Following a long, chaotic day of trucking and trying to convince congressional Republicans to back the American Health Care Act, President Donald Trump demanded that the House vote on the bill on Friday. The message was delivered by White House budget director Mick Mulvaney, who told a Thursday evening meeting of GOP representatives that Trump was done negotiating the issue. Mulvaney also warned that, should the bill fail to pass, Trump was prepared to leave the Affordable Care Act in place, potentially denying House Republicans their big opportunity to follow through on years of pledges to kill Obamacare. “The president needs this, the president has said he wants a vote tomorrow up or down,” said Mulvaney, according Representative Chris Collins. “If for any reason it’s down, we’re just going to move forward with additional parts of his agenda.”
The plan for a Friday vote was confirmed by House Speaker Paul Ryan. “We have been promising the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” a frustrated-looking Ryan told reporters. “And tomorrow we’re proceeding.” The vote had originally been scheduled for Thursday, but Ryan was forced to postpone it when it became clear that Trumpcare lacked the support needed to win House approval.
What will happen on Friday is unclear. Assuming that all of the House Democrats oppose the AHCA, Ryan and Trump can only afford to lose 22 Republican votes. As of Thursday night, the far-right House Freedom Caucus appeared to pose the most significant threat to the bill’s passage. Earlier this week, its members got Ryan and Trump to agree to eliminate Obamacare’s provision that insurance plans offer ten “essential benefits” — only to go on to demand even more draconian adjustments. As Politico reported:
[A] sizable chunk of [the Freedom Caucus’s] 30-plus members have made it crystal clear that no amount of tweaking or minor changes to Ryan’s replacement bill can win them over. Insiders in the House and the White House believe about 10 to 15 of the Freedom Caucus members will vote “no” on the measure regardless of what concessions they receive or what pressure Trump and the leadership try to bring against them.
Meanwhile, the concessions to the Freedom Caucus have likely further alienated more moderate Republicans who were already worried that Trumpcare was too harsh to support. A handful of them have publicly said that they’ll be voting “no.”
Also on Thursday, the Congressional Budget Office released a new score of the AHCA based on modifications made to the bill on Monday. It wasn’t good: According to the CBO, the revised bill would reduce the deficit by about half as much as the original version while still causing 24 million people to lose their insurance — and that projection doesn’t take into account the more recent changes.
Despite the imperfect circumstances, Ryan was still doing what he could to realize his lifelong dream of taking away people’s health care. From the Washington Post:
Leaders continued to plead with individual lawmakers to support the measure well into Thursday night, with the House Rules Committee slated to meet early Friday morning to consider the proposed changes. Ryan got down on a knee to plead with Rep. Don Young, an 83-year-old from Alaska who is the longest-serving Republican in Congress and remains undecided. When the speaker finished with Young, he spent about 10 minutes in an animated discussion with Rep. Mo Brooks (R-Ala.), one of the bill’s most outspoken critics. At one point, the speaker took his own arms and held them up, his hands at face level, then slowly lowered them to his waist — presumably trying to demonstrate his belief that the bill will lower costs.The ongoing effort to whip the vote, Rep. Joe Barton (R-Tex.) said at one point, involved “back-patting and butt-kicking.”
Barton added, “Democracy’s messy” — a reality that may just now be setting in for Trump. The New York Times reports that the health-care debacle has left the president “grappling with rare bouts of self-doubt.” Trump has reportedly “told four people close to him that he regrets going along with [Ryan’s] plan to push a health care overhaul before unveiling a tax cut proposal more politically palatable to Republicans. He said ruefully this week that he should have done tax reform first when it became clear that the quick-hit health care victory he had hoped for was not going to materialize on Thursday.”
To be fair, absolutely nobody knew health care could be so complicated.