White House in Search of Artful Health Care Deal on Hill

Donald Trump’s White House is in search of a deal—any deal—to get a health care bill through Congress.

Photo Illustration by The Daily Beast

Congressional Republicans seem to have brushed up on The Art of the Deal in the last few weeks, because the GOP’s rank and file seem to know they have the leverage in the internal battle over what to do with the nation’s health care system.

President Donald Trump wants a major legislative victory in these early, though exhausting, days of his presidency, which seems to be why his advisers seem willing to do anything to get an Obamacare replacement through the House of Representatives.

But this new White House’s calculation may be off, because what they gain in placating the demands of the Tea Party wing of the party risks losing the increasingly important moderates in the GOP.

Republicans at the Capitol seem to be slowly recognizing they have a math problem while the White House is recognizing it has a deal-making problem: It doesn’t seem the current bill can make it to President Trump’s desk but he’s so eager to score a legislative victory that the White House seems to be promising everything to everyone at the same time.

After the Congressional Budget Office released its gloomy estimate that 24 million people will lose health insurance under the House Republican plan, on Tuesday, the White House sent Health and Human Services secretary Tom Price and Vice President Mike Pence to Capitol Hill to try to win over skeptical Republicans.

They seem to have only left confusion in their wake because they defended the current bill and argued the CBO report didn’t take into account what Price can do from his perch at HHS, according to Sen. Thom Tillis (R-NC).

“There are other things even outside of the scope of the CBO report that are affected through the rulemaking process; some of it it addresses, some of it it doesn’t,” Tillis told The Daily Beast.

While in the same meeting House Ways and Means Chairman Kevin Brady (R-TX) and Energy and Commerce Chairman Greg Walden (R-OR) appeared to break with the White House and signaled a willingness to offer more tax breaks to older Americans than are included in the current bill, according to Sen. Bill Cassidy (R-LA).

“Much of what we talked about specifically was changing the Medicaid policy that we have right now, but they did speak about somehow addressing the concerns that, again, someone who is 60 will not perhaps have the ability to afford much,” Cassidy said.

The fact that key Republicans at the center of the health care debate seem to be telling different things to even the same audience is allowing both sides of the legislative divide to hold out hope that their wing of the party maintains more leverage.

While moderate Republicans in the Senate are calling on House leaders to put the brakes on their rushed effort to replace the bill, White House press secretary Sean Spicer confirmed Trump’s team is working behind closed doors on a new replacement bill that’s reported to try to placate conservative members of the party who are vital to getting a bill out of the House.

Speaker Paul Ryan’s office denies they’re embracing the more conservative approach, but the White House has been rolling out the red carpet for members of the conservative House Freedom Caucus to try to win them over.

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Those conservative members don’t like the proposal to slowly phase out Obamacare’s Medicaid expansion, which is why many who represent the rightward flank of the party argue the CBO score doesn’t matter at all.

“No it doesn’t, people forget. Do you want to try to force feed people? I don’t,” Sen. James Inhofe (R-OK) told The Daily Beast. “If you get rid of the penalties, that’s good, and then they can decide what they want to do. If they don’t want coverage, then they don’t have to have coverage, and it sounds like a lot of them are estimating, of course CBO is not very often accurate, they’re estimating how many people will reject.”

Conservatives also don’t like that Republicans want to turn tax subsidies into tax credits, which many view as a new GOP backed entitlement program.

“I think that the whole problem with the way this is being presented is we’re going to continue to think that it’s the government’s responsibility somehow to subsidize insurance,” Sen. Rand Paul (R-KY) told The Daily Beast. “If you subsidize it half as much you’ll probably insure half as many people, and what I think we should be doing is talking about some of the things that actually could insure more people at a lower price.”

Paul is in the far-right camp calling for an immediate end to all of Obamacare’s regulations, which is also the camp of Sen. Ted Cruz (R-TX) who Trump wined and dined at the White House last week.

“For six years we have campaigned promising the voters, if you elect us, we will repeal the disaster that is Obamacare that is hurting millions of Americans. We need to honor that commitment,” Cruz told The Daily Beast. “When it comes to repealing Obamacare, failure is not an option. We have to get this done. I don’t believe the current House bill accomplishes that objective. I’ve got significant concerns about the House bill and as drafted, the House bill would not pass the Senate.”

But while those hardliners are demanding outright repeal, more moderate Republicans report never being able to support undercutting one-fifth of the American economy without having a backup plan in place.

“We promised repeal and replace, okay, that’s what our promise was. Not just repeal. And those who say repeal is sufficient, in my view, is a betrayal of the promise we made to the American people in 2016,” Sen. John McCain (R-AZ) told The Daily Beast, arguing some in his party are boxed in because they over-promised on the stump. “I didn’t promise it would be easy. Some did, I can only speak for myself, I didn’t think it was going to be easy, particularly in a state that expanded Medicaid.”

By moving the legislation to the right, through phasing out coverage more swiftly for millions of Americans, Republican leaders threaten to lose the support of more moderate Republican senators who are alarmed by the CBO’s projections.

“The CBO estimate that millions of Americans could lose their health insurance coverage if the House bill were to become law is cause for alarm,” Sen. Susan Collins (R-ME) told reporters at the Capitol. “It should prompt the House to slow down and reconsider certain provisions of the bill.”

That’s why moderate Republicans aren’t happy their party leaders are doubling down on the House Republican bill in spite of the new data provided by the non-partisan budget office.

“Too much is at stake. So that’s the bias that I bring to this, it can’t be, well, ‘We hope.’ It has to be plausibly,” Sen. Cassidy told The Daily Beast, even though he argued the CBO makes mistakes.

The marble halls of the Capitol are proving much different than a board room on Fifth Avenue, especially after the CBO gave many moderate Republicans a punch in the gut.

“We all want to get to ‘yes’ or the vast majority of us do,” Sen. Mike Rounds (R-SD) told reporters. “I think you can make the House plan better, and I don’t think we should be in a hurry. I think we should work our way through it, flesh it out, and we should actually know what the impacts are before we vote on it.”