WASHINGTON -- The House won't vote on Republican legislation scuttling much of President Barack Obama's health care law until at least next week, a GOP leader said Thursday. The decision deals a setback to the White House, which has pressured congressional Republicans to pass the bill by Saturday -- President Donald Trump's 100th day in office.
"As soon as we have the votes, we'll vote on it," House Majority Leader Kevin McCarthy, R-Calif., told reporters late Thursday after leaving a meeting of the House GOP leadership that lasted nearly two hours. He said the vote would not occur today or Saturday.
White House and Republican leaders had labored all day to wring votes out of resistant moderate GOP lawmakers for the health care measure. But they remained shy of the support they'd need to fully rouse the measure back to life, and it was uncertain when the vote would occur.
Centrist Republicans were the primary target of the lobbying, a day after the conservative House Freedom Caucus announced its support for a revised version of the legislation. The fresh backing from that group exhumed the bill from the legislative graveyard, but leaders need moderates who've resisted the effort to jump aboard.
While the White House was eager for a vote this week, Speaker Paul Ryan, R-Wis., wants to avoid an encore of last month's failed attempt to pass the bill, when he abruptly canceled a vote on a health care overhaul because of opposition from moderates and conservatives alike.
Ryan told reporters that leaders were making progress but added, "We're going to go when we have the votes." He noted that he had spoken earlier this year about a 200-day legislative plan because of the complexity of revamping the nation's health system, its tax code and border security.
White House budget director Mick Mulvaney told CNBC on Thursday that a House vote on the measure could happen next week or earlier. "I'm still holding out for Saturday," he said.
The bill got a new lease on life Wednesday when the conservative House Freedom Caucus, which helped derail the measure last month, formally endorsed the latest draft.
"While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health-care costs," the group said in a statement. "We look forward to working with our Senate colleagues to improve the bill."
In at least one instance, Trump and Vice President Mike Pence spoke to one recalcitrant conservative who is now a yes vote. Rep. Mo Brooks, R-Ala., said he'd already decided to switch to backing the revamped bill on Wednesday before he got two phone calls from Pence, who on the second call handed the phone to Trump.
"Donald Trump expressed his appreciation for the position I was taking," Brooks said Thursday. "That gives you a good feeling inside about what you're doing."
Medicaid cuts for poor
The recast bill would let states escape a requirement under former President Barack Obama's health care law that insurers charge healthy and seriously ill customers the same rates. They also could be exempted from Obama's mandate that insurers cover a list of services like maternity care, and from its bar against charging older customers more than triple the rates for younger ones.
Overall, the legislation would cut the Medicaid program for the poor, eliminate Obama's fines for people who don't buy insurance and provide generally skimpier subsidies.
Democrats remained solidly against the legislation, which they said would make health care coverage less available and costlier. House Minority Leader Nancy Pelosi, D-Calif., told reporters that for Republicans, voting for the bill "is going to be doo-doo stuck to their shoe for a long time."
Conservatives embraced the revisions as a way to lower people's health care expenses. Moderates saw them as diminishing coverage because insurers could make policies for their most ill -- and expensive -- customers too costly for them to afford.
"No bill is going to solve every issue," said Rep. Tom MacArthur, R-N.J., who crafted the newest edition of the legislation with Rep. Mark Meadows, R-N.C., who heads the hard-line Freedom Caucus. MacArthur is a leader of the roughly 50-member moderate House Tuesday Group, but it is unclear that he has won over many of their votes and he conceded that some lawmakers "are struggling to get to yes."
Rep. Charlie Dent of Pennsylvania, a leading Republican centrist, said he believes most moderates remain opposed. He called the new version an effort at "blame-shifting" for the failure of the repeal effort.
But Meadows said other undecided Republicans "are so close to yes." He added that he's "very optimistic [that] whether the vote is tomorrow or Saturday or next week, the votes will be there to actually pass this."
Two moderate Pennsylvania Republicans affirmed Thursday that they would vote no -- Reps. Patrick Meehan, who'd been publicly undeclared, and Ryan Costello, who'd said he'd have opposed the original bill.
Both cited fears that the new bill would leave people with serious illnesses unprotected. Meehan said he was called recently by Pence and lobbied "by everyone in leadership."
Rep. Raul Labrador, R-Idaho, joined other Freedom Caucus lawmakers against the original legislation who said they'd support the amended version.
Some lawmakers and GOP aides suggested leaders were fewer than 10 away from the 216 votes Republicans will need to prevail. Others were more cautious, and there was little overt indication of new support from party moderates.
"I still think there's a lot of work to be done" before a vote can be held, said Rep. Steve Stivers, R-Ohio, part of the House GOP leadership.
Medical input shut out
In crafting their bill, senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates and others who work in the health care system, industry officials say, despite pleas from many health care leaders to seek an alternative path that doesn't threaten protections for tens of millions of Americans.
But not a single major group representing doctors, hospitals and patients supported the original House legislation, which the nonpartisan Congressional Budget Office has estimated would increase the ranks of the uninsured by 24 million over the next decade.
The American Medical Association said it opposed the newly reshaped bill, as it did the original legislation. The doctors group said letting insurers boost premiums on people with pre-existing conditions "will likely lead to patients losing their coverage."
"To think you are going to revamp the entire American health care system without involving any of the people who actually deliver health care is insanity," said Sister Carol Keehan, president of the Catholic Health Association, whose members include many of the nation's largest medical systems.
Health insurers, who initially found House Republicans and Trump administration officials open to suggestions for improving insurance markets, say it is increasingly difficult to have realistic discussions, according to numerous industry officials.
"They're not interested in how health policy actually works," said one insurance company official, who asked not to be identified discussing conversations with GOP officials. "It's incredibly frustrating."
Another longtime health care lobbyist, who also did not want to be identified criticizing Republicans, said he had never seen legislation developed with such disregard for expert input. "It is totally divorced from reality," he said.
Opposition among those who work in health care only has deepened during the current GOP efforts to win over conservative lawmakers with the new amendment, with the American Medical Association and the American Hospital Association restating their rejection of the House legislation.
The American Cancer Society's advocacy arm -- one of many leading groups representing patients with serious illnesses who have spoken out against the GOP campaign to repeal Obama's health care law -- warned of the return of "a patchwork system of health coverage in which patients with pre-existing conditions in some states would no longer be protected."
The powerful AARP said provisions in the House bill would push up insurance costs for older Americans while doing nothing to tackle high prescription drug costs.
Information for this article was contributed by Alan Fram, Kevin Freking and Andrew Taylor of The Associated Press; by Anna Edgerton, Billy House, Shannon Pettypiece, Margaret Talev, Erik Wasson, Arit John, Sahil Kapur and Steven T. Dennis of Bloomberg News; and by Noam N. Levey of Tribune News Service.
A Section on 04/28/2017