The deal with hard-line conservatives in the House of Representatives who scuttled the last effort to pass Trumpcare is being taken as a signal the latest incarnation will fly.
However, final passage of legislation to repeal Obamacare and replace it with Trump’s American Health Care Act remains far from certain. And this time Trump’s reputation is more on the line than ever.
That is because he let House and Senate Republicans take the lead on the failed effort to pass Trumpcare in March. But in the wake of that disaster, Trump set into motion an all-hands effort by the White House – led by Vice President Mike Pence – that has taken over the job of getting it passed from House Speaker Paul Ryan (R-Wisconsin) and others in Congress.
Pence and others on Trump’s team negotiated in small groups with legislators. Some Congress members were brought to the White House for personal meetings with Trump – to get their vote.
However, the gains that they made come at a cost. The new bill, among other things, doesn’t support a Medicaid expansion, which is very popular in many states, and includes a clause that kills the popular Obamacare rules that prohibit insurers from discriminating based on a patient’s pre-existing condition.
Many of the moderate Republicans who were on board for the last version of Trumpcare over Easter break held town halls in their districts where they were told in no uncertain terms that the pre-condition issue is a very big deal, as are other parts of Obamacare – according to polls.
Moderate Republican OH in the Capitol just now: "If I vote for this healthcare bill it will be the end of my career"
— Scott Wong (@scottwongDC) April 26, 2017
“So far,” reports The Hill, “no moderates have moved from no to yes on the bill, and there are divisions within the moderate Tuesday Group…over a decision to negotiate changes to an earlier bill.”
Rep. Tom MacArthur (R-NJ), a leader of the Tuesday Group, who was involved in the negotiations with conservatives was forced to admit he was speaking only for himself and had no authority to hold discussions on behalf of other Republican centrists in the House.
MacArthur is said behind a compromise that would allow states to get waivers from federal mandates that insurers cover certain “essential health benefits,” reports the New York Times, which include emergency services, substance abuse care, mental health services, ambulance servieces, and pregnancy/maternity care.
He also helped shape the compromise that permits states to waive requirements forcing insurers to charge the same rates to people of different ages. This is the part that would end the ban on rejecting coverage for pre-existing conditions. It could cost people with past health problems, especially seniors, tens of thousands of dollars in added health care costs, and make it impossible for others to afford insurance.
So while the three dozen conservatives in the House known as the Freedom Caucus may now be on board, the 50 or so members of the House Tuesday Group of moderates are not on board or at best reconsidering their support.
If somehow Trump can push a version of Trumpcare that pleases ultra right-wing conservatives through the House, it will face even greater obstacles in the Senate, where more moderate voices have already made known their displeasure with the compromises.
“In effect,” reports the New York Times, “the more that the bill changes to get through the House, the less chance it has of surviving in the Senate, both because of Senate rules and because the provisions that conservatives have excised are popular.”
There are virtually no Democrats in either chamber who have said they will vote for Trumpcare, and that is not expected to change. That means the Republicans cannot afford to lose more than 22 votes among their members. The Hill already has counted half a dozen or more Republicans in Congress who plan to vote no or are waiting to see the final language of the bill, but may still vote against it.
One clause inserted in the new bill that has incensed Democrats would guarantee many of the benefits of Obamacare for members of Congress even as they are eliminated for everyone else.
“The monstrous immorality of Trumpcare is perfectly encapsulated in House Republicans’ plan to exempt their own health coverage from the damage it will do to everyone else,” said House Democratic leader Nancy Pelosi (D-Ca.).
For many, it is an issue of keeping their jobs. Recent special elections around the U.S. have indicated a lot of voters are not happy with Trump’s push to a deeply conservative agenda, and voters have discovered they actually like Obamacare.
The new Trumpcare would still result in at least 24 million Americans losing health coverage, and that the cost of health care for older Americans would certainly go up, all of which is unpopular.
Trump, in meetings with legislators, has pushed hard for a compromise, according to reports by POLITICO and others, as he reaches and passes the 100-day mark of his administration. He has been telling Congress people, “We have got to get a win.”
Trump is not saying this is a good bill for Americans or will be popular, but rather that there is a need for his Presidency to reflect he can get things done. At present, after a campaign in which he said he would win, win, win, all he has done is lose, lose, lose. That clearly has pressured him to get a win at any cost.
So passage of Trumpcare is far from assured, even with his bullying.
“The president overestimated his ability to get people into the Oval Office and make some deals,” reports Politico.
Overestimating, exaggerating, misrepresenting and twisting the truth are things Trump has proven he is good at, but this time deceit and being a bully may not be enough to get him his precious “win.” In 100 days as President, he has not yet brokered any “deals” of note.
And if he fails again, the only one to blame will be that face that stares at Trump in the mirror every morning.