21 or 22 votes on their side and still achieve a majority. Democrats will vote en masse against the bill. Public whip counts put the defections at well over that number, but party leaders can still cross the threshold if they flip the group of conservative opponents led by Meadows. The bill would still need to pass the Senate, which would be an even more Herculean task for GOP leaders, considering they have a narrow, 52-48 seat majority and several Republicans have also declared the House plan unacceptable.
In a scene reminiscent of the fiscal showdowns of the Obama years, lawmakers were waiting in their offices on Wednesday awaiting news of a deal. One member of the Freedom Caucus, Representative David Schweikert of Arizona, even wandered over to Ryan’s office in the Capitol to ask the assembled reporters what they heard. When they told him there was no news, he began pitching them on his own plan to fix the nation’s health-care system, which the leadership had ignored.
Sidelined from negotiations, all Democrats could do was watch, wait, and try to stoke more public support for a law that is finally gaining in popularity just as it sits on the precipice of repeal. Nancy Pelosi, the former House speaker whose success shepherding Obamacare to passage ultimately helped relegate her to minority leader, mocked Trump and Ryan for stumbling in their headlong rush to schedule a vote before they knew their bill could pass. “Rookie’s error, Donald Trump,” she told reporters Thursday morning. “Rookie’s error for bringing this up on a day when clearly you weren’t ready.”
A day earlier, former Vice President Joe Biden returned to the Capitol to appear with Pelosi and other Democratic leaders at a rally heralding the Affordable Care Act and denouncing the GOP attempts to eviscerate it. “This is not going to pass,” he predicted. And on Thursday, former President Obama issued a rare public statement to commemorate the law that bears his name.
“The reality is clear: America is stronger because of the Affordable Care Act,” he said. The statement continued:
There will always be work to do to reduce costs, stabilize markets, improve quality, and help the millions of Americans who remain uninsured in states that have so far refused to expand Medicaid. I’ve always said we should build on this law, just as Americans of both parties worked to improve Social Security, Medicare, and Medicaid over the years. So if Republicans are serious about lowering costs while expanding coverage to those who need it, and if they’re prepared to work with Democrats and objective evaluators in finding solutions that accomplish those goals—that’s something we all should welcome. But we should start from the baseline that any changes will make our health-care system better, not worse for hardworking Americans. That should always be our priority.
For Republicans, Obama’s statement might serve only to remind them of what they are trying to do—repeal and replace the ACA in accordance with their repeated promises to voters. Despite the defections, Trump and party leaders remain publicly committed to holding a vote Thursday night, even if it means rushing the bill to the floor without a final cost estimate from the Congressional Budget Office. Shortly before midnight, the Rules Committee approved a motion allowing party leaders to bypass a required waiting period and bring up the legislation on the same day they determine the rules for debate. “Call your local representative or senator: Let them know you’re behind our plan,” Trump said in a video posted on Twitter Thursday morning.
He said nothing about what was actually in the Republican bill, and as party leaders spent the day searching for last-minute votes, its fate was anyone’s guess.