WASHINGTON — House Republicans are moving forward with a climactic vote on their health care bill Friday with or without the votes to pass it after President Trump told them to pass the bill now or never.
Trump wrote in his book The Art of the Deal that a key to negotiating is that you've got to be willing to walk away from the table. The question now is whether rebelling Republicans are willing to do that as well.
After a day full of meetings and last-minute arm-wringing went nowhere, Trump dispatched several of his deputies to Capitol Hill for an evening meeting of the House Republican conference. Trump adviser Kellyanne Conway, White House senior adviser Steve Bannon and former representative Mick Mulvaney, now director of the Officer of Management and Budget, were in the meeting. There, Mulvaney told Republicans that the White House is done negotiating and will move on from the health care issue unless the House passes the bill on Friday, according to a GOP aide.
The threat comes after House Republican leadership desperately scrambled Thursday to save the American Health Care Act. Despite talk of progress, Speaker Paul Ryan and his team clearly still did not have the necessary votes to bring the sweeping bill to replace Obamacare to the floor on Thursday, as originally planned.
Republican leadership can now only hope to change some hearts and minds before the vote, which will take place Friday at 3 p.m., according to Rep. Chris Collins.
The final package will include the AHCA and a new amendment stripping away the federal essential health benefits introduced under Obamacare.
Essential health benefits mandate that all health insurance plans must cover certain things such as hospitalization, maternity costs, ambulances, pediatric care, addiction treatment, emergency services, and prescription drugs.
Removing these rules — and states could still choose to keep them in place — would allow insurance companies to offer cheaper, bare-bones insurance plans. On the surface that would help one of the main criticisms of the bill, that it would lead to a projected 24 million more uninsured people. Premiums would drop and more people would likely sign up, but the quality of insurance plans would deteriorate.
Ryan briefly spoke to reporters after a caucus meeting Thursday evening. "For seven and a half years we've been promising the American people that we would repeal and replace this broken law because it is collapsing and failing families. Tomorrow we're proceeding," Ryan said, taking no questions and walking away.
When asked whether Republicans now have the votes to pass the bill, Rep. Steve Stivers, who chairs the National Republican Congressional Committee, told reporters they will see where they are on Friday.
"I think we'll find out tomorrow," Stivers said. "I think it's gonna be a surprise."
Both the hard-right House Freedom Caucus and some moderate Republicans remain opposed to the bill, despite an overwhelming push from Republican leadership and the White House.
In the afternoon, Freedom Caucus chair Mark Meadows expressed optimism and vowed that "we're committed to stay here until we get it done."
But by the evening Meadows conceded that he was still voting no on the bill. He said the Freedom Caucus has not taken an official position opposing the AHCA. But with several moderates opposed as well, even a portion of the Freedom Caucus voting no could doom the bill.
In the end, Republicans stretched as much as they could but one simple problem haunted the negotiations — any push to win over the Freedom Caucus further alienates moderates and vice versa. After nearing a deal on Wednesday night that the Freedom Caucus seemed optimistic about, moderate members said they could not support the changes.
Even after the meeting with members and White House officials on Thursday night, some Republicans remained unmoved. New York Rep. Dan Donovan, the lone Republican congressman in New York City, exited the meeting saying he was still a no.
"I'm not a fan of the Affordable Care Act," he said. "It's hurt people in my district. This is not giving them the relief that they need."
Meanwhile, Republicans who are on-board with the plan are growing increasingly frustrated with their colleagues who won't sign on. "You get one chance at something like this. So we need to get it done," Oklahoma Rep. Tom Cole said. "You're either part of a team or you're not."
It takes 22 Republicans to vote no to kill the bill.
White House press secretary Sean Spicer told reporters Thursday that the administration is confident the bill will pass, after saying in a press conference earlier this week that "there is no plan B."
“It’s going to pass, so that’s it," Spicer said Thursday.
Sarah Mimms contributed reporting to this story.
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Paul McLeod is a politics reporter for BuzzFeed News and is based in Washington, DC.
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