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House GOP Heads Into Health Care Vote ‘Between a Rock and a Hard Place’

Regardless of outcome, Republicans will walk away with losses

House Majority Whip Steve Scalise, R-La., has been trying to woo undecided Republicans to support the health care bill as a do-or-die vote approaches on Friday. (Photo By Bill Clark/CQ Roll Call)
House Majority Whip Steve Scalise, R-La., has been trying to woo undecided Republicans to support the health care bill as a do-or-die vote approaches on Friday. (Photo By Bill Clark/CQ Roll Call)

The outcome of Friday’s House vote to partially repeal and replace the 2010 health care law is not certain, but one thing is: All parties to the Republican negotiations will walk away with some losses.

After a marathon few weeks of debate over the health care measure, President Donald Trump decided he was done dealing and urged the House to vote on the measure and let the chips fall where they may.

The vote is set for Friday afternoon, and the chips in this case are a group of conservative hardliners and moderate majority-makers (members leadership typically relies on to help pass bills) that have stood in opposition to bill before the latest round of changes.

While at least a dozen of those Republicans have said since the final plan was announced Thursday evening that they remain “no” votes, several others appear to be wavering.

“Between a rock and a hard place,” House Freedom Caucus member Randy Weber of Texas said when asked late Thursday where he was on the bill.

That sentiment appears to be shared among a few dozen members who indicated after a GOP conference meeting, during which the do-or-die vote was announced, that they are still mulling over their vote.

For conservative holdouts in the House Freedom Caucus, the decision seems to be between voting “yes” and helping Trump — whom they generally like — avoid a major policy defeat that could have lasting impacts on his infant presidency, and voting “no” because the bill doesn’t go far enough in repealing current law insurance mandates that they believe are driving up premiums for their constituents.

Undecided moderates in the Tuesday Group appear to be weighing the pros and cons of voting “no” because the bill likely won’t play well in their swing districts, and voting “yes” because their leadership and their party needs their help to show Republicans can be more than just an opposition party.

The nuances of each individual member’s decision extend beyond those dynamics, of course, but they are among the driving forces. And with Trump and House GOP leaders moving to the vote without knowing 100 percent how it will go down, they’re effectively telling members to vote their conscience while simultaneously hoping the pitches they’ve been making factor into members’ decision. 

“I think that everything that can be done has been done,” Ways and Means Chairman Kevin Brady told CQ Roll Call Thursday night, noting he believes the president has reached the same conclusion.

“The movement is very positive, but members are clearly going to sleep on it, pray on it, think hard about their vote tomorrow, which is the right way to do it,” the Texas Republican said. 

Brady said GOP leaders are moving forward with the vote so members can be on the record. Part of leadership’s gamble is on the belief that a lot of members who had been talking about voting against the bill are just posturing and when push comes to shove they’ll be on board with the rest of the team.

“Sometimes principle and politics collide and that’s when you have to make a heart decision,” Ohio Rep. Bill Johnson, a member of the Tuesday Group and Republican Study Group, told Roll Call. Johnson’s heart has led him to a “yes.”

In a sign that Republicans’ hearts are guiding this vote, members are departing from their normal voting blocs in large fashion. 

Pennsylvania Rep. Charlie Dent will vote “no” and New Jersey Rep. Tom MacArthur plans to vote “yes,” putting the two Tuesday Group co-chairs on opposite sides of the voting board.

Likewise, the Freedom Caucus has divisions in its group, not only on how members plan to vote but on their predictions for the outcome. 

Texas Rep. Joe Barton, who has moved from a “no” to “yes” after the most recent round of changes, said he expected the bill to pass, while Michigan Rep. Justin Amash, who has sustained his plan to vote “no,” said leadership does not have the votes to pass it. 

If the bill fails, Speaker Paul D. Ryan will likely be dealt the heaviest blow, since the plan on which the bill is based was crafted from his “A Better Way” agenda. Ryan said lots of members had input in building the policy, and those that followed him blindly on this will likely suffer loses, too — Democrats are hoping those loses will come when Republicans run for re-election. 

Trump, too, would be credited with defeat if the bill goes down, given that he threw much of his weight behind it. The president also agreed to make a health care overhaul his first major legislative push, so a loss on agenda item one doesn’t bode for items two and three and so on. 

Under the scenario that the bill goes down, the opponents who sink it would likely lose the trust and confidence of Ryan and/or Trump.

If the bill passes, the biggest losers are the ones who caved to pressure and backed down from their demands. It will be obvious who they are, and they’ll undoubtedly be criticized for it. 

Ryan and Trump could lose a bit here, too, if the vote margin is razor thin, because it doesn’t speak well for their ability to unite the GOP and will raise questions of whether they’re capable of reaching consensus on other difficult items of their agenda, like a tax code overhaul.

And either way, Republicans all lose by breaking their promises to adhere to so-called regular order, after bashing Democrats for the process under which they enacted the 2010 law. 

The losses will definitely pile on either way, but if the bill musters through, there are some wins as well — in particular sweeteners in the bill for every group Trump and Ryan tried to woo. Those include concessions to the Republican Study Committee on Medicaid, funding for the Senate to boost the tax credits for the Tuesday Group, and rollback of the essential health benefits for the Freedom Caucus. 

The question is whether giving everyone a little bit of what they want — and arguably a lot of what they didn’t — will do the trick. Supporters of the bill believe it will, arguing that’s what governing is all about: compromise. 

“We understand that everybody has to walk away from the table winning something,” Johnson said. “It’s not one way or no way.”

— Rema Rahman, Erin Mershon and Joe Williams contributed to this report.

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