House Speaker Paul D. Ryan (R-Wis.) visited White House at midday Friday to brief President Trump on an overhaul of the nation’s health-care system, amid mounting evidence that enough House Republicans would spurn their pitches and send the bill to defeat.
Ryan was prepared to tell Trump there are not enough votes to pass the legislation, two GOP aides familiar with his plans said. It was unclear whether leaders would proceed with a planned afternoon vote. As Ryan met with Trump at the White House at 1:30 p.m., Press Secretary Sean Spicer said during his daily briefing that a vote would proceed at 3:30 p.m.
A House GOP aide confirmed the expected timing of a vote.
If the bill does not pass Friday, a day after Trump delivered an ultimatum to lawmakers, it would represent multiple failures for the new president and the Republican Congress.
It would leave the Affordable Care Act in place and leave a major GOP campaign promise unfulfilled. It would cast doubt on the GOP’s ability to govern and specifically to move forward on other high-stakes agenda items, such as tax reform and infrastructure spending. And it would undermine Trump’s image as a skilled dealmaker willing to strike compromises to push his agenda forward.
Spicer reminded reporters that Trump had personally lobbied 120 lawmakers, either in person or on the phone. The president had “left everything on the field.” Asked whether the president would continue to fight for the bill if it does not pass Friday, Spicer said, “This is it.”
Spicer said that no matter what happens, the White House doesn’t think it slows other parts of their agenda such as immigration or tax reform. He also dismissed questions about whether the White House would call on Ryan to pull the legislation.
“You guys are so negative,” Spicer told reporters.
Meanwhile, Vice President Pence left a huddle at the Capitol Hill Club with members of the hard-line House Freedom Caucus, who are most stridently opposed to the legislation, joined by Health and Human Services Secretary Tom Price and White House Chief of Staff Reince Priebus. He waved to a crowd of reporters and tourists, but did not answer shouted questions about whether Ryan had the votes.
In one stunning defection Friday, House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced at midday that the health care bill is “currently unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.”
“We need to get this right for all Americans,” he said.
Other members who had raised concerns about the bill — both conservative and moderate — said the late changes had done nothing to change their minds.
Rep. Paul Gosar (R-Ariz.), a Freedom Caucus member, was one of six Republicans who voted against a procedural resolution bringing the bill to the floor.
“You know what? I came here to do health care right,” said Gosar, a dentist. “This is one chance we that can get one-sixth of our GDP done right. It starts with here.”
At the heart of the argument made by GOP leaders to skeptical members: Keeping the Affordable Care Act is a worse outcome than passing a potentially flawed replacement.
“You want to score a touchdown, but sometimes, on the fourth down, you kick a field goal,” said Rep. Joe Barton (R-Tex.), the longest-serving member of Congress in the Freedom Caucus. “The choice is yes or no. I’m not going to vote no and keep Obamacare. That’d be a stupid damn vote.”
At the White House on Friday morning, Trump projected confidence as he briefly answered shouted questions following an announcement of a presidential permit for the Keystone XL pipeline, a revived project that the president said would create jobs. And Vice President Pence postponed a scheduled trip to Arkansas and Tennessee to help build support for the bill.
Asked by a reporter what he would do if the bill fails, Trump — seated at his Oval Office desk — shrugged and said: “We’ll see what happens.”
Trump also said he didn’t feel the process had been rushed and that Ryan should remain as speaker if the bill fails.
On Twitter, Trump said that “After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!”
With 237 House Republicans, party leaders can afford only 21 or 22 defections, depending on how many Democrats are present on Friday. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation. An unsuccessful vote could also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.
No matter what happens in the House, the ultimate fate of the legislation hinges on the Senate, where new uncertainty emerged about the timing of a vote despite earlier guidance that Senate Majority Leader Mitch McConnell (R-Ky.) planned to push for a vote next week.
The Congressional Budget Office warned senators on Friday that recalculating the rewritten House bill could take a week or more to produce, said several officials familiar with the discussions, who were not authorized to speak publicly about the matter.
That was expected to upend McConnell’s plan to finish their work and send the legislation to the White House for Trump’s signature before a two-week Easter recess, according to three people briefed on the matter.
Senate budget rules require that party leaders provide an official estimate of how much the legislation would cost and how it would change the deficit before scheduling a vote.
McConnell’s aides didn’t immediately return requests for comment.
Republicans have a 52-to-48 advantage in the Senate, but at least a dozen Republicans are on the fence about the legislation, because many of them want to maintain some of the current law’s more generous spending components.
At the Capitol, House Majority Leader Kevin McCarthy (R-Calif.) chuckled when a reporter asked on Friday morning if GOP leaders had secured the votes: “You guys ask me the same question every day. You know I don’t talk about Fight Club.”
When formal debate on the bill began, McCarthy and other leaders used a procedural vote to gauge last-minute support. House Majority Whip Steve Scalise (R-La.), the top GOP vote-counter, was seen conferring with Rep. Christopher Smith (R-N.J.), a key holdout. House Ways and Means Committee Chairman Kevin Brady (R-Tex.) sat in the row behind them cajoling Rep. Patrick Meehan (R-Pa.), another moderate who has yet to announce what he plans to do.
Rep. Mark Meadows (R-N.C.), who chairs the Freedom Caucus, said late Thursday that he was leaning against the legislation. He did not immediately respond to requests for comment on Friday morning.
Rep. Ken Buck (R-Colo), a caucus member who said before the election that minor losses in the House Republican ranks would increase conservative clout, said he remained undecided.
“I’m examining life experiences,” he said. Asked to explain what he meant, he said he was joking.
And Rep. Andy Harris (R-Md.), a caucus member who had been a hard “no” earlier in the week, told NPR on Friday morning that he could potentially vote yes.
“If I think that premiums are going to come down enough . . . I could be a yes,” Harris said, citing a letter Trump sent Thursday to Freedom Caucus members outlining administrative steps he could take to address that issue. “But my yardstick is, will premiums come down enough under these actions?”
Rep. Peter King (R-N.Y.), a moderate who had expressed qualms as recently as Tuesday, when he was singled out by Trump inside a private meeting of House Republicans, said he had all but decided to vote for the bill.
“I’m not one they should worry about,” he said.
Rep. Louie Gohmert (R-Tex.), one of Trump’s most ardent congressional supporters, said he remained opposed to the legislation because it made more political sense to keep current law than to start rewriting it.
“A no vote means we save Donald Trump from a Democratic majority in 2019,” Gohmert said. “If this passes, then Obamacare stays.”
Republican leaders on Thursday introduced several tweaks intended to appeal to skeptics on either ideological flank. The amendment looks to appease moderates by adding $15 billion to a flexible fund for states to pay for maternity, mental health and substance abuse programs under Medicaid. That money adds to an existing $85 billion pot of money created by leaders earlier in the week.
The amendment attempted to appease conservatives by allowing states to determine the minimum standards for health insurance plans. It would allow insurers to drop basic coverage, like maternity care and preventative screenings, in order to cut premium rates.
Several members from both groups said the new additions were helpful but did not go far enough to win their votes. Moderate Rep. Leonard Lance (R-N.J.) told reporters Friday that he worries the bill still does not give states enough flexibility.
“I think there’s trouble with a significant number,” he said.
With Republicans in total control of the chamber, House Democrats could do little but clash and shout. A rare early-morning meeting of the Rules Committee held to set the rules of debate and add the amendment to the legislation quickly became tense.
“You never intended for there to be a health plan of consequence for this nation,” said Rep. Alcee Hastings (D-Fla.), raising his voice as he spoke.
He added: “What we will have done is helped rich people. And we will not have helped poor people.”
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and one of the bill’s architects, forcefully rejected Hastings’s claim during testimony before the rules panel, saying he was “offended” by the remark. He tried tempering the tone of his exchange with Hastings, who wouldn’t oblige.
“I’m mad as hell about what you all are doing!” the Democrat exclaimed.
Later, Rep. Joe Crowley (D-N.Y.) told reporters that some Republicans were likely “ashamed” by a process that had been defined by “back-room deals,” turning an old Republican attack back onto the majority.
“For what? To keep a seven-year old campaign promise?” said Crowley. “So Trump doesn’t send a mean tweet about you? That’s not leadership; that’s politics.”
Sean Sullivan, David Nakamura, David Weigel, John Wagner and Paul Kane contributed to this report.