Despite President Trump’s personal appeals to lawmakers, the fate of the Republican healthcare bill remained uncertain Tuesday, as the fraught relationship between the president and congressional Republicans faces what could be a defining test.
“Honestly, a loss is not acceptable, folks,” Trump warned lawmakers, bluntly telling fellow Republicans that failure to pass the bill to repeal much of the Affordable Care Act could cost the GOP its majorities in the House and Senate.
The morning strategy session at the Capitol was the first time in his two months as president that Trump met with almost the full House Republican Conference that was elected with him in November. The membership reflects the disparate coalition of Republicans who aligned to make him their standard-bearer last year. The question for the party now is whether that ideologically diverse group can govern.
Before Trump spoke, House Speaker Paul D. Ryan (R-Wis.) made a characteristically wonky presentation of changes that had been made to the legislation in hopes of winning over both conservatives and centrists.
After Ryan spoke, the president followed with a presentation that attendees described as trademark Trump, focused less on the substance of the bill than on the consequences should he and his party stumble out of the gate on an issue on which they had long promised to deliver.
He came into the room armed with an index card identifying specific lawmakers, some of whom he singled out for praise after they were convinced to support the legislation, and others who were holding out. Among the latter were Rep. Mark Meadows of North Carolina, leader of the conservative Freedom Caucus and also an early Trump backer in last year’s contentious Republican primaries.
“Mark, I'm gonna come after you,” Trump said in a remark interpreted by some as a joke, by others as a threat, and by still more as potentially a little of both.
“The president was very direct," said Rep. Chris Collins (R-N.Y.), another longtime Trump backer who plans to vote for the bill. “We get this done — and tax reform — he believes we pick up 10 seats in the Senate and we add to our majority in the House. And if we don’t get it done, we lose the House and we lose the Senate.”
Trump "certainly put all of the elements of ‘The Art of the Deal’ together in one speech," said Rep. Tom McClintock (R-Elk Grove), who had agreed to support the bill before Trump's visit.
But by day’s end, vote tallies indicated that the White House could still not firmly count on a majority in the vote, which is scheduled for Thursday. “I think we'll continue down the path to get the votes,” White House Press Secretary Sean Spicer said. But, he conceded, “we've got a ways to go.”
How much Trump’s appeals or the changes in the bill have done to shift skeptics from no to yes remained unclear. Assuming all Democrats vote against the bill, Republican leaders can afford to lose no more than 21 votes on their side.
"I haven't heard anyone who changed their mind after this morning," said Rep. Warren Davidson (R-Ohio), a member of the Freedom Caucus, who remains opposed.
"The president’s a persuasive guy, and he’s well-liked," said Davidson, adding that most of those who plan to vote against the bill "worked hard to see our president elected."
But he added, "I didn’t run on a pretty slogan like 'repeal and replace.' I ran on fixing the problem."
Outside groups were adding pressure, with Heritage Action and the Club for Growth, both influential conservative groups, opposing the bill and the Chamber of Commerce supporting it. All the groups promised the vote would be counted in their annual scorecards of lawmakers' performances.
The Club for Growth started running ads in the districts of 10 Republican lawmakers who had expressed reservations about the bill, pushing them to vote against it.
Congressional aides concede some members remain skeptical about just how full-throated a case Trump will ultimately make for the legislation and how much political capital he might spend to see it through.
The president’s own comments have helped fuel those doubts.
Trump promised repeatedly throughout the campaign to repeal “the disaster known as Obamacare.” But he has often seemed more interested in other long-elusive Republican goals. He has seldom spoken about repealing the Affordable Care Act with the same kind of passion he has about trade, taxes or immigration; it usually was part of a list of issues he knew were important with the base.
“Have to do it, folks,” he would say, adding little else before returning to issues that excited him more. The one health-related issue he repeatedly does mention—government authority to negotiate prices for prescription drugs — is not in the bill and has been strongly opposed by Republican leaders in the past.
Trump repeated his pattern Monday night at a rally in Louisville, Ky., saying little about the bill he was ostensibly there to promote.
“We're going to be doing some trade deals as soon as we get the healthcare finished. Oh, I'm looking forward to these trade deals," he said.
But Ryan and other Republican leaders have worked with Trump since just after his election to lay out their legislative agenda in an order they believe gives them the greatest likelihood of success. For both procedural and policy reasons, healthcare emerged at the top of the list.
And while Trump has never been interested in the technical details of health policy, officials say he has seized on the interpersonal aspect of legislative horsetrading over the last week, especially as he's seen his efforts translate into shifting votes.
The changes that GOP leaders made in the bill Monday night include giving states new authority to limit who qualifies for Medicaid, the government health plan for the poor, and to impose work requirements for some aid recipients.
For more-centrist lawmakers, subsidies that help older Americans buy insurance were made more generous. The proposal, however, punted many of the toughest issues to the Senate, where Majority Leader Mitch McConnell of Kentucky promised to take up the bill as soon as next week.
But Tuesday, neither those tweaks nor Trump’s appeals appeared to have quite closed the deal. Some of the most conservative Republican lawmakers remained deeply skeptical despite the president's hard sell. On the other end of the GOP caucus, some centrists also said they would oppose the bill.
Rep. Walter B. Jones (R-N.C.), a conservative who has often bucked the party leadership, said he was taken aback by Trump's behavior. It did not win his vote.
"For me, I'm raised in the South, I’ve learned to say thank you, no thank you," said Jones. "That’s no way — you shouldn't single anybody out. They're not up here to represent a president or an administration. They're up here to represent the people of their district."
Rep. Paul Gosar (R-Ariz.) skipped Trump's talk for an unrelated meeting on water issues important to his state. He said he was voting no and would not be moved by tactics like Trump’s.
"I don’t care who says it. I’ve lived this," said Gosar, a dentist. The process is being arbitrarily rushed, he complained.
"I'm tired of this place,” he said. “You got to pass something because there’s some little deadline? Do the right thing."
Democrats, clearly relishing the tensions within the GOP, spent the day stirring the pot. Senate Minority Leader Charles E. Schumer (D-N.Y.) said the late changes that Republican leaders had made in the bill were no better than "putting a fresh coat of paint on an old jalopy."
Republicans were "walking the plank," he said, by taking votes on a bill that will not pass the Senate.