White House Pushing Congress To Revisit Failed Effort To Repeal And Replace Obamacare
Faced with the fact that it has little to show for its first 100 days in office, the Trump Administration is pressuring Congress to come up with a new health care reform bill before the end of next week.
Less than a month after seeing the American Health Care Act die in the House, the White House is pressuring Republicans in Congress to pass a new health care bill to repeal and replace the Affordable Care Act, preferably before the expiration of the Presidents first 100 days in office:
President Trump is pushing Congress toward another dramatic showdown over the Affordable Care Act, despite big outstanding obstacles to a beleaguered revision plan and a high-stakes deadline next week to keep the government running.
The fresh pressure from the White House to pass a revision was met with skepticism by some Capitol Hill Republicans and their aides, who were recently humiliated when their bill failed to reach the House floor for a vote and who worry now that little has changed to suggest a new revision would fare any better.
The effort reflects Trump’s sense of urgency to score a victory on Obamacare replacement and move on to other legislative objectives, notably tax restructuring. Passing an Affordable Care Act revision would also allow the president to show progress toward a major campaign promise as he completes his first 100 days in office.
“The plan gets better and better and better, and it’s gotten really good, and a lot of people are liking it a lot,” Trump said at a news conference Thursday. “We have a good chance of getting it soon. I’d like to say next week, but we will get it.”
Congressional Republicans also worry that they must attract Democratic support to fund the government past the month’s end — a step they must take by midnight April 28 to avoid a shutdown. That could become difficult if Democrats grow alienated by the effort to alter former president Barack Obama’s key domestic policy achievement, which some White House officials said they hope will come up for a vote as early as Wednesday.
Several congressional GOP aides, who spoke on the condition of anonymity to talk openly about the ongoing negotiations, said they worry that the rushed process threatens to create another embarrassing public failure over health care. The schedule would also make it nearly impossible for lawmakers to finish their work in time for official scorekeepers to provide a clear estimate of how much the legislation would cost or how it would affect coverage numbers.
House GOP aides in Washington worked furiously to scale back expectations for a quick vote on the legislation, citing the fact that lawmakers have not been fully briefed on the discussions. There was no deadline for finishing the legislation as of Thursday evening, and GOP leaders have not committed to plans for a Wednesday vote, according to one House GOP leadership aide.
The fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates that the measure can pass in the House. White House officials said language would be circulated among members in the next few days, and the modifications will be discussed Saturday in a conference-wide call as Republicans prepare to return to Washington next week.
The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have demanded.
As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states.
House leadership and committees are taking a secondary role in the negotiations, which are being largely carried out by MacArthur, head of the moderate Tuesday Group, and Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. Members from both groups had balked at voting for the bill last month, forcing leaders to pull it from the floor at the last minute.
Meadows was silent Thursday on whether he supports the proposed changes.
As Politico notes, this pressure from the White House is coming at the same time that Congress, which returns from its two-week Easter recess on Monday, is seeking to make a deal by the end of the month that funds the government through the end of the current Fiscal Year and avoids a government shutdown that neither Republicans nor Democrats want:
Congressional leaders’ efforts to hatch a massive spending deal have been thrown off course by the Trump administration’s 11th-hour intervention, leaving the bipartisan bill teetering on the brink of collapse just a week before a government shutdown deadline.
The hard line taken by White House officials, particularly Office of Management and Budget Director Mick Mulvaney, has strained an emerging deal between House and Senate leaders that would skirt hot-button issues that could shut down the government. In particular, administration officials’ hopes of giving President Donald Trump a win during his first 100 days, such as border wall funding or a crackdown on sanctuary cities, have complicated what had been a relatively smooth, bicameral, bipartisan negotiation, according to staffers in both parties.
But Democrats are taking an aggressive stance, too, flatly insisting that Trump or Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan make a commitment to funding Obamacare’s cost-sharing subsidies as a precondition to voting for any bill to fund the government through September. Democrats have also talked tough on ruling out funding for a wall or a provision restricting billions in federal grants from cities that don’t enforce federal immigration laws.
“Negotiations are slow-going,” said a Republican aide familiar with the bargaining. “There is a deal to be had — a good one with wins for both parties, but I think with a new minority leader and a new president, anything can happen. … If we don’t get much progress by this weekend, bad news.”
Republican leaders are desperate to avoid a shutdown after April 28, and Trump himself said on Thursday, “We wanna keep the government open.” But productive talks among McConnell, Ryan, Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi stalled over the last 24 hours after administration officials signaled they would dig in over wall funding.
Legislative text detailing the agreement that some lawmakers expected to be released late this week is now not expected until next week — if ever. To avoid a shutdown, Congress could also pass a one-week extension to give negotiators more time.
Congressional leaders “could have struck a deal” on a larger package, said a Senate Democratic aide. The White House’s involvement means hopes for a bipartisan agreement are “just getting murkier.”
Republicans are mulling a fallback plan that would keep the government operating at current funding levels through September, known as a continuing resolution, aides said. That bill would likely contain some new money for fighting terror, a priority of both parties.
However, some Republicans doubt a long-term patch can pass the House. And both parties want to avoid a stopgap spending bill that would amount to a major disappointment for both parties and do little to change Washington’s reputation for gridlock, even with a new president.
Some hope rose on Thursday when Mulvaney signaled openness to allowing Obamacare’s subsidies to continue flowing to Americans of low income for one to two years on Thursday at a forum hosted by the Institute of International Finance, intriguing some Republicans.
But House Democratic leadership told the White House they want a permanent fix included in the spending bill that would ensure Obamacare subsidies are deemed mandatory government spending, rather than subject to the yearly whims of Congress, a source familiar with the conversation said.
And just as he appeared open to cutting a deal, Mulvaney also told The Associated Press that “elections have consequences” and Trump must receive funding for the planned border wall in the spending bill.
“There are a lot of people on the Hill, especially in the Democratic Party, who don’t like the wall, but they lost the election,” Mulvaney told the AP.
Republican said privately it would be helpful for Mulvaney and the White House to concede that the Democrats are not going to fund the wall and move on. But there is a combative element to the divided Trump White House that believes otherwise.
“There are people in the West Wing who want the shutdown fight because they think that’s how you get things done. And there is another faction in the White House that knows that’s a bad idea,” said a senior House Republican aide.
The odds of Congress being able to handle both health care reform and getting a budget measure passed prior to the end of the month are, of course, somewhere close to impossible.
As far as health care is concerned, for example, we’ve already seen that it’s nearly impossible to reconcile the competing demands of conservatives in the House Republican Caucus such as the House Freedom Caucus and those of the moderates led by the so-called Tuesday Morning Group (a name derived from the day of the week on which they typically meet when the House is in session) and it seems unlikely that these hastily arranged meetings and arbitrary deadlines are going to help the process. In addition to the problems of putting together something that would have even a slight chance of passing the House, drafters also have to remain wary of the Senate in two regards. First of all, whatever bill they put together would need to be structured in such a way that it could be considered under the Senate’s budget reconciliation rules. If they fail to do so, then the legislation would be subject to being blocked by expected Democratic opposition in the form of a “no” vote on a cloture motion. Since it’s incredibly unlikely that Mitch McConnell would be able to keep his caucus together to eliminate the legislative filibuster, that would mean that the repeal and replace effort would die in the Senate. Second, even if they can put together a House bill that can get through under reconciliation, there’s still no guarantee that it can pass the Senate given the fact that several Senators have voiced objections to what the House is even considering. For some, such as Senator Rand Paul, it’s because the bill doesn’t go far enough in repealing the PPACA. For other, more moderate Republicans, it’s because of the threat that the bill poses to Republican-controlled states such as Ohio and others that chose to take advantage of the PPACA’s expansion of Medicaid. Taken together, it’s entirely possible that the House bill would not survive a Senate floor vote and that whatever changes the Senate will be unacceptable to the House.
Getting a budget measure passed, meanwhile, has complications of its own. Even if Republicans agree to rely on Democratic support to get it done, especially in the House, there are still potential problems facing both the House and the Senate that will likely mean that Congress goes down to the wire in an effort to get something passed by a week from Sunday. The most pressing appears to be the issue of continuing the subsidies provided under the Affordable Care Act, with Democrats saying that they will insist that Republicans agree to keep them on long-term rather than using this part of the budget as a backdoor way to undermine the PPACA. Additionally, as noted above, the funding of the President’s so-called border wall is likely to be an issue that many Democrats, and likely some Republicans will disagree with and it’s clear that many Republicans would just as soon let the issue die for purposes of getting this budget finalized and deal with it in the process of putting together a new budget for the coming Fiscal Year over the summer. The Trump Administration, though, is pushing in the other direction on both issues, and any Congressional reluctance to provide even minimal funding for the wall would likely result in an outburst by Trump. Add into this the fact that Congress also has to keep its eye on an impending necessity to raise the debt ceiling, and it promises to make what should be a routine budget measure far more complicated.
With these competing pressures, it seems not only unlikely that the House can address both health care reform and the budget in the coming week, meaning that choices will have to be made in order to avoid a government shutdown. Good luck with that, guys.
Governing is hard. Who knew?
Funny, but Trump was bragging on Twitter this morning about how much he’s accomplished, but the press won’t give him any credit for it.
One, I doubt that Trump has even a surface level of understanding of the proposals.
Two, I am frustrated with the media in their inability to explain anything about the proposals except, of course, for focusing on the politics of the matter.
Three, once again, the proposal is a tax cut bill posing as a health care bill.
Scott,
To be fair, it’s kind of hard to comment on the substance of a bill that hasn’t been drafted yet.
So the world’s greatest negotiator has managed things so that the best possible outcome, for him, is that within the next ten days the House will pass a shitty bill that everyone knows won’t pass the Senate. And the more likely outcome is a failed bill, again, and a government shutdown on his hundredth day. Brilliant.
Republicans just won’t stop until they kill every cancer survivor, chronic disease sufferer, and mentally-ill person in America.
But, hey, with all of them dead, health insurance will be so cheap!
Of course, they’ll probably “fix” it so insurance costs just as much as it does now, but the 1% get a boffo tax cut.
FTFY
Despite having control of the House and Senate, he has accomplished nothing on this list. This is the most incompetent administration in history.
Thank heavens.
Ah, the ancient wisdom of “if at first you don’t succeed, you’re a pathetic failure and a fraud.”
So far, he’s:
A) Gotten an extremely qualified Justice on the Supreme Court.
B) Dealt quite firmly with Syria’s WMDs that the Obama administration swore up and down had been removed, with the cooperation of Assad and Russia.
C) Gotten China on board with leaning hard on North Korea over their WMD program.
D) Gotten American coal miners a new market by getting China to turn back North Korea’s coal and buy from the US.
E) Gotten several NATO countries to increase their commitment to actually close to what they’re treaty-bound to spend.
But he hasn’t achieved everything yet, and he’s passed the critical “5% of his entire first term” landmark, so he’s a pathetic failure. And a fraud.
Can we impeach him, or should we just skip the intermediate steps and behead him?
He promised 10 pieces of legislation in the first 100 days, and accomplished zero. And now he’s calling 100 days a ridiculous standard:
He’s the Leader of the Fools.
@Bob The Arqubusier: Please make that “Syria’s use of WMDs.” Assad still has plenty, despite the best promises of Obama, John Kerry, Susan Rice, Vladimir Putin, and Bashar Assad.
I don’t remember Obama, Kerry, and Rice promising to defeat ISIS in the first 30 days. Somebody made that promise, I can’t remember who at the moment….
@teve tory: How would you rate that on a scale from “the most transparent administration ever” to “if you like your doctor, you can keep your doctor?”
@gVOR08:
And if he succeeds beyond what anyone else thinks is possible and convinces congress to pass a bill that bears any relationship to the one that failed last month now, his voters will have 3 years of worse health care before he runs again. They may well support him if he shoots someone on 5th Avenue, but helping to kill off Grandma may be a different story altogether….
@Bob The Arqubusier: BTW, is anyone else really, really, really fed up with political discussions all coming down to “let’s find new ways to call the other person a hypocrite?” Just what the hell is that supposed to achieve, anyway?
I guess if your goal is “make them shut up and go away,” and not “have a reasonable discussion,” it’s a pretty sound strategy.
@Bob The Arqubusier:
We shall list this under Mitch McConnell’s accomplishments.
One air strike. Assad and Putin laughed.
Leaning so hard, NK tested a missile!
And yet he did nothing for the horse buggy makers….
But have they written the checks?
How’s the Muslim ban doing? Has construction started on the wall? Is Hillary in jail? I’m pretty sure that’s why you elected Trump, not to goad NK into testing a missile. Amirite?
@Bob The Arqubusier: Dunno…how do you rate that on the scale of “we’re not going to release White House visitor records” to “significant evidence of direct collusion with Russia?”
@James Pearce: Patience, grasshopper. You don’t eat a pig like that all at once.
@Mikey: Lemme guess: the first quote is from Obama, and the second is from Hillary, right?
Second guess on the second one: John Podesta?
@James Pearce: “Has construction started on the wall?”
Several cities have declared that they will blackball any company that submits a bid to work on the wall. I think that an appropriate response from the Trump administration is to cite the North Carolina Bathroom ban and say that any city or state that pulls that will be blackballed from having any federal travel funds expended taking any federal employees to or from those cities and states. Also a blackball from ANY federal infrastructure funds — if they’re going to use that kind of thing as a political weapon, then they can be on the receiving end of it as well.
Plus a Justice Department investigation into how such bans might violate the Interstate Commerce Act, as its interpretation was greatly expanded under the ObamaCare debates.
@Bob The Arqubusier:
I don’t want him impeached. You guys elected this clown. He – along with your Tea Party / “Freedom” 🙄 Caucus bombthrowers – represents the internal divisions that will increasingly rip the GOP apart.
I want both infections – Trump and Meadows & Friends – to remain exactly where they are, wreaking as much internecine damage on the GOP as possible. The sooner this faction of the right cuts off its own head, the better off the rest of us – and the country – will be.
@Doug Mataconis:
But, that’s not what Trump is saying:
I’ve wondered what it would be like if Palin somehow became our president – now I know.
Palin or Trump, with a Republican Congress, are the same appalling combination that I imagined.
@Bob The Arqubusier: No, the first quote is from the Trump White House and the second is from the U. S. intelligence community.
Here in Texas, most Texans are coming to the realization that most of Trump’s policies are detrimental to Texas. The focus on the wall, trade restrictions, immigration, coal; none of these are in their interest. Watch the unpopularity rise and Republican congresspeople start hedging their bets.
@James Pearce:
You do realize that the “committment” Trump is referring to is to spend at least 2% of their GDP on ….their own defense.
Trump continually acts like HE is expecting a check from Canada etc.
@Bob The Arqubusier:
Gotta repeal and replace Obamacare first, right?
At any rate, I’m not sure I’d be counseling patience is the way to go. I’d go with skepticism.
@teve tory:
Not bug… Feature !!!
He was elected by people that want to burn the place down. The fact that he has accomplished nothing just proves that Washington DC is feckless. And that just adds fuel to their fevered fire.
For example: When you look at Bob’s defense of Trump, it is not so much an actual defense of Trump himself, but Trump’s “success” working in the world that surrounds Trump. And I’m sure he will tell you that the whole world is against Richie Rich Trump.
The reality is Trump is surrounded by a GOP majority in the House and Senate, as well as a cabinet of billionaires, and still cant get his agenda passed. Because his agenda is not based in reality.
Americans don’t really WANT less health care. They don’t WANT the rich and corporations to pay less taxes so they can get less services (and themselves pay more taxes).
As a result, we will lily see many continued unconstitutional challenges put forth by Jeff Sessions, in an attempt to feed the animals raw meat. It’s what they have.
@Bob The Arqubusier:
By all means, please link me to investigations being carried out with regard to how healthcare policy violates an act which regulates surface transportation. I’m all ears.
Oh, and let’s not forget that White House meddling in the current funding negotiations is making a government shutdown (and one which will be blamed on the White House by BOTH sides in Congress) much, MUCH more likely to occur.
FTFY
@Bob The Arqubusier:
For years, Republicans distinguished themselves as Federalists who would oppose this kind of approach. Can you think of a reason why?
@James Pearce: Maybe it’s escaped your notice, but Trump isn’t exactly a mainstream, doctrinaire Republican. He hasn’t shown himself particularly bound to that yet; why would you think he’d be so bound now?
Oh, yeah. Because that would be convenient for you now. That makes all sorts of sense.
Trump don’t play by your rules, and nobody but you and your peers judge him by how well he abides by them. He never agreed to do so, and he’s be astonishingly stupid if he did.
@Bob The Arqubusier:
It didn’t escape my notice, but it appears to have escaped the notice of dunderheads who don’t understand the intellectual underpinnings of their own movement.
Before you get too braggy about this….consider that our next Democratic president will be playing by “Trump’s rules,” and if that means compelling red states to fund Planned Parenthood under threat of “blackballing” then so be it.
Anybody but Hillary, right?
@James Pearce: I’m not getting braggy, my dear fellow. Just acknowledging reality. Trump’s insistence of following his own style and making his own rules has its pluses and minuses.
Might I suggest you try to “acknowledge reality” every now and then, too? It’s quite refreshing.
Companies and businesses come and go. Others come in and pick up their clients and customers. People move on. Things keep going. With the Obama Care decline, many people are already moving off of it to better plans that cost less. Around here the private companies are calling day and night offering this and that health plan. If you ask about the government plan, they just laugh.
So there is no plan to leave anyone out in the cold. People who are on the plan now will simply be moved to another plan and will have the choice of more. They will have lower rates and better coverage. Obama care fulfilled its purpose and paved the way for better plans – a bridge if you will.
My medicare plan has changed three times in two years: BC/BS, Humana, now United. Change happens now in the insurance arena.
In many states the exchanges have closed or there is just one company left for the government plans (Bronze, Silver, Gold).
Companies come and go: look at the last several months. Who ever thought that Sears, Kmart, Macy’s, General Foods, Eastern Airlines, E. F. Hutton, and JC Penney would either be closing or nearly gone ? These were American icons. But the customers will survive and move on.
“Obama Care in death spiral” Aetna ceo
“Obama Care is repealing itself” American Thinker
Insurance companies now gone: Lumbermans Mutual, Standard Life, Company, Southern States Life, Republic Insurance, Southern Rock, New Century
@Tyrell:
‘American Thinker’?
Seriously, many Republican states refused to fully implement ACA exchanges or Medicaid expansion, and are of course vested in the ‘death spiral.’ Republican healthcare policy is the ‘death panel’ that they accused ACA of being.
The reality Bob? This guy has contradicted his positions depending on the time of day and the latest Fox news report he happens to see.
An unhinged lunatic reflecting those who voted for him and their own insanity. See your post as Exhibit A in the denial/rationalization department of his supporters.
Won’t even go to Trump’s total 180 on “I hate NATO/I love NATO” foolishness. Which is it Bob? Make them pay for NATO? Disband NATO? Embrace NATO?
You tell me Bob, whats his position today?
@Bob The Arqubusier:
Trump doesn’t have any style and his “pluses” are minuses.
He’s been pretty awful so far, and that’s by his own standards.
“…should we just skip the intermediate steps and behead him?”
Considering the brain is not what he thinks with* it might be more useful to remove another appendage.
Another Duganism, unrelated to the topic at hand.
“Did anyone ever tell you, you look like a penis with a little hat on?”
(President Lump…has a ring to it.)
*viewer discretion advised
@Bob The Arqubusier: I didn’t downvote this because I don’t downvote things I haven’t/won’t read. Also: it’s spelled ‘a-r-q-u-e-b-u-s-i-e-r’.
@Doug Mataconis: “To be fair, it’s kind of hard to comment on the substance of a bill that hasn’t been drafted yet.”
True, but the major shape is clear – less health care for fewer people, costing far more, and vast tax cuts for the rich.
@Bob The Arqubusier: “Dealt quite firmly with Syria’s WMDs that the Obama administration swore up and down had been removed, with the cooperation of Assad and Russia.”
Even the other lies are stuck dumb by the sheer dishonesty of this one.
@Barry: The only serious modifications to the AHCA we’ve heard about are putting Essential Health Benefits back into the bill, to appease the moderates, but then allowing states to request exemptions from this, to appease the conservatives. A stupid, garbage strategy.
The most that will come out of this is House republicans get sick of the damage they’re taking from the process, and pass something, anything, just to get it out of their hair and to the Senate, where it has as much chance of survival as Woody Allen at Al Qaeda’s christmas party.
@teve tory:
He used to be all about the “first 100 days” until he came to the end of it an abject failure. Now he calls it a “ridiculous standard.”
It’s just so juvenile, so beneath the dignity of the office…so emblematic of Trump himself.
The goal is to get as many people into the health insurance as possible. That can be done by offering more choices. That will bring down the rising costs.
I remember a time when I had the choice of over eight HMO’s through work. Then they started dwindling down.
The big shadow no one wants to talk about. It is the huge numbers of the boomer generation who are now moving into the senior citizen age range. This will mean an huge demand for health care and assisted living. Most of these people do not have funds to pay for this.
See: “Thanks to Democrats Pre-existing Conditions Outweigh the Uninsured In the GOP Replacement Deal” (Forbes)
“The Strategy That Will Fix Health Care” (Harvard Business Review, Michael Porter)
@Tyrell:
You keep saying this, no matter how many times people correct you.
It is not true. It is the opposite of true. “More choices” is how people get to self-select out of the risk pool you need them to be in if that pool is going to be solvent. “More choices” makes health care cheaper for the people who can already afford health care, and even less available for the people who can’t.
If you want to cover everyone, the most efficient and cost-effective way to do that is to put everyone in the same risk pool. Republicans would rather die than permit this, because Freedom(tm) .