High stakes for Trump as vote looms on Republican health plan

WASHINGTON (Reuters) - As the clock ticked on Friday toward a high-stakes vote demanded by Donald Trump to overhaul the U.S. healthcare system, fellow Republicans in Congress scrambled to secure enough votes to avoid a loss that could hobble his presidency.

The showdown on the House of Representatives floor follows Trump's decision to cut off negotiations to shore up support inside his own party, with moderates and the most conservative lawmakers balking. On Thursday night he had issued an ultimatum that lawmakers pass the legislation that has his backing or keep in place the Obamacare law that Republicans have sought to dismantle since it was enacted seven years ago.

The House was tentatively set to vote by 4:45 p.m. ET (2045 GMT) on Friday on the bill to replace Democratic former President Barack Obama's signature domestic policy achievement, the 2010 Affordable Care Act, widely known as Obamacare.

Republicans control Congress and the White House but have deep divisions over the first major legislative test since Trump became president on Jan. 20. The vote looked to be a cliffhanger.

Representative Rodney Davis, a member of the House Republican team trying to win passage, said the bill was still short of the needed votes, telling MSNBC the "next few votes" would be the toughest to secure. White House budget director Mick Mulvaney told ABC it was not clear if Republicans had enough votes.

Vice President Mike Pence, a former House member and influential among Republican lawmakers, postponed a planned trip to Arkansas and Tennessee to help secure passage.

If all House members vote on the measure, Republicans can afford to lose only 21 votes. At least 35 Republicans still plan to vote against the bill, according to CBS News.

"We'll see what happens," Trump said at the White House, adding that House of Representatives Speaker Paul Ryan, who has championed the bill, should keep his job regardless of the outcome.

Ryan headed to the White House for a meeting hours before the vote.

The president and House Republican leaders cannot afford to lose many votes in their own party because Democrats are unified in opposition, saying the bill would take away medical insurance from millions of Americans and leave the more-than-$3 trillion U.S. healthcare system in disarray.

Republican supporters said the plan would achieve their goal of rolling back the government's "nanny state" role in healthcare.

FOREHEAD TATTOO

House Democratic leader Nancy Pelosi said, "What's happening today is a lose-lose situation for the Republicans. It's a lose-lose for the American people, that's for sure. But the people who vote for this will have this vote tattooed to their foreheads as they go forward."

Failure of the measure would call into question Trump's ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

"If it doesn't pass, this issue is dead," Republican Representative Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. "This is the one shot."

Even if the legislation passes in the House, it faces an uncertain future in the Senate, where Republicans have expressed misgivings.

Trump, a real estate magnate who touted his deal-making prowess in the 2016 presidential campaign, is facing the first major test of how well his skills would work with Congress. Days of negotiations led to some changes in the bill but failed to produce a consensus deal.

Trump put fresh pressure on the House Freedom Caucus, which includes some of the chamber's most conservative members and strongest critics of the bill. Trump said it would be ironic that opposition by anti-abortion lawmakers would preserve federal funding for Planned Parenthood, the women's healthcare provider that includes abortions in its programs.

While Planned Parenthood is barred from using federal funds for abortions, conservatives argue that any federal money for other health services frees the organization up to use its own money on abortions.

U.S. stocks were higher Friday as some of the worry investors about a possible failure of the bill appeared to be ebbing ahead of the scheduled vote in the House. Some analysts suggested a failure could be a catalyst to bring forward action on tax reform, which has always been a greater priority for investors.

"Lawmakers will have to be accountable as to why they didn't vote to get rid of Obamacare when they had the chance and that chance is today," Mulvaney said on CBS's "This Morning" program.

The vote had been set for Thursday, the seventh anniversary of Obama's signing of the 2010 law, but in an embarrassing setback it was postponed because of uncertain support.

'GET ON BOARD'

Health Secretary Tom Price put pressure on Republican holdouts on Friday.

"It's time to put up," he said on Fox News. "This is the first step and they need to get on board."

Trump added on Twitter, "This is finally your chance for a great plan!"

The partisan, emotional debate expected in the House on Friday was previewed during a testy early-morning hearing of the House Rules Committee.

"I don't have to be nice to nobody when you are being nasty to poor people,” Democratic Representative Alcee Hastings of Florida said during an exchange with Republicans on the panel.

A Quinnipiac University poll released on Thursday found 56 percent of U.S. voters opposed the House bill, with only 17 percent supporting it. Quinnipiac said its poll had a margin of error of plus or minus 3 percentage points.

The bill is the first foray into legislation for Trump, who took office on Jan. 20 with no political experience.

Replacing Obama's signature health care plan was a key campaign pledge for Trump and Republicans, who view it as overly intrusive and expensive.

Obamacare aimed to boost the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The nonpartisan Congressional Budget Office said under the Republican legislation 14 million people would lose medical coverage by next year and more than 24 million would be uninsured in 2026.

The House plan would rescind a range of taxes created by Obamacare, end a penalty on people who refuse to obtain health insurance, end Obamacare's income-based subsidies to help people buy insurance while creating less-generous age-based tax credits

It also would end Obamacare's expansion of the Medicaid state-federal insurance program for the poor, cut future federal Medicaid funding and let states impose work requirements on some Medicaid recipients.

House leaders agreed to a series of last-minute changes to try to win over disgruntled conservatives, including ending the Obamacare requirement that insurers cover certain "essential benefits" such as maternity care, mental health services and prescription drug coverage.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans' views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, Susan Cornwell, Jeff Mason, David Morgan, David Lawder, Amanda Becker, and Doina Chiacu; Writing by Will Dunham; Editing by Bernadette Baum and Bill Trott)