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| Key to Health Vote, Hard-Line Conservatives Push New Cuts | Key to Health Vote, Hard-Line Conservatives Push New Cuts |
| (about 2 hours later) | |
| WASHINGTON — Hard-line conservatives in the House left their White House meeting with President Trump Thursday afternoon without consensus on legislation to repeal the Affordable Care Act, as they pressed to eliminate federal requirements that health insurance plans provide a basic set of benefits like maternity care, emergency services and wellness visits. | |
| House Republican leaders had placed their faith in a House Freedom Caucus negotiating session at the White House with Mr. Trump. Without an agreement, a vote on the House floor, still scheduled for Thursday, could slip, although House leaders have not made that decision. | |
| “My party intends to bring forth an agreed-to bill that we will be able to show to the American people, and we will own it,” said Representative Pete Sessions, Republican of Texas and the chairman of the Rules Committee. | “My party intends to bring forth an agreed-to bill that we will be able to show to the American people, and we will own it,” said Representative Pete Sessions, Republican of Texas and the chairman of the Rules Committee. |
| President Trump appealed to his supporters to weigh in, assuring them, “Go with our plan. It’s going to be terrific.” | President Trump appealed to his supporters to weigh in, assuring them, “Go with our plan. It’s going to be terrific.” |
| But the prospect of a vote on Thursday on a newly revised bill exposed Republicans to criticism that they were moving recklessly in a desperate bid to get their plan passed. Representative Jim McGovern, Democrat of Massachusetts, pleaded with Republicans to slow down. | But the prospect of a vote on Thursday on a newly revised bill exposed Republicans to criticism that they were moving recklessly in a desperate bid to get their plan passed. Representative Jim McGovern, Democrat of Massachusetts, pleaded with Republicans to slow down. |
| “This health care repeal affects millions upon millions upon millions of Americans,” he said. “Don’t jam a disastrous bill through the House with patched-up fixes.” | “This health care repeal affects millions upon millions upon millions of Americans,” he said. “Don’t jam a disastrous bill through the House with patched-up fixes.” |
| The emerging power of the Freedom Caucus, a group that has been historically marginalized in policy-making but a thorn in the side of leadership, is one of the surprises of the rushed health care debate. The Freedom Caucus has been empowered by the addition of one of their own, former Representative Mick Mulvaney, to the senior White House staff as budget director, and Mr. Trump’s disengagement from policy details coupled with his intense desire to score a win after a rocky start to his presidency. | The emerging power of the Freedom Caucus, a group that has been historically marginalized in policy-making but a thorn in the side of leadership, is one of the surprises of the rushed health care debate. The Freedom Caucus has been empowered by the addition of one of their own, former Representative Mick Mulvaney, to the senior White House staff as budget director, and Mr. Trump’s disengagement from policy details coupled with his intense desire to score a win after a rocky start to his presidency. |
| Mr. Trump, Vice President Mike Pence and the House speaker, Paul D. Ryan of Wisconsin, worked on Wednesday to placate conservative House Republicans who said that the bill did not do enough to lower health insurance costs by reducing federal regulations. The legislation would roll back major provisions of the Affordable Care Act, a pillar of President Barack Obama’s legacy. | Mr. Trump, Vice President Mike Pence and the House speaker, Paul D. Ryan of Wisconsin, worked on Wednesday to placate conservative House Republicans who said that the bill did not do enough to lower health insurance costs by reducing federal regulations. The legislation would roll back major provisions of the Affordable Care Act, a pillar of President Barack Obama’s legacy. |
| But in trying to satisfy conservatives, the Trump administration and House Republican leaders risked jeopardizing support for the bill among more moderate Republicans. | But in trying to satisfy conservatives, the Trump administration and House Republican leaders risked jeopardizing support for the bill among more moderate Republicans. |
| Mr. Obama stepped into the fray on Thursday with a lengthy defense of his signature domestic achievement — and a call for bipartisan improvements. | Mr. Obama stepped into the fray on Thursday with a lengthy defense of his signature domestic achievement — and a call for bipartisan improvements. |
| “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,” he wrote in a mass email to followers on the seventh anniversary of signing the measure into law. “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 hard-working Americans.” | |
| As the crucial vote approached, party leaders appeared to be short of a majority, as moderate Republicans continued to move away from the bill. | As the crucial vote approached, party leaders appeared to be short of a majority, as moderate Republicans continued to move away from the bill. |
| Representative Jaime Herrera Beutler, Republican of Washington, said Thursday that she would oppose the bill. “We can do better than the current House replacement plan,” she said. | Representative Jaime Herrera Beutler, Republican of Washington, said Thursday that she would oppose the bill. “We can do better than the current House replacement plan,” she said. |
| And late Wednesday night, Representative Charlie Dent, Republican of Pennsylvania and a leader of a moderate bloc of lawmakers known as the Tuesday Group, said that he would oppose the bill. | And late Wednesday night, Representative Charlie Dent, Republican of Pennsylvania and a leader of a moderate bloc of lawmakers known as the Tuesday Group, said that he would oppose the 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,” Mr. Dent said. He added that he hoped that the House could “step back from this vote and arbitrary deadline to focus on getting health care reform done right.” | “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,” Mr. Dent said. He added that he hoped that the House could “step back from this vote and arbitrary deadline to focus on getting health care reform done right.” |
| Conservatives were still hoping to win changes to make the bill more palatable to them. Representative Mark Meadows, Republican of North Carolina and the chairman of the Freedom Caucus, expressed optimism that talks with Republican leaders would lead to revisions to the bill. | Conservatives were still hoping to win changes to make the bill more palatable to them. Representative Mark Meadows, Republican of North Carolina and the chairman of the Freedom Caucus, expressed optimism that talks with Republican leaders would lead to revisions to the bill. |
| “We’re encouraged tonight, just based on the real willingness of not only the White House, but our leadership, to make this bill better,” Mr. Meadows said on Wednesday night, crediting the personal involvement of Mr. Trump and Mr. Pence. | “We’re encouraged tonight, just based on the real willingness of not only the White House, but our leadership, to make this bill better,” Mr. Meadows said on Wednesday night, crediting the personal involvement of Mr. Trump and Mr. Pence. |
| The tenacity and persistence of the conservatives appeared to give them outsize influence as Mr. Ryan struggled to round up votes for the repeal bill, which faces solid opposition from House Democrats. Supporters of their bill have put their faith in Mr. Trump, whose young presidency could be badly damaged by a public and consequential loss. | The tenacity and persistence of the conservatives appeared to give them outsize influence as Mr. Ryan struggled to round up votes for the repeal bill, which faces solid opposition from House Democrats. Supporters of their bill have put their faith in Mr. Trump, whose young presidency could be badly damaged by a public and consequential loss. |
| “When the president calls someone and says, ‘I need your vote on this,’ it’s very hard to say no to the president of the United States when this torpedoes our entire conference, Trump’s entire presidency, and we end up losing the Senate next year and we lose members in the House,” said Representative Chris Collins, Republican of New York and a top Trump supporter in the House. | “When the president calls someone and says, ‘I need your vote on this,’ it’s very hard to say no to the president of the United States when this torpedoes our entire conference, Trump’s entire presidency, and we end up losing the Senate next year and we lose members in the House,” said Representative Chris Collins, Republican of New York and a top Trump supporter in the House. |
| But conservative opposition was over substance, not politics. Conservatives are upset by the failure of the House bill to repeal a set of regulations in Mr. Obama’s signature health law, which require insurers to cover a base set of benefits, like maternity care, preventive services, wellness checkups and rehabilitative services. These “essential health benefits” raise the cost of insurance and prevent companies from offering stripped-down options, the conservatives say. | But conservative opposition was over substance, not politics. Conservatives are upset by the failure of the House bill to repeal a set of regulations in Mr. Obama’s signature health law, which require insurers to cover a base set of benefits, like maternity care, preventive services, wellness checkups and rehabilitative services. These “essential health benefits” raise the cost of insurance and prevent companies from offering stripped-down options, the conservatives say. |
| “How can you talk about repealing the Affordable Care Act, Obamacare, without repealing the essential health benefits?” asked Representative Scott Perry, a Pennsylvania Republican who attended the meeting with Mr. Pence. | “How can you talk about repealing the Affordable Care Act, Obamacare, without repealing the essential health benefits?” asked Representative Scott Perry, a Pennsylvania Republican who attended the meeting with Mr. Pence. |
| Republican leaders say that if the House makes such changes to the bill, it could imperil their ability to push the legislation through the Senate using expedited procedures that neutralize the threat of a filibuster. | Republican leaders say that if the House makes such changes to the bill, it could imperil their ability to push the legislation through the Senate using expedited procedures that neutralize the threat of a filibuster. |
| A spokeswoman for the Freedom Caucus, Alyssa Farah, said Wednesday that more than 25 members of the caucus were considered “no” votes on the health care measure — enough to sink the bill in the House, though that count could not be independently verified. | A spokeswoman for the Freedom Caucus, Alyssa Farah, said Wednesday that more than 25 members of the caucus were considered “no” votes on the health care measure — enough to sink the bill in the House, though that count could not be independently verified. |
| Representative Andy Harris, Republican of Maryland, said that despite recent changes to the health care bill, he was unable to vote for it. | Representative Andy Harris, Republican of Maryland, said that despite recent changes to the health care bill, he was unable to vote for it. |
| “This legislation simply won’t lower premiums as much as the American people need, and lowering the cost of coverage is my primary goal,” said Mr. Harris, an anesthesiologist and Freedom Caucus member. | “This legislation simply won’t lower premiums as much as the American people need, and lowering the cost of coverage is my primary goal,” said Mr. Harris, an anesthesiologist and Freedom Caucus member. |
| Sean Spicer, the White House press secretary, said he was sure the House would pass the repeal bill. “Slowly but surely we’re getting there,” he said. “There is no Plan B. There’s Plan A and Plan A. We’re going to get this done.” | Sean Spicer, the White House press secretary, said he was sure the House would pass the repeal bill. “Slowly but surely we’re getting there,” he said. “There is no Plan B. There’s Plan A and Plan A. We’re going to get this done.” |