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| House Pushes Back Health Bill Vote After Again Failing to Round Up Enough Votes | |
| (about 2 hours later) | |
| WASHINGTON — An 11th-hour White House push to give President Trump a major legislative victory in his first 100 days in office broke down late Thursday as House Republican leaders failed to round up enough votes for their bill to repeal the Affordable Care Act. | |
| Some White House officials had hoped for a vote on Friday on a measure to prove that Mr. Trump was making good on his promise to undo the sweeping health law — President Barack Obama’s signature domestic achievement — in his first 100 days in office. | |
| But seesawing commitments and the reservations from numerous lawmakers throughout Thursday laid bare the difficulty that Republican leaders faced in trying to push through a repeal bill. While revisions to their bill won over the conservative hard-liners in the Freedom Caucus this week, those same changes threatened to drive away other members, even some who supported the first version. | |
| At least 18 House Republicans oppose the latest version of the bill, the American Health Care Act, and leaders can lose no more than 22 to win passage if all members vote. | At least 18 House Republicans oppose the latest version of the bill, the American Health Care Act, and leaders can lose no more than 22 to win passage if all members vote. |
| “We’re going to go when we have the votes,” said Speaker Paul D. Ryan of Wisconsin, who added that Republicans would not be constrained by “some artificial deadline.” | “We’re going to go when we have the votes,” said Speaker Paul D. Ryan of Wisconsin, who added that Republicans would not be constrained by “some artificial deadline.” |
| House Democrats, sensing an advantage, pressured Republicans to once again back away from the bill, just as they did a month ago in an embarrassing defeat for Mr. Trump and Mr. Ryan. Democratic leaders threatened to withhold votes from a stopgap spending measure to keep the government open past Friday if Republicans insisted on trying to jam the health care bill through the House on Friday or Saturday, which is Mr. Trump’s 100th day as president. | |
| The House Democratic leader, Nancy Pelosi of California, said Mr. Trump was “really making fools of the members of Congress of his own party” by asking them to support a health bill that is unpopular with the public. | The House Democratic leader, Nancy Pelosi of California, said Mr. Trump was “really making fools of the members of Congress of his own party” by asking them to support a health bill that is unpopular with the public. |
| “If they vote on it, the minute they cast that vote, they put doo-doo on their shoe,” she said. | “If they vote on it, the minute they cast that vote, they put doo-doo on their shoe,” she said. |
| Republican leaders in both chambers plan to pass the stopgap measure to give lawmakers another week to work out a spending package to fund the government for the remainder of the fiscal year, which ends Sept. 30. | Republican leaders in both chambers plan to pass the stopgap measure to give lawmakers another week to work out a spending package to fund the government for the remainder of the fiscal year, which ends Sept. 30. |
| The longer-term spending deal is expected to provide more funding for the military and for border security, although Mr. Trump backed off his demand that lawmakers provide money for the wall he wants to build along the border with Mexico. | The longer-term spending deal is expected to provide more funding for the military and for border security, although Mr. Trump backed off his demand that lawmakers provide money for the wall he wants to build along the border with Mexico. |
| Mr. Ryan brushed off the threat from Democrats. “I would be shocked that they would want to see a government shutdown,” he said. | Mr. Ryan brushed off the threat from Democrats. “I would be shocked that they would want to see a government shutdown,” he said. |
| But Mr. Trump was not so dismissive. He unleashed a torrent of Twitter posts on Thursday accusing Democrats of wanting to shut down the government. The posts accused Democrats of putting the needs of health insurance companies, Puerto Rico and undocumented immigrants over the military, visitors to national parks and coal miners — claims that Democrats called absurd. | But Mr. Trump was not so dismissive. He unleashed a torrent of Twitter posts on Thursday accusing Democrats of wanting to shut down the government. The posts accused Democrats of putting the needs of health insurance companies, Puerto Rico and undocumented immigrants over the military, visitors to national parks and coal miners — claims that Democrats called absurd. |
| The latest House plan to repeal and replace the health law would include an amendment drafted by Representative Tom MacArthur, Republican of New Jersey and a leader of a centrist bloc of lawmakers called the Tuesday Group. | The latest House plan to repeal and replace the health law would include an amendment drafted by Representative Tom MacArthur, Republican of New Jersey and a leader of a centrist bloc of lawmakers called the Tuesday Group. |
| Mr. MacArthur’s amendment would allow states to opt out of certain provisions of the Affordable Care Act, including one that requires insurers to provide a minimum set of health benefits and another that prohibits insurers from charging higher premiums based on a person’s health status. | Mr. MacArthur’s amendment would allow states to opt out of certain provisions of the Affordable Care Act, including one that requires insurers to provide a minimum set of health benefits and another that prohibits insurers from charging higher premiums based on a person’s health status. |
| Republicans say the federal mandates drive up costs, but Democrats say they provide important protections for consumers. | Republicans say the federal mandates drive up costs, but Democrats say they provide important protections for consumers. |
| Under Mr. MacArthur’s amendment, states could obtain waivers letting them redefine the “essential health benefits,” which now include maternity care, emergency services, mental health care and drug addiction treatment. | Under Mr. MacArthur’s amendment, states could obtain waivers letting them redefine the “essential health benefits,” which now include maternity care, emergency services, mental health care and drug addiction treatment. |
| Republicans say their bill maintains protections for people with pre-existing conditions. But Democrats say the waivers would severely weaken these protections because insurers could charge higher premiums to sick people who wanted to buy insurance after a gap in coverage. | Republicans say their bill maintains protections for people with pre-existing conditions. But Democrats say the waivers would severely weaken these protections because insurers could charge higher premiums to sick people who wanted to buy insurance after a gap in coverage. |
| Republicans say their bill offers billions of dollars that states could use to operate high-risk pools or other programs to provide or subsidize insurance for people with pre-existing conditions. | Republicans say their bill offers billions of dollars that states could use to operate high-risk pools or other programs to provide or subsidize insurance for people with pre-existing conditions. |
| The American Medical Association and AARP, the lobby for older Americans, oppose the latest version of the Republicans’ health care bill. | The American Medical Association and AARP, the lobby for older Americans, oppose the latest version of the Republicans’ health care bill. |
| “Although the MacArthur amendment states that the ban on pre-existing conditions remains intact, this assurance may be illusory, as status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions,” said Dr. James L. Madara, the chief executive of the American Medical Association. | |
| Nancy LeaMond, an executive vice president of AARP, said the bill would allow insurers to charge much higher premiums to people age 50 to 64. In addition, she said, it would worsen the financial outlook of the Medicare trust fund; increase the number of people without health insurance; and endanger services for low-income people who depend on Medicaid. | Nancy LeaMond, an executive vice president of AARP, said the bill would allow insurers to charge much higher premiums to people age 50 to 64. In addition, she said, it would worsen the financial outlook of the Medicare trust fund; increase the number of people without health insurance; and endanger services for low-income people who depend on Medicaid. |
| Mr. MacArthur said Thursday that his amendment had won over some of his Republican colleagues, though not enough to pass the bill. “But we are closer today than we’ve ever been,” he said. “We’re getting there.” | Mr. MacArthur said Thursday that his amendment had won over some of his Republican colleagues, though not enough to pass the bill. “But we are closer today than we’ve ever been,” he said. “We’re getting there.” |
| If his amendment cannot win over enough Republicans, Mr. MacArthur said he was not sure what would be able to attract the necessary support. “This is my great concern — that if we don’t get this done now, we may be losing our last chance,” he said. | If his amendment cannot win over enough Republicans, Mr. MacArthur said he was not sure what would be able to attract the necessary support. “This is my great concern — that if we don’t get this done now, we may be losing our last chance,” he said. |
| At the same time, his amendment highlighted the gulf between hard-line conservatives and more moderate Republicans when it comes to how to go about repealing and replacing the Affordable Care Act. | At the same time, his amendment highlighted the gulf between hard-line conservatives and more moderate Republicans when it comes to how to go about repealing and replacing the Affordable Care Act. |
| For the Freedom Caucus, which shouldered much of the blame for the House bill’s failure last month, the amendment functioned as a way to shift any finger-pointing to a different bloc of members. | For the Freedom Caucus, which shouldered much of the blame for the House bill’s failure last month, the amendment functioned as a way to shift any finger-pointing to a different bloc of members. |
| But the latest version of the House bill seemed to offer little that would entice anyone with reservations other than the hard-line conservatives. | But the latest version of the House bill seemed to offer little that would entice anyone with reservations other than the hard-line conservatives. |
| Numerous moderate members who were opposed last month remain opposed to the bill. | Numerous moderate members who were opposed last month remain opposed to the bill. |
| “The proposed changes to this bill would leave too many of my constituents with pre-existing conditions paying more for health insurance coverage, and too many of them will even be left without any coverage at all,” Representative Ileana Ros-Lehtinen, Republican of Florida, said Thursday. | “The proposed changes to this bill would leave too many of my constituents with pre-existing conditions paying more for health insurance coverage, and too many of them will even be left without any coverage at all,” Representative Ileana Ros-Lehtinen, Republican of Florida, said Thursday. |
| It also gave pause to some Republicans who were ready to vote in favor of the measure last month. | It also gave pause to some Republicans who were ready to vote in favor of the measure last month. |
| Representative Mario Diaz-Balart, Republican of Florida, planned to support the bill last month before it was pulled. But on Thursday, he was undecided about what to do about the revised legislation. | Representative Mario Diaz-Balart, Republican of Florida, planned to support the bill last month before it was pulled. But on Thursday, he was undecided about what to do about the revised legislation. |
| “There’s a lot of red flags,” he said. One of them, he said, was what would happen to people with pre-existing conditions. “How are they treated?” he asked. “What options do they have?” | “There’s a lot of red flags,” he said. One of them, he said, was what would happen to people with pre-existing conditions. “How are they treated?” he asked. “What options do they have?” |
| Even if House leaders could get a bill through their chamber, it faces deep skepticism in the Senate, where other policy concerns are certain to be debated, like the future of Medicaid in states that expanded eligibility under the Affordable Care Act. | Even if House leaders could get a bill through their chamber, it faces deep skepticism in the Senate, where other policy concerns are certain to be debated, like the future of Medicaid in states that expanded eligibility under the Affordable Care Act. |
| The Senate Democratic leader, Chuck Schumer of New York, argued on Thursday that the core of Mr. MacArthur’s amendment would violate the budget rules that Republicans must follow in order to sidestep a Democratic filibuster. | |
| Mr. Schumer warned House Republicans against voting for a flawed bill “to save face for the president in the first 100 days.” | Mr. Schumer warned House Republicans against voting for a flawed bill “to save face for the president in the first 100 days.” |
| “Why,” he asked, “would you risk voting yes for a bill that is devastating to your constituents and has no chance of becoming law?” | “Why,” he asked, “would you risk voting yes for a bill that is devastating to your constituents and has no chance of becoming law?” |