Ryan Tells Trump: Votes Not There for AHCA

Debate on the House floor covered familiar ground: Republicans called for an end to the individual mandate and decried rising premiums and fewer insurers on the exchanges, while Democrats blasted the proposed cuts to Medicaid. The late change to cut essential health benefits cost House leaders a key moderate vote.

House Speaker Paul Ryan told President Donald Trump Friday that the House Republicans do not have the votes to replace the Affordable Care Act (ACA) with the Republican plan, the American Health Care Act (AHCA). Both CNN and The New York Times were reporting that Ryan was on his way to the White House to deliver the news to the president in person.

CNN later reported that the meeting did not go well, but White House spokesman Sean Spicer said the vote was still scheduled for 3:30 pm.

Trump had delivered an ultimatum Thursday that the House Republicans vote today on the AHCA or he would move on to other priorities. The president had already made several concession to woo votes from conservatives, but in the end those steps pushed away more moderate House members who feared their constituents would lose coverage.

A Congressional Budget Office update late Thursday said 24 million Americans would still lose coverage until the revised version of the AHCA, but the deficit reduction number would fall by more than half to $150 billion over 10 years.

A key moderate, House Budget Chairman Rodney Frelinghuysen, R-New Jersey, said mid-morning Friday he could no longer support the AHCA after an element was added to strip out the 10 essential health benefits contained in the ACA. In addition, New Jersey is a state that expanded Medicaid, and an estimated 500,000 people in that state were to lose coverage under the Republican proposal.

“Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey. In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues.

“I remain hopeful that the American Health Care Act will be further modified. We need to get this right for all Americans.” (See today’s coverage on why the essential health benefits are important in the healthcare debate.)

Frelinghuysen thus became the fourth New Jersey House Republican to come out against the plan, and Governor Chris Christie, once one of the president’s closest allies, has not criticized any of them for doing so. The defection of the House Budget chairman opened the floodgates for other moderates to walk away from the bill. 

Members of the House spent hours debating the AHCA, with the 2 sides repeating the merits and criticisms of Obamacare heard since it passed in 2010.

Leading floor debate were the chairman and ranking member of the Ways and Means Committee, US Representatives Kevin Brady, R-Texas, and Richard Neal, D-Massachusetts. With each Republican speaker, Neal had ready the number of people in the district projected to lose insurance, while Brady countered with the number in the member’s home state who declined to buy coverage though qualified for subsidies.

During debate, Republicans described what US Representative Pat Tiber, R-Ohio, called “a road of broken Obamacare promises.” In particular, members from rural districts gave examples of rising premiums and out-of-pocket costs, along with dwindling choices on the marketplace exchange. Tiberi described a constituent who had a recurrence of cancer but learned her oncologist was no longer in her network.

Americans, Tiberi said, “deserve more choices. They deserve better access.”

Republicans also praised the end of the individual and employer mandates and tax reduction in the bill. But Democrats said the AHCA’s true purpose was to draw $1 trillion out of the healthcare system, which would pave the way for tax cuts for the wealthy.

Several Democrats warned about the bill’s proposed cuts to Medicaid, which would go beyond the ACA’s expansion to the working poor. US Representative Sander Levin, D-Michigan, reminded fellow members that Medicaid is the largest source of long-term care for the elderly, and warned that seniors would be evicted from nursing homes.

Levin and other Democrats retold the stories of Americans who would have had no coverage during a life-threatening illness without the ACA. Under the Republican plan, “There will be lives lost that could have been saved,” Levin said.

US Representative Joseph Crowley, D-New York, decried the loss of essential health benefits and said even Republicans are rejecting the AHCA because of its “age tax” and because of a process that crafted the bill “behind closed doors.”

Like several others, Crowley warned that the loss of essential health benefits would result in the sale of policies that take advantage of consumers by taking their premiums and offering little in return. “Imagine that–health care coverage that doesn’t cover your health!” Crowley said.