Trump health care reform hangs in balance

Mar 23, 2017

"I'm expecting we are going to negotiate in good faith and hopefully get to a yes before 7:00 tonight," when the House of Representatives is expected to vote on the Republican health care plan, Meadows said.

US President Donald Trump had yet to bring skeptical conservative Republicans on board Thursday with his plan to repeal and replace Obamacare, throwing the health care bill into doubt as the clock ticked down on a vote in Congress.

Failure to win support in the last-gasp negotiations would mark a humiliating defeat in Trump's biggest legislative battle to date, with Republican conservatives threatening to torpedo the bill unless key changes are made.

"There are not enough votes as of 1:30 (1730 GMT) today," Mark Meadows, chairman of the grassroots conservative Freedom Caucus, told reporters after a meeting with Trump and other lawmakers.

"I'm expecting we are going to negotiate in good faith and hopefully get to a yes before 7:00 tonight," when the House of Representatives is expected to vote on the Republican health care plan, Meadows said.

Republicans have spent years railing against the Affordable Care Act, branding it an example of Democrats pushing for socialized medicine.

But seven years to the day since Barack Obama signed his landmark reforms into law, House Republican leaders were facing the grim prospect of insufficient support within their own ranks for the alternative.

With Democrats opposed to Trump's effort to rip out his predecessor's crowning domestic achievement, and his own party's right flank in revolt, the White House and Republican leaders have been burning midnight oil to find ways to make the bill palatable to enough conservatives without angering moderates.

Trump spent hours in phone calls and meetings deep into the night Wednesday, and the negotiations were set to continue right up until the vote.

The president's spokesman Sean Spicer denied that the morning's encounters with Republicans fell short of expectations, saying: "We weren't asking for a deal."

Asked whether House Speaker Paul Ryan might pull the bill off the floor and delay the vote, Spicer said "nothing leads me to believe that that's the case."

"We have been very, very pleased with the direction it's going in," Spicer told reporters. "Today is the seventh and we hope the last anniversary of the day that President Obama signed Obamacare," he said.

'Still opposed'

Many conservatives have balked at their own party's plan, saying it is still too costly for the government.

They have said they want to repeal health benefits that all insurance policies must pay for under Obamacare -- including maternity care, emergency room visits, and preventive care like screenings and vaccines -- arguing they have driven up costs.

At the other end of the spectrum, some Republican moderates also worry their constituents would no longer be able to afford health insurance under the new plan.

A nonpartisan congressional budget estimate says it would lead 14 million Americans to lose their coverage from next year.

The House vote on the American Health Care Act (AHCA) looks tight.

The Democratic minority is prepared to vote against it as a bloc, so Republican leaders need to limit defections to just 22 out of their party's 237 representatives among the House's 430 current members.

As of midday Thursday, 36 Republicans, mostly conservatives, had announced their opposition, according to a Washington Post count.

Further upping the pressure on recalcitrant Republicans, Trump tweeted out messages to his 27 million personal followers, and to the 16 million who follow the official presidential account, urging them to contact their local lawmakers in support of the repeal and replace plan.

But congressman Thomas Massie said the arm-twisting would not work on him.

"I'm still opposed to the bill," the Kentucky Republican told MSNBC.

"I think it's worse than Obamacare."

Obama weighs in

A key element of Republican opposition is the House Freedom Caucus, about 30 lawmakers who are heirs apparent to the ultra-conservative Tea Party movement and are known to buck party leadership.

They dub the new bill "Obamacare Light," as it will only reduce, not eliminate, health coverage subsidies by replacing them with refundable tax credits.

Corralling them will be critical.

Trump has put his own credibility and deal-making skills on the line for the measure, but he has also suggested he could single out lawmakers and make their lives difficult if they defy him.

Obama himself weighed in ahead of the day's vote, saying the law which has helped 20 million people get coverage should be improved, not pulled out by its roots.

"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," Obama said in a statement.

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