Politics

Trump, Ryan lack House votes for ‘do-or-die’ health care bill

Representative Mark Meadows, chairman of the House Freedom Caucus, spoke about health care on March 7.
Susan Walsh/Associated Press
Representative Mark Meadows, chairman of the House Freedom Caucus, spoke about health care on March 7.

WASHINGTON — President Trump and House Speaker Paul Ryan pushed conservative lawmakers to get behind the GOP health care plan Wednesday, but their efforts appeared to come up short, casting Thursday’s vote into doubt, along with the ability of Republicans to drive a legislative agenda despite their control of the White House and Congress.

Less than 24 hours before the House of Representatives was scheduled to vote on the conservative plan, the group of right-wing lawmakers known as the House Freedom Caucus announced they had more than 25 members voting “no” — enough opposition to sink the bill’s prospects of passage. More moderate House Republicans also signaled their opposition Wednesday.

The announcements were a serious blow for the White House and Republican party leadership, who had expended heaps of political capital to secure the necessary 215 yes votes by Thursday. A defeat would also spell trouble for Trump, who could be seen as ineffective if he fails to unite his own party around an issue central to his campaign.

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Wednesday night, Ryan announced plans to convene skeptics for a late meeting, signaling that last-minute negotiations on the bill had reached a fever pitch. Some lawmakers indicated there had been progress toward a deal.

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‘‘The president has been profoundly engaged,’’ said Representative Trent Franks, Republican of Arizona. ‘‘I think things are going in a very good direction right now.’’

Trump spent Wednesday morning trying woo GOP holdouts at the White House. He and Vice President Mike Pence focused some of those efforts on those who say the bill is too similar to the Affordable Care Act signed into law by President Obama, and also tried to convince moderates, who want to keep some portions of Obama’s expansion of Medicaid.

When asked by reporters what would happen if the House bill fails, Trump responded, “We’ll see what happens.”

Earlier, in a morning appearance on conservative radio, Ryan outlined the stakes for the Republicans.

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“We made a promise,” Ryan said. “This is the one chance we have to actually repeal Obamacare and replace it with the stuff we believe in.”

Ryan and other House Republicans made changes earlier in the week to win over Republicans, including amendments that would allow states to require single, able-bodied Medicaid recipients to work to qualify, and that would make Medicaid funding a capped block grant to states.

During the day, Representative Mark Meadows of North Carolina, the chairman of the Freedom Caucus, tweeted that he would not support the bill, even after meeting with Trump and Pence Wednesday. Meadows also said he was still “hopeful” that the bill could change and would work “around the clock” to make changes, but Wednesday afternoon he tweeted ““I cannot support the #AHCA as it stands.’’

Moderate Representative Leonard Lance of New Jersey made no mistake in declaring his position.

”I’m a no,” Lance said. “The word is a simple, two-letter word. The word is no.”

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Another group of House members said they were still unsure of how they would vote.

“It seems to be evolving,” Pennsylvania Representative Charlie Dent said on NPR Wednesday. “Some changes are better, but I’m not convinced it goes far enough.”

Moderate Republicans Frank LoBiondo of New Jersey and David Young of Iowa also announced their opposition.

Senate opposition, as well as pressure from outside groups, was taking a toll on House lawmakers.

Freedom Works, a Tea Party group in Washington, D.C., released a statement Wednesday that specifically called on Ryan and other members of House leadership to scrap the AHCA and start over.

Meanwhile, two groups affiliated with the conservative Koch network, Americans for Prosperity and Freedom Partners, announced late Wednesday the creation of a special fund to support House members who vote against the health care bill.

‘‘The bill as it stands today is Obamacare 2.0,’’ said James Davis, executive vice president of Freedom Partners.

Senator Ted Cruz of Texas sat in the Freedom Caucus meeting Wednesday and voiced his opposition to the House bill in its current form. Republican Senator Rand Paul of Kentucky, a former physician, was hoping Republicans would pull the legislation from the agenda.

“I think there is a little tone deafness up here. . . . Nobody likes the bill,” Paul said Wednesday morning during an appearance on Fox Business.

In the Senate, where the bill would go if approved, the margin for error would be razor-thin, and the White House, according to most scenarios, could ill afford more than two defections by members of the Republican Party.

Still, Republican Senator Susan Collins of Maine, a critical swing vote and the only Republican senator from New England, has already come out against the House bill.

Collins, unlike Paul and Cruz, is hesitant to roll back the government’s role in the health insurance market, which would almost certainly increase the number of uninsured Americans. According to the Congressional Budget Office, an earlier version of the GOP bill would result in 24 million people losing subsidized insurance or Medicaid by 2026.

The nail-biter situation underscores the extent to which Trump’s surprise electoral win merely papered over deep divisions within the Republican Party. The health care debate has brought those fractures back to the surface, with the far-right House Freedom Caucus mounting the most vigorous and unified opposition to the Trump-backed bill.

This is the same group that drove former House speaker John Boehner, seen as a member of the old-school Republican establishment, to resign his position in frustration in 2015.

Trump “didn’t solve the problems that existed before him and to expect him to is unfair. None of this is going to be easy, and if Hillary Clinton were in office she would be having similar issues with Democratic constituencies,” Sam Geduldig a former top congressional staffer and who now leads an-all GOP public affairs and lobbying shop, CGCN Group.

If Trump and Ryan fail to twist enough arms to get the GOP health care bill through the House, the rest of Trump’s agenda could be imperiled, observers say. Some Republicans believe Ryan would have to step down as speaker, and the fallout could cost House lawmakers their seats in the 2018 midterm elections.

While some Republicans are quietly saying that the smart move would be to pull the health care bill and move on to another key agenda item like tax reform, former Boehner press secretary Michael Steel, among others, believes that would be a mistake.

“If you can’t deliver on a promise that’s been made as often and as publicly as the promise to repeal Obamacare, its difficult to see how something else works,” he said.

Steel, now a managing director at public affairs consulting firm Hamilton Place Strategies, is among those betting that the high stakes involved means Ryan will end up pulling this off.

“If they don’t get there tomorrow, I think there’s a pretty good chance they get there the next day.”

All the while, Democrats are attempting to seize on their colleagues’ uncertainty, though they hold little more than rhetorical power in Congress.

Michigan Senator Debbie Stabenow, along with other Democrat Senators including Maggie Hassan of New Hampshire, and Bob Casey of Pennsylvania, held a rally with parents of children with disabilities.

House minority leader Nancy Pelosi held a rally Wednesday with Joe Biden, the former vice president.

“This is not the end,” Biden said. “The American public is not going to put up with these changes.”

Material from the Washington Post and the Associated Press was used in this report. Astead W. Herndon can be reached at astead.herndon @globe.com. Follow him on Twitter @AsteadWH