WASHINGTON — Republicans muscled their capstone health care overhaul past an initial barrier and toward a climactic roll call Friday, plunging ahead despite uncertainty over whether they had the votes to prevail in what loomed as a monumental gamble for President Donald Trump and his GOP allies in Congress.
With Trump budget chief Mick Mulvaney and other White House officials heading toward the Capitol to lobby wavering lawmakers, Friday’s showdown was occurring after the president warned that he was through negotiating with holdouts. In a message delivered to rank-and-file Republicans at the Capitol late Thursday, top Trump aides said if the measure failed he would move on to the rest of his agenda.
“We’ll see what happens,” Trump said at the White House Friday when asked his course should the measure fail.
In a morning tweet, Trump targeted the House Freedom Caucus, whose hard-right members have been the core of opposition to the GOP legislation and have come under intense pressure from the White House and party leaders to fall into line. The bill would replace major parts of President Barack Obama’s health care law and would block federal payments for a year to Planned Parenthood.
“The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!” Trump wrote.
In the day’s first meaningful roll call, the House used a near party-line 230-194 vote to insert changes into the measure that leaders hoped would win over unhappy Republicans. These included improving Medicaid benefits for some older and disabled people and abolishing coverage requirements that Obama’s 2010 law imposes on insurers.
The GOP bill would eliminate the Obama statute’s unpopular fines on those who do not obtain coverage and the often generous subsidies for those who purchase insurance.
Instead, consumers would face a 30 percent premium penalty if they let coverage lapse. Republican tax credits would be based on age, not income. The bill would also end Obama’s Medicaid expansion and trim future federal financing for the federal-state program and let states impose work requirements on some of its 70 million beneficiaries.
GOP aides were privately saying conservative opposition was softening, yet another moderate announced he would oppose the legislation. Rep. Rodney Frelinghuysen, of New Jersey, chairman of the House Appropriations Committee, said the bill “would place significant new costs and barriers to care on my constituents.”
Friday’s votes stood as the biggest vote to date for Trump and for House Speaker Paul Ryan, R-Wis., both aware that conservatives comprising the heart of their party’s constituency were demanding no less than an all-out assault on Obama’s law.
For Trump, victory would clear an initial but crucial hurdle toward achieving the GOP’s lodestar quest to repeal “Obamacare,” the former president’s 2010 health care overhaul. Defeat could weaken Trump’s political potency by adding a legislative failure to a resume already saddled with inquiries into his campaign’s Russia connections and his unfounded wiretapping allegations against Obama.
In a setback Thursday, leaders abruptly postponed the vote because a rebellion by conservatives and moderates would have doomed the measure. They’d hoped for a roll call Thursday, which marked the seventh anniversary of Obama’s enactment of his landmark health care statute that Republicans have vowed ever since to annul.
The leaders seem to be calculating that at crunch time enough dissidents will decide against sabotaging the bill, Trump’s young presidency and the House GOP leadership’s ability to set the agenda, with a single, crushing defeat.
Even if they prevail, Republicans face an uphill climb in the Senate, where conservatives and moderates are also threatening to sink it the legislation.
In a bid to coax support from conservatives, House leaders proposed a fresh amendment — to be voted on Friday — repealing Obama’s requirement that insurers cover 10 specified services like maternity and mental health care. Conservatives have demanded the removal of those and other conditions the law imposes on insurers, arguing they drive premiums skyward.
Many moderates are opposed because they say the GOP bill would leave many voters uninsured. Medical associations, consumer groups and hospitals are opposed or voicing misgivings, and some Republican governors say the bill cuts Medicaid too deeply and would leave many low-income people uncovered.
Republicans can lose only 22 votes in the face of united Democratic opposition. A tally by The Associated Press found at least 32 “no” votes, but the figure was subject to fluctuation amid frantic GOP lobbying.
Rep. Mark Meadows, R-N.C., head of the House Freedom Caucus, said he remained a “no” but didn’t answer when asked whether the group still had enough votes to kill the legislation. He’d long said caucus opposition alone would defeat it without changes.
Other foes said they’d not flipped. These included moderate Reps. Charlie Dent of Pennsylvania, Dan Donovan of New York and Leonard Lance of New Jersey, plus conservative Walter Jones of North Carolina.
The nonpartisan Congressional Budget Office said changes Republican leaders had proposed before Thursday to win votes had cut the legislation’s deficit reduction by more than half, to $150 billion over the next decade. But it would still result in 24 million more uninsured people in a decade.
Obama’s law increased coverage through subsidized private insurance for people who don’t have access to workplace plans, and a state option to expand Medicaid for low-income residents. More than 20 million people have gained coverage since the law was passed in 2010.
By ALAN FRAM and RICARDO ALONSO-ZALDIVAR, Associated Press
Associated Press writers Matt Daly, Kevin Freking, Mary Clare Jalonick, Richard Lardner, Stephen Ohlemacher, Vivian Salama, Ken Thomas and Erica Werner contributed to this report.