With his public approval ratings at stunning lows and his White House reeling from Monday’s devastating revelation that the FBI is investigating possible collusion between his campaign staff and Russian intelligence agencies during the presidential election, President Trump today will try to convince wary House Republicans to rally behind him in support of a plan to repeal and replace the Affordable Care Act.
Reuters reported that the president will address the House Republican Conference personally on Tuesday, in advance of a looming vote on the American Health Care Act, the controversial piece of legislation that GOP leadership is trying to gather enough support to pass.
It would be a tall order even under ideal circumstances because this is a politically perilous vote for both conservative and moderate members of the GOP.
An analysis of the bill by the nonpartisan Congressional Budget Office last week found that, as written, it would reduce the number of Americans with health insurance by 14 million immediately and by 24 million over a decade. It would also raise costs and reduce service for vulnerable Americans, including the elderly and the poor. That combination of factors has left Republicans on the moderate end of the party’s spectrum reluctant to support the bill.
At the same time, the bill leaves in place some elements of the ACA and creates a new system of tax credits meant to help low-income Americans pay for health insurance on the private market. Those elements of the bill have led to a revolt among the party’s hard right members, who have labeled the legislation “Obamacare-lite” and say they will refuse to vote for it.
The result has been a spectacle of arm-twisting and glad-handing by House leadership and the White House over the past few days to bring enough Republicans on board -- 216 given the current make-up of the House -- to send the bill to the Senate.
And all this is being done in the service of a piece of legislation that Republican members of the Senate have preemptively declared dead-on-arrival in the upper chamber. That means that House Republicans are being asked to take a politically damaging vote on a bill that may never even get voted on in the Senate, much less become law.
Under other circumstances, a newly-elected president might be able to rouse the members of his party to his support. Particularly with the GOP in control of both Congress and the White House, there is little upside for Republicans in allowing their president to take an embarrassing pratfall in his first major legislative effort.
But Trump will arrive on Capitol Hill Tuesday, two months into his presidency, dragging more political baggage than many presidents accumulate in a full four-year term.
He will be speaking just a day after his own Justice Department publicly repudiated him in testimony before the House Intelligence Committee. FBI Director James Comey, making it clear that he was speaking as a representative of DOJ, said that there was no evidence for Trump’s repeated insistence that former President Barack Obama had ordered a wiretap of his offices during the presidential campaign. In the same hearing, Admiral Mike Rogers, the director of the National Security Agency, angrily denied another White House claim, alleging that Obama had pressed British intelligence services to surveil Trump.
Comey also revealed that the FBI is investigating efforts by Russian intelligence services to disrupt the presidential campaign by stealing and releasing damaging information about Democratic candidate Hillary Clinton, but that it is looking into whether there was any collusion between the Trump campaign and the Kremlin as part of that effort.
Wavering House members will, understandably, be asking themselves if they really want to take a political bullet for Trump at this stage.
House leadership, late Monday, tried to soften the blow for various constituencies in their conference. According to Politico, which obtained a copy of an amended version of the legislation, multiple changes were made to try to appease dissatisfied lawmakers.
-- An $85 billion provision meant to cushion older Americans from sharply increased costs under the plan. The amended bill would instruct the Senate to restructure the tax credit scheme to make it more generous to older Americans.
-- A measure to allow states to add a work requirement for Medicaid recipients.
-- Allowing states to choose between a per-person cap on federal contributions to Medicaid, or a fixed-sum block grant offering more freedom in how Medicaid dollars are spent.
-- Accelerated repeal of taxes imposed by the ACA.
-- Closing of a loophole that might have made it possible for recipients of the tax credits to use that money to pay for abortions.
Republican leadership, in a move reminiscent of the infamous “Cornhusker kickback” that helped get the ACA passed, added language to the bill that applies only to the state of New York. It bars the state from seeking Medicaid reimbursement from rural counties in the state but allows it to continue taxing more metropolitan areas, like New York City.
The proposal, which has infuriated that state’s Democratic governor and representatives of urban districts, was added to the bill to appease a coterie of conservative upstate lawmakers who signaled Monday that it had, in effect, been sufficient to buy their votes.
As the House nears its planned vote on AHCA Thursday, though, it remains unclear whether the persuasive power of the president and the new changes to the law will be enough to drag the necessary 216 lawmakers over the line.
Late Monday, some key conservatives in the House said that they will not support the bill even with the new changes. However, in a glimmer of hope for the White House, leaders of the House Freedom Caucus said that, while they do not support to bill themselves, they will not specifically direct their members to vote against it.