Trump gambles with push for health vote

Washington — Abandoning negotiations, President Donald Trump on Thursday demanded a make-or-break vote on health care legislation in the House, threatening to leave “Obamacare” in place and move on to other issues if Friday’s vote fails.

The risky move, part gamble and part threat, was presented to GOP lawmakers behind closed doors Thursday night after a long and intense day that saw a planned vote on the health care bill scrapped as the legislation remained short of votes amid cascading negotiations among conservative lawmakers, moderates and others.

At the end of it the president had had enough and was ready to vote and move on, whatever the result, Trump’s budget director Mick Mulvaney told lawmakers.

“’Negotiations are over, we’d like to vote tomorrow and let’s get this done for the American people.’ That was it,” Rep. Duncan Hunter of California said as he left the meeting, summarizing Mulvaney’s message to lawmakers.

And if the vote fails, Obamacare “stays for now,” Hunter said.

“Let’s vote,” White House chief strategist Steve Bannon said as he left the meeting.

Rep. Justin Amash, the Grand Rapids-area Republican, had been among Freedom Caucus members to meet with Trump before the vote was delayed as the president was still rallying for the bill.

Amash has said he wants the Republican majority to start over because it would “make the system worse” by repealing only portions of the law.

“Repealing EHB (essential health benefits), w/out making other substantial changes, would make the bill worse, not better. It would hurt the sickest people on exchanges,” he tweeted.

The outcome of Friday’s vote was uncertain. Both conservative and moderate lawmakers claimed the bill lacked votes after a long day of talks.

“It’s done tomorrow. Or ‘Obamacare’ stays,” said Rep. Chris Collins, R-N.Y., a top Trump ally in the House.

House Republicans proposed last-minute changes to the health care bill, which they’ve offered in hopes of winning over wavering lawmakers. The House will vote on them when it considers the overall legislation.

Changes are:

■Repealing essential health benefits former President Barack Obama’s health overhaul requires insurers to cover. These include outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services and pediatric care.

■An additional $15 billion for states to address health care needs.

■The earlier version of the GOP bill abolished an additional 0.9 percent tax Obama’s law imposed on higher-income Americans to help pay for Medicare. The proposed changes would delay the repeal for six years.

Collins was among those predicting success on Friday, but others didn’t hide their anxiety about the outcome.

Thursday’s maneuvers added up to high drama on Capitol Hill, but Friday promised even more suspense with the prospect of leadership putting a major bill on the floor uncertain about whether it would pass or fail.

The Republican legislation would halt Obama’s tax penalties against people who don’t buy coverage and cut the federal-state Medicaid program for low earners, which the Obama statute had expanded. It would provide tax credits to help people pay medical bills, though generally skimpier than Obama’s statute provides.

It also would allow insurers to charge older Americans more and repeal tax boosts the law imposed on high-income people and health industry companies.

Moderates were given pause by projections of 24 million Americans losing coverage in a decade and higher out-of-pocket costs for many low-income and older people, as predicted by the nonpartisan Congressional Budget Office. In an updated analysis Thursday, the CBO said late changes to the bill meant to win over reluctant lawmakers would cut beneficial deficit reduction in half, while failing to cover more people.

The deficit reduction figures dropped mostly because the updated measure has additional tax breaks and makes Medicaid benefits more generous for some older and disabled people.

The measure would also block federal payments to Planned Parenthood for a year, another stumbling block for GOP moderates.

The drama unfolded seven years to the day after Obama signed his landmark law, an anniversary GOP leaders meant to celebrate with a vote to undo the divisive legislation. “Obamacare” gave birth to the tea party movement and helped Republicans win and keep control of Congress and then take the White House.

Instead, forced to delay the vote, the anniversary turned into bitter irony for the GOP. As the House recessed and lawmakers negotiated, C-SPAN filled up the time playing footage of Obama signing the Affordable Care Act.

In a danger sign for Republicans, a Quinnipiac University poll found that people disapprove of the GOP legislation by 56 percent to 17 percent, with 26 percent undecided. Trump’s handling of health care was viewed unfavorably by 6 in 10.

House Minority Leader Nancy Pelosi, D-Calif., who as speaker was Obama’s crucial lieutenant in passing the Democratic bill in the first place, couldn’t resist a dig at the GOP disarray.

“You may be a great negotiator,” she said of Trump. “Rookie’s error for bringing this up on a day when clearly you’re not ready.”

Royal Oak Democrat Rep. Sandy Levin said the proposed revisions to the GOP legislation would “obliterate” care by removing the mandate that insurers cover “essential” benefits such as outpatient care, emergency room trips, prenatal and maternity care and mental health and substance abuse services, making it harder for them to find coverage.

“Republicans say they want ‘patient-centered’ care, but if people have no insurance policy, there won’t be any care,” Levin said. “They’re saying, ‘everyone on their own.’ ”

Obama declared in a statement that “America is stronger” because of the current law and said Democrats must make sure “any changes will make our health care system better, not worse for hardworking Americans.” Trump tweeted to supporters, “Go with our plan! Call your Rep & let them know.”

Congressional leaders have increasingly put the onus on the president to close the deal, seemingly seeking to ensure that he takes ownership of the legislation — and with it, ownership of defeat if that is the outcome.

Yet, unlike Obama and Pelosi when they passed Obamacare, the Republicans had failed to build an outside constituency or coalition to support their bill. Instead, medical professionals, doctors and hospitals, the AARP and other influential consumer groups were nearly unanimously opposed. So were outside conservative groups who argued the bill didn’t go far enough. The Chamber of Commerce was in favor.

And, House members were mindful that the bill, even if passed by the House, faces a tough climb in the Senate.

Detroit News Staff Writer Melissa Nann Burke contributed.