House Republicans, deeply divided, face painful choice on health vote

PHOTOGRAPHER: The New York Times

Health and Human Services Secretary Tom Price, joined by House Republicans, speaks about the proposed American Health Care Act.

WASHINGTON — For the House Republicans who have never served under a Republican president — roughly two-thirds of them — Thursday’s vote on a measure that would repeal President Barack Obama’s signature health care law is a legislative fantasia, the culmination of seven years of campaign promises impeded by Obama’s veto pen.

But weeks of back-room machinations to bring a disparate group of lawmakers on board have left many Republicans with an excruciating choice: pass a bill with an extremely limited constituency that could well wreak havoc with their own voters, and on Republicans’ re-election prospects, or turn it back, leaving President Donald Trump’s agenda deeply wounded.

Should House Republicans reject the measure, the working relationship between the White House and Republican leaders in Congress, still in its infancy, would suffer a powerful blow. In Washington, failure often begets more failure, as opposition forces strengthen, allies fragment and the thin foam of bipartisanship evaporates.

“How do we have any momentum to do anything else?” asked Rep. Richard Hudson, R-N.C. “Without this bill, I don’t know how you do tax reform,” he said. If the bill fails, “it’s going to have negative repercussions for all of us.”

On Wednesday morning, House leaders and the White House continued to scramble for a portion of the roughly 25 more votes they need for passage of their repeal measure — scheduled for a vote on Thursday — working one by one to woo — or cajole — members they think can be moved.

A group of the most conservative House members met with the president at the White House on Wednesday. On Tuesday afternoon, Trump met with moderate House Republicans for over an hour in the Oval Office to entertain their concerns, but did not appear to have a clear grasp of the policy specifics in question, some of them said.

Trump, a man who rushes to hang his name in gold anywhere he can, has rejected the moniker that some have given the House bill, Trumpcare.

But he has begun a last-minute campaign to both sweet talk and vaguely threaten fellow Republicans into supporting the leadership’s hastily written bill, though the measure, which would replace the Affordable Care Act’s health insurance mandate and generous subsidies with tax credits to purchase insurance, has suffered criticism from the right and left. Republican leaders are depending on Trump to finish the job.

Indeed, this week many Republicans have begun to acquiesce to the president and House leadership’s desires, accepting that the bill, however flawed, as the best they are going to get.

At least for now, though, too many have not.

Rep. Rod Blum, R-Iowa, expressed his concern on Tuesday in a Twitter post that said the House Republican bill “doesn’t do enough to lower premiums for hard-working Americans.” For that reason, he said, “I’m a ‘no.”’ Likewise, Rep. Ted Budd, R-N.C., said he could not support the bill “as currently written.”

Further hampering them, House Republicans failed to do the grueling work of building a coalition outside of the Capitol as Democrats did with their measure in 2009. While anti-abortion groups have warmly embraced the bill, which could restrict coverage of the procedure, it lacks other advocates. Doctors, nurses, hospitals have come out strongly against the measure, and insurance companies have been largely skeptical.

Even if Speaker Paul D. Ryan manages to secure the bare minimum of votes required, the bill that would pass the House would not become law. The Senate expects to greatly change the legislation, dragging out the process deep into the spring, if it can pass any version at all. Republican senators, largely those from states that chose to expand their Medicaid program under the Affordable Care Act, so far have not seemed susceptible to pressure from leaders and Trump, listening instead to governors and constituents concerned with significant rollbacks in benefits.

Part of the bill’s problem is time itself. Much has changed in the years since the Affordable Care Act passed, with millions of Americans, many in red states, now getting health insurance for the first time as a result of the law, as well as treatment for the prescription drug addictions that have plagued scores of communities.

“My goal for this whole process was to help the people the law harmed and not harm the people it helps,” said Rep. Dan Donovan, R-N.Y. At the same time, a fair number of conservatives would like to see those benefits greatly reduced, the central tension of the Republican debate.

As a result, it remains difficult to imagine a bill that could find its way out of the Capitol to Trump’s desk, given the broad disparities in what Republicans now seek.

Even if they can come together, House Republicans risk making the same mistakes Democrats made in the beginning of Obama’s term, when they pushed through the Affordable Care Act. That achievement, monumental at the time, came to drag down a once formidable Democratic majority and reduce their ability to get further legislation accomplished during his presidency.

Yet should the bill fail, House Republicans could end up like House Democrats under President Bill Clinton, who passed a controversial energy tax that was reduced to rubble in the Senate, but remained an albatross for Democrats in the 1994 election.

The Democratic majority repeated that error in the early years of the Obama administration when the House passed a highly unpopular bill to cap carbon emissions that cause climate change, only to see it go nowhere in the Senate, bringing down some House Democrats in the process.

House and Senate leaders are privately telling members that they do not want to be tarred as Republicans who voted with Democrats to maintain the Affordable Care Act. It’s a message they expect to resonate once the bill reaches the Senate.

“We remain committed to the repeal and replacement of Obamacare with policies that actually work,” said Sen. Mitch McConnell of Kentucky, the Republican leader, on the Senate floor as he urged members to get on board. “Americans are ready for a better way forward after the failure of Obamacare.”

But the flaw in that theory is that plenty of groups that usually support Republicans have already expressed distaste for the measure, and are urging members to reject it.

“In 2018, members are going to have to campaign for re-election and say, ‘Look we repealed Obamacare’ and voters are going to look at their premiums and say, ‘Oh no you didn’t,’” said Dan Holler, a spokesman for Heritage Action for America, a conservative group. “In the long term, it is not in the best interest of the Republican Party to pass this bill.”

House Republicans could console themselves in thinking that the Thursday vote could be more like the excruciating vote in 2003 for President George W. Bush’s Medicare prescription drug benefit.

Then, House Republican leaders had to keep the vote open for hours as they twisted arms, finally securing passage, 216-215, over the opposition of the party’s most conservative members, including then-Rep. Mike Pence, R-Ind.

But that measure, which did become law, has proved popular and durable, and the vote — which led to ethics charges against some of the arm-twisters — has largely receded into the history books.