The White House began signaling to conservatives this weekend that negotiations are closing on the GOP Obamacare alternative, nudging the far-right to get in line before a crucial Thursday House vote on the bill.
During a meeting at Donald Trump’s Mar-a-Lago estate in Florida Saturday, the president’s top advisers told three of the most vocal conservative opponents of the bill — Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) and House Freedom Caucus Chairman Mark Meadows (R-N.C.) — that they agree with some of their demands in principle, according to several sources familiar with the discussions. But it’s also become increasingly apparent to the White House that the conservatives’ requests, which include phasing out Obamacare’s Medicaid expansion earlier and deregulating the insurance industry, are unlikely to pass the Senate.
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Multiple administration and Hill sources close with GOP leadership now expect a couple smaller tweaks to the legislation this week before the vote. But by-and-large they feel talks with the far-right are just about done, and that they can’t give conservatives everything they want.
That marks a major shift in the White House’s recent posture — news that will come as music to House GOP leaders’ ears. The White House last Monday instructed Speaker Paul Ryan (R-Wis.) to make a number of smaller concessions to conservatives, including allowing optional work requirements for Medicaid.
Those changes won over several conservative Republican Study Committee members who were previously “no” votes. But Ryan and his top lieutenants worried that if they kept moving too far right, they’d lose a bunch of centrist Republicans. Some have already started to peel off or threatened to.
Still, hardliners like Cruz, Lee, Meadows and the Freedom Caucus want more. That’s why they met with White House officials in Florida, on a side trip while in the state for events with the conservative Club for Growth. Trump did not meet with them personally, though they huddled with chief of staff Reince Priebus, chief strategist Steve Bannon, domestic policy director Andrew Bremberg and legislative affairs director Marc Short.
The meeting comes as Trump’s and Ryan’s leadership teams are joining forces to whip support for the GOP bill, working around the clock to win over wary members before the make-or-break vote Thursday. Sources say all the principals were working the phones over the weekend, including Vice President Mike Pence, Trump budget director Mick Mulvaney, Health and Human Services Secretary Tom Price, Ryan, Majority Leader Kevin McCarthy (R-Calif.), Majority Whip Steve Scalise (R-La.), chief deputy whip Patrick McHenry (R-N.C.) and committee chairmen who authored the bill.
House policy staffers also worked through the weekend, haggling over several additional bill changes they believe could pick up another few moderate and conservative votes. Ryan announced one of those publicly Sunday: more generous health care tax credits for the elderly, a nod to centrist Republicans worried about the bill’s effect on people in their 50s and 60s. They were also looking at speeding up the timeline for repealing the Obamacare taxes, something one insider said was unlikely give Senate opposition.
Insiders say it will be all hands on deck on both sides of Pennsylvania Avenue for the next four days. Trump is expected to play an active role this week in helping whip votes — just as he did Friday, when he flipped about a dozen conservative ‘no’ votes to ‘yes’ during an Oval Office meeting. GOP insiders expect he’ll meet with other wary lawmakers and may even head to the Hill to rally the troops.
A half-dozen administration and Hill sources close to leadership sounded confident Sunday that they’d have the votes to pass the bill by Thursday, if they don’t already. They feel momentum building as Trump increasingly involves himself personally.
Many lawmakers on Capitol Hill wanted to make sure Trump was all-in for the bill, after hearing mixed messages from leadership and conservative members about whose side he is on. Trump on Friday made it clear, telling Republicans at the White House he is “1000 percent” behind the legislation before them.
“This president’s been willing to roll up his sleeves and get in the middle of a negotiation, and actually get people to yes — and put his weight behind this bill,” Scalise, the top GOP vote-counter, said on Friday. “It just shows you what it takes to build a coalition to pass a major and complicated bill.”
He added: “We have been wanting to pass a lot of these reforms for generations, and for various reasons it never happened. But we have a rare moment in history now to deliver a big win for the American people and the president is all in on making that happen.”
In an interview late last week, Cruz laid out his concerns with a bill that he says “doesn’t get the job done” and can’t pass the Senate. He wants to reduce the “unacceptable” premium projections laid out by the CBO by allowing people to use pre-tax health savings accounts as well as association health plans; he also wants to implement work requirements and a block grant option for Medicaid — two provisions that already been agreed to by the administration.
But his vision for Medicaid is too conservative for many of his colleagues, who hail from states that expanded the program and would see hundreds of thousands of constituents lose coverage.
“We can fix it by meaningful Medicaid reform in particular: Freezing Medicaid expansion immediately, not holding open expansion for three more years to allow states to put yet more healthy childless adults onto an already overburdened Medicaid system,” he said.
This is the message Cruz, Lee and Meadows brought to Florida. They made the case for an earlier phase out of the Medicaid expansion, earlier repeal of the Obamacare taxes and a fuller repeal of the law and its regulations, which may not be allowed under Senate rules. The latter has become a top ask for conservatives, who want to tuck de-regulation provisions into a fast-tracked bill instead of passing legislation separately in the future, as is the current strategy. Senate rules, however, require those changes to go through legislation that can be filibustered and so would need to win least eight Democratic votes, which seems unlikely.
Some on the right argue the Senate parliamentarian could be overruled by the vice president to jam as much repeal of Obamacare into the bill as possible, although it’s a precedent that Senate Majority Leader Mitch McConnell is loath to set.
White House officials at the meeting said they agreed with conservatives on everything in theory, but challenged them to show 51 votes to support their ideas and pass the bill in the Senate.
The conservative trio also argued that the bill wouldn’t pass as is and would cause premiums to skyrocket in the short-term, which would hurt Republicans in 2018. But White House officials noted that they’ve also argued that Republicans will get creamed in the mid-term elections if they don’t pass an Obamacare repeal bill by then as well. White House officials said they can’t have it both ways and said they must write a bill that can pass Congress.
Bannon — who is sympathetic to the plight of the far-right and close with top Cruz allies, Robert Mercer and his daughter, Rebekah — didn’t say much in the meeting, a person familiar with the gathering said.
It is unclear what this new message means for members of the Freedom Caucus and other conservative critics like Sen. Rand Paul (R-Ky.), who have called the bill “Obamacare 2.0” and “Obamacare-lite.”
Paul has encouraged the Freedom Caucus, a group of a couple dozen conservatives, to sink a House rule prepping the bill for passage. Should they do that, conservatives feel they may be able to squeeze more concessions from GOP leadership and the White House.
But doing so is risky — especially if Trump is now on GOP leadership’s side.
“I think they come back Monday, they do a little more posturing and then I think at the end of the day they’re going to get on board,” said one senior GOP source who requested anonymity to speak frankly. “They’ll have to hang their hats on some of these wins, which are really huge wins. … They’re just pissed off because they’re not getting” everything they want.