With health-care vote, Republicans seek to prove they can get things done

With the outcome of the American Health Care Act still up in the air, President Trump headed to the Capitol to lobby his party Tuesday. This week's vote is the GOP's first big legislative test as a governing party.

On Tuesday morning, President Trump came to the basement conference room of House Republicans to do what he was supposedly born to do: Seal the deal. In this case, that meant lining up enough House votes to pass the GOP plan to repeal and replace the Affordable Care Act on Thursday.

The closer-in-chief talked up the huge opportunity to deliver on a major promise to voters. He also pointed to the political cost of failure to deliver – singling out Rep. Mark Meadows, the leader of the hard-line House Freedom Caucus. The North Carolinian opposes the GOP health-care bill.

Mr. Trump’s involvement has intensified as the House nears its do-or-die vote on the American Health Care Act, the Republican effort to replace Obamacare. Last week, Trump invited more than a dozen conservatives to the White House, worked out a compromise with them, then proudly announced they had all flipped to “yes” votes.

Compromise is not exactly what House Republicans are known for. But it will be necessary if they are to pass their first big legislative test as a governing party this week. While the outcome is still up in the air, the “party of no” is trying mightily to prove that it can get things done, with leaders urging members to back the bill, even if they don’t get everything they want.

“They’ve been in blocking mode. I think they are starting to learn that they have to govern,” says John Feehery, spokesman for Republican Dennis Hastert of Illinois when he was speaker during the George W. Bush presidency.

To get to “yes,” House leaders have worked out a compromise amendment to the bill to lure moderates and conservatives. It promises more financial help to older Americans whose premiums are expected to skyrocket under the GOP plan – $85 billion to people between 50 and 65 years old.

To appease conservatives, it gives states more flexibility in running Medicaid, the federal-state program for the poor – for instance by allowing them the option to institute a work requirement for able-bodied recipients.

The amendment is changing some minds, with several Republicans coming on board. “This is a bill that I think has come a long way,” said Rep. Tom MacArthur (R) of New Jersey on Tuesday. He now supports the bill. 

Compromise is an adjustment. For eight years, Republicans worked hard to thwart much of President Barack Obama’s agenda – through a partial government shutdown, in the courts, and legislatively. In both houses, the majority of Republicans have never known anything but being in the opposition.

In the House, only 60 Republicans – a mere quarter of their members – have served in the majority when a Republican occupied the White House.

The opposition mind-set is starting to change, said Rep. Hal Rogers (R) of Kentucky, a congressman with more than three decades under his belt.

“I think there is beginning to be a realization of ‘Hey, we’re in charge here, and we’ve got to cast some maybe personally unpopular [votes] in order to lead,’ ” he said after the president’s visit Tuesday.

Negotiations at Mar-a-Lago

Another sign of that realization: The Freedom Caucus has decided not to vote as a block on the health-care bill, but to leave this one up to individual members to decide. Representative Meadows has also reached out to moderates in the House and Senate, in addition to an intense weekend of negotiation with White House aides in Mar-a-Lago over the weekend.

He’s still a “no” vote, and says there are enough opponents in the caucus to sink the bill – and perhaps wrangle more concessions. But one Freedom Caucus member in the group that visited with Trump last week has been convinced. That presidential attention is itself another sign of a party intent on getting things done.

“Neither Republicans nor Democrats have seen any charm offensive coming from the White House in many years, and a little goes a long way,” says former Rep. Matt Salmon (R) of Arizona, who retired from Congress last year and used to belong to the Freedom Caucus.

Despite many aspects of the plan that appeal to Republicans – the elimination of penalties associated with the individual and employee mandates of Obamacare and a reduction of federal deficits by $337 billion within 10 years – the legislation encountered a fierce political tornado last week.

That’s when the nonpartisan Congressional Budget Office estimated that 24 million people would lose coverage by 2026 under the plan. Federal contributions to Medicaid would drop by $880 billion over the same period. The program would be radically changed, with open-ended federal payments capped based on the number of people a state has enrolled in Medicaid. That cheers budget hawks but has some governors reeling.

Additionally, the plan would hit older, low-income Americans particularly hard, with premiums for a 64-year-old soaring from $1,700 a year to more than $14,000.

Steep road ahead

The path to passage is particularly steep for House Speaker Paul Ryan (R) of Wisconsin. He can afford to lose only 21 votes. The Freedom Caucus alone has roughly 30 members and then there are Republicans from swing districts and members of the moderate Tuesday Group to convince.

Democrats are hammering home the “crushing costs” of Trumpcare’s “age tax.” On average, only 30 percent of voters approve of the Republican bill, compared with 47 percent who oppose it, according to Nate Silver’s FiveThirtyEight blog.

Meanwhile, if the bill passes and is taken up by the Senate next week, enough moderate and conservative Republicans stand opposed that it has no chance of passing there as-is – even with the compromises added this week.

“In this day and age, in this business, in politics, if you get 85 percent of what you want, that’s pretty darn good,” said Speaker Ryan, talking with reporters after the president’s visit and enumerating the compromises added to accommodate members’ suggestions.

If Republicans want to keep their “rendezvous with destiny,” as the speaker put it, they’ll have to give a little. It’s part of governing. Whether enough Republicans will see it that way is the question.