Pass US health bill Friday or he’ll move on – the Trump ultimatum

Mick Mulvaney Mick Mulvaney of the Office of Management and Budget

Donald Trump warned Republicans that he is done negotiating and wants a vote Friday on dismantling Obamacare, setting up a high-stakes showdown with members of the president’s own party over his embattled health care plan.

House leaders were forced to postpone a Thursday vote on the measure amid a revolt by mainly conservative Republicans, who were complicating the first major legislative test for the new president by signalling it would not pass without key changes.

Trump himself set the stage, dispatching an aide to a closed-door meeting of Republican lawmakers to demand a Friday vote.

“The message is tomorrow it’s up, it’s down — we expect it to be up — but it’s done tomorrow,” White House budget director Mick Mulvaney told the lawmakers, according to congressman Chris Collins.

Mulvaney then delivered Trump’s extraordinary ultimatum.

“If it doesn’t pass, we’re moving beyond health care,” Mulvaney said, paraphrased by Collins.

“We would be moving on to other parts of his agenda.”

The idea that Trump — who campaigned relentlessly on a pledge to bury Barack Obama’s signature legislative accomplishment — would wash his hands of the fight and let Obamacare stand is a startling departure from the party playbook.

But Mulvaney’s blunt take-it-or-leave-it approach could be part of Trump’s hardball strategy to get Republican rebels to fall in line.

House Speaker Paul Ryan, a champion of the legislation dubbed the American Health Care Act, put on a brave face despite the bill’s hanging by a thread.

“We have been promising the American people we will repeal and replace this broken law because it’s collapsing and failing families, and tomorrow we’re proceeding,” he told reporters after the conference meeting.

A procedural vote on the bill is set for approximately 10:00 am (1400 GMT) Friday, followed by a full floor vote in the afternoon.

The president and his lieutenants had repeatedly voiced optimism about the bill’s prospects, saying they had made progress convincing doubters to join Trump’s camp.

But the votes weren’t there.

“I am still a no at this time. I am desperately trying to get to yes,” said Mark Meadows, chairman of the conservative House Freedom Caucus, whose members have demanded changes to the plan before giving their blessing.

Although Meadows sought to portray optimism about the process, he revealed the width of the gap between Trump and the plan’s opponents.

“At this point, we are trying to get another 30 to 40 votes that are currently in the ‘no’ category to ‘yes,'” Meadows said after meeting with his caucus.

That did not happen, and Ryan pulled the bill off the floor.

‘Time to vote’

Republicans have spent years railing against the Affordable Care Act, branding it a result of a Democratic push for socialised medicine.

With Democrats opposed to Trump’s plan and his own party’s right flank in revolt over legislation they say falls short, the White House and Republican leaders looked to make the bill palatable to enough conservatives without angering moderates.

Trump spent much of the day lobbying both conservative lawmakers and moderates in a delicate arm-twisting effort.

“Tomorrow it’s time to vote,” White House spokesman Sean Spicer told Fox News.

“At the end of the day, this is the only train leaving the station that’s going to be repealing Obamacare and giving us an alternative to replace it,” he said.

Many conservatives say their party’s plan is still too costly for the government.

They want to repeal “essential health benefits” that all insurance policies must cover under Obamacare — including maternity care, emergency room visits and preventive care like screenings and vaccines — arguing they have driven up costs.

Republican leaders conceded to that demand, introducing an amendment to the bill that repeals those benefit requirements.

Limiting defections

The House Freedom Caucus — some 30 lawmakers who are heirs-apparent to the ultra-conservative Tea Party movement — have dubbed the new bill “Obamacare Lite,” saying it will only reduce, not eliminate, health coverage subsidies by replacing them with refundable tax credits.

At the spectrum’s other end some Republican moderates are worried their constituents would no longer be able to afford health insurance under the new plan.

The amendment also provides a sweetener for moderates: it keeps an Obamacare tax on high-income earners for an additional six years to generate some $15 billion to finance patient benefits.

A nonpartisan congressional budget estimate says the Republican plan would force 14 million Americans to lose their coverage from next year.

An update of that estimate Thursday, accounting for recent changes aimed at lowering premium costs for the elderly, said the plan would reduce the deficit by less than the previous version, while not improving coverage numbers.

The Democratic minority is prepared to vote against the bill as a bloc, so Republican leaders need to limit defections to fewer than 22 of their party’s 237 representatives among the House’s 430 current members.