Politics

Trump’s health care talks: ‘I'm gonna come after you’

President Donald Trump arrives, followed by Health and Human Services Secretary Tom Price, left Capitol Hill on Tuesday.

J. Scott Applewhite/Associated Press

President Trump and Health and Human Services Secretary Tom Price on Capitol Hill on Tuesday.

WASHINGTON — President Trump stormed Capitol Hill on Tuesday to sell the House Republican leadership’s plan to overhaul the health-care system, warning his party that not passing the legislation would yield a political crisis and sweeping electoral defeats.

The president addressed a closed-door meeting of House Republicans days before the measure is expected to come to a vote on the House floor.

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Trump used both charm and admonishment as he made his case, reassuring skittish members that they would gain seats in Congress if the bill passed — and singling out Representative Mark Meadows, of North Carolina, the chairman of the hard-line House Freedom Caucus, in front of colleagues.

‘‘I'm gonna come after you, but I know I won’t have to, because I know you'll vote ‘yes,’ ” Trump said, according to several Republican lawmakers who attended the meeting. ‘‘Honestly, a loss is not acceptable, folks.’’

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For Trump, who talked up the House bill the previous evening at a raucous rally in Kentucky, the presentation was the latest example of his mounting urgency to secure a major legislative victory in the early months of his presidency and repeal the signature law of President Barack Obama.

‘‘That’s just the demeanor of this president. He wants to get this bill done,’’ said Senator David Perdue, Republican of Georgia, a Trump ally. ‘‘I don’t hear that as a threat. It’s a statement of reality.’’

‘‘Read ‘The Art of the Deal,’ ” Perdue said, referring to Trump’s book, when asked whether Trump thinks keeping members on edge is effective.

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But Trump’s ability to translate his negotiation skills from the business world to the congressional realm — and to rouse his party behind him — remained unclear by late Tuesday as Meadows and other Republicans stayed firmly on the fence.

After the meeting, Meadows told reporters that the president had not closed the sale, describing the call-out as merely good-natured and insisting that conservative holdouts will continue to press for a tougher package.

‘‘I'm still a ‘no,’ ” Meadows said. ‘‘I've had no indication that any of my Freedom Caucus colleagues have switched their votes.’’ The group has about 30 members.

Meadows said he didn’t take Trump’s remarks that he would ‘‘come after’’ him too seriously: ‘‘I didn’t take anything he said as threatening anybody’s political future.’’

Said Representative Harold Rogers, Republican of Kentucky, a supporter of the bill: ‘‘Oh, he was kidding around. I think.’’

White House press secretary Sean Spicer said later in the day: ‘‘Mark Meadows is a long-time, early supporter of the president. He had some fun at his expense this morning during the conference meeting.’’

Asked whether Trump believed that Republicans who opposed the bill would be damaged at the ballot box, Spicer answered: ‘‘I think they'll probably pay a price at home.’’

Spicer explained that statement was not a threat but ‘‘a political reality.’’

Trump, who when angered has turned on Republicans on numerous occasions in the past, is putting his considerable political weight behind a proposal crafted by House Speaker Paul D. Ryan of Wisconsin, that would represent a powerful if symbolic achievement for the president and the speaker if the House approves it. Even if it passed, the legislation would face an uphill battle in the Senate.

No Democrats are expected to support the legislation, meaning Republican leaders can afford to lose no more than 21 Republicans on the House floor. The House Rules Committee is slated to meet at 10 a.m.

‘‘We made a promise and now it is the time to keep that promise,’’ Ryan said. ‘‘If we keep that promise, the people will reward us. If we don’t keep our promise, it will be very hard to manage this.’’

Ryan minimized the chance that Freedom Caucus members could band together to bring down the measure and said that conservatives should be pleased that many of their demands would likely be in the legislation, such as limiting the expansion of Medicaid and including work requirements for those who receive coverage from the program for the poorest Americans.

Ryan said conservatives will eventually realize that pushing for more extensive changes, such as ending payments to states that accepted the Medicaid expansion, could jeopardize the legislation’s chances in the Senate.

‘‘If you get 85 percent of what you want, that’s pretty darn good,’’ he said. ‘‘We don’t want to put something in this bill that the Senate is telling us is fatal.’’

Senate Majority Leader Mitch McConnell of Kentucky took a cautiously optimistic tone Tuesday. He confidently promised that the Senate would forge ahead with plans for votes on the health- care legislation but left the immediate success of the venture in the hands of House leaders.

‘‘If the House passes something, I will bring it up,’’ McConnell said. ‘‘We'll try to move it across the floor next week.’’

McConnell also cautiously avoided confronting mounting criticism of the bill from within Senate GOP ranks. He instead dismissed the concerns as a natural part of the legislative process and assured reporters that he would consider the legislation quickly to clear the way for a vote on Supreme Court nominee Neil Gorsuch.

‘‘We will reach a conclusion on health care next week,’’ McConnell said. ‘‘Because we’re going to judge Gorsuch the week after that.’’

On Tuesday afternoon, several Republican senators — including those from states that expanded Medicaid under the Affordable Care Act — expressed reservations about the House bill and said it would need to change significantly to win their support.

Senator John Boozman of Arkansas said he wasn’t sure what the House bill will ultimately contain.

‘‘I don’t really know what the American Health Care Act consists of right now. It’s constantly changing,’’ he said.

‘‘Arkansas and its governor would very much like to keep the [Medicaid] expansion,’’ Boozman said. ‘‘So I think at the end of the day, there will be some compromise.’’

Senator Tom Cotton, Boozman’s fellow Arkansan, also said Tuesday that he ‘‘still cannot support’’ the House bill.

Senator Lisa Murkowski of Alaska expressed reservations about the Medicaid revisions, saying she wants the bill’s backers to ‘‘show me’’ how the legislation would be fair to her state.

Unlike some lawmakers such as Senator Ted Cruz of Texas — who recently visited Trump’s Mar-a-Lago resort in Palm Beach, Fla., to talk health care with the president — Murkowksi said she hasn’t been similarly wooed.

‘‘I have not gone to Mar-a-Lago,’’ she said, chuckling. ‘‘I did go to the White House last week — no, two weeks ago — to talk about energy.’’

Perdue said Trump was engaged in selling the House bill to senators.

‘‘A few votes get to be more critical here,’’ he said. ‘‘He’s been having dinners. . . . He’s listening and trying to probe what it will take to get this bill done and how to fix it right.’’

Senator Rand Paul of Kentucky, who has pressed Trump to abandon the bill, insisted that the legislation is fading in the House.

‘‘There are enough conservative votes for it not to pass in its current form,’’ he said. ‘‘Negotiation begins in real earnest in the next 24 hours or so once they discover they don’t have the votes. My count is there are more than enough votes to stop the Ryan plan.’’

Some GOP governors also have weighed in.

In a letter Tuesday to every member of Michigan’s congressional delegation, Governor Rick Snyder warned that the House GOP bill ‘‘shifts significant financial risk and cost from the federal government to states without providing sufficient flexibility to manage this additional responsibility.’’ Individual letters were sent to each House member detailing how many residents in their districts depend on both traditional Medicaid and the expanded Medicaid program created by the Affordable Care Act.

The House vote is expected to be narrow after a Congressional Budget Office study found that 14 million fewer people would have insurance by 2018 under the GOP proposal.

Trump arrived on the Hill to address the private meeting of House Republicans shortly after 9 a.m., bringing with him many of his top White House aides. They included senior adviser Stephen K. Bannon, Chief of Staff Reince Priebus and senior policy adviser Steven Miller.

After the meeting, Trump was confident that the legislation will pass the House.

‘‘We’re going to have a real winner,’’ he told reporters. ‘‘There are going to be adjustments but I think we'll get the vote on Thursday.’’

Inside the room, however, Trump did not get into much detail about what needed to be adjusted for the bill to win approval. He focused more on the political risks and rewards of passage, telling Republicans that they ‘‘kept passing and passing and passing’’ repeal bills under President Obama and would be punished if they did not make good on their campaign promises.

‘‘We won’t have these crowds if we don’t get this done,’’ he said, referring to his Monday night rally in Kentucky.

‘‘If we get this done, and tax reform, he believes we pick up 10 seats in the Senate and we add to our majority in the House,’’ said Representative Chris Collins of New York., the first member of Congress who endorsed Trump’s presidential bid. ‘‘If we don’t get it done, we lose the House and the Senate.’’

The president’s sales push comes after Ryan and other House leaders released key proposed changes to the legislation on Tuesday night that they hope will help secure the bill’s passage.

The tweaks addressed numerous GOP concerns, including the flexibility the package would give states to administer their Medicaid programs and the amount of aid it would offer older Americans to buy insurance. The changes are the product of two weeks of negotiations that stretched from the Capitol to the White House to Trump’s Florida resort.

The bill’s proponents also appeared to overcome a major obstacle Monday after a key group of hard-line conservatives declined to take a formal position against the bill, known as the American Health Care Act.

The House Freedom Caucus has threatened for weeks to tank the legislation, arguing that it would not do enough to undo the seven-year-old Affordable Care Act. Their neutrality gives the legislation a better chance of passage: If the group of about three dozen hard-right GOP members uniformly opposed the bill, it could block its passage.

Their decision not to act as a bloc frees House leaders and White House officials to persuade individual Freedom Caucus members to support the measure — a process that Meadows, the caucus chairman, said is underway.

‘‘They’re already whipping with a whip that’s about 10 feet long and five feet wide,’’ he said Monday. ‘‘I'm trying to let my members vote the way that their constituents would want them to vote. . . . I think they’re all very aware of the political advantages and disadvantages.’’

Some of the changes announced Monday were made to placate conservatives, such as accelerating the expiration of the ACA’s taxes and further restricting the federal Medicaid program. But a major push was made to win moderate voters, including a maneuver that House leaders said would allow the Senate to beef up tax credits for older Americans whose premiums could increase greatly under the GOP plan.

There were signs Monday that the bill had growing support among the moderate wing of the House GOP. Representative Tom MacArthur of New Jersey, who had voted against the leadership in an early procedural vote on the health-care legislation, said that he was ‘‘satisfied enough that I will support the bill.’’

MacArthur said he was assured that the measure would do more for older and disabled Americans covered under Medicaid and that an additional $85 billion in aid would be directed to those ages 50 to 65.

‘‘That’s a $150 billion change in this bill to help the poor and those who are up in years,’’ he said.

MacArthur told reporters Tuesday that he is satisfied with the way the House amendment is structured and that he trusts that the Senate will further refine the legislation. He also said he is confident that the new changes will be enough to sway many of the approximately 50 members of the Tuesday Group, which he co-chairs.

‘‘I believe the majority will vote for the bill,’’ MacArthur said after the meeting with Trump.

Several House Republicans from upstate New York won an amendment that would allow counties in their state to keep hundreds of millions of dollars of local tax revenue that they forward to the state government to fund its Medicaid program. One member, Rep. Claudia Tenney, told the Syracuse Post-Standard on Monday that her support of the bill was conditioned on the amendment’s inclusion.

The Freedom Caucus had pushed for a variety of alterations, including an earlier phaseout of the ACA’s Medicaid expansion and a more thorough rollback of the insurance mandates established under the law.

But for political and procedural reasons, few of the group’s major demands stand to be incorporated into the bill.

‘‘It’s very clear that the negotiations are over,’’ said Meadows, who met with White House officials at Mar-a-Lago on Saturday.

Many Freedom Caucus members left Tuesday’s meeting resolved to continue to oppose the bill.

‘‘The president always does a good job in these settings,’’ said Representative Jim Jordan of Ohio, a co-founder of the caucus. ‘‘But the legislation is still bad, and doesn’t do what we told voters we would do.’’

David Nakamura, Mike DeBonis and Juliet Eilperin contributed to this report.
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