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Postponed Trumpcare decision threatens Donald Trump's dealmaker reputation

Paul McGeough
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Washington: A moment of high drama has gripped the Trump presidency. For eight years, Republicans voted again and again to repeal Obamacare, but without ever drafting a replacement. And now that they control the White House and both chambers of Congress, they seemingly still can't agree on the terms of a bill.

Donald Trump's self-congratulation as a dealmaker was on the line late on Thursday as he dared recalcitrant Republicans in Congress to defy him by holding to their refusal to back his terms for repealing and replacing Obamacare. Some because the makeover was too harsh, others because it was not harsh enough.

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Republicans warned about healthcare bill

White House Press Secretary Sean Spicer told reporters that lawmakers who fail to support the Obamacare replacement health care bill will 'pay a price at home.'

After haggling late into the night, the President issued an ultimatum through his budget director Mike Mulvaney – unless the rebels surrendered to his demands, he'd move on with the rest of his legislative agenda leaving Obamacare in place. And they could take their chances with angry Republican voters at the next election.

It was a huge gamble by Trump and House Speaker Paul Ryan, who authored the disputed bill that the GOP leadership offers as a replacement for Obamacare – their credibility is as much on the line as that of the congressional rebels.

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The numbers had shifted through the evening in Trump's favour, but the leadership reportedly was still a "handful" of votes short of being assured a win.

But Ryan opted to support Trump's brinksmanship. Leaving the Capitol, he declared: "We've been promising the American people that we are going to repeal and replace this broken law," Ryan said. "Tomorrow [Friday in DC] we're proceeding."

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Trump meanwhile belted out a tweeted challenge: "Disastrous #Obamacare has led to higher costs & fewer options. It will only continue to get worse! We must #RepealANDReplace. #PassTheBill".

Amidst warnings that failure posed an existential threat to the GOP, it became woefully clear earlier in the day that Trump and Republican leaders in Congress were in a cleft stick. The upshot of which was the postponement of a House vote freighted with symbolism, because it was to be taken on the seventh anniversary of Obamacare being signed into law.

Chaos and drama mounted in equal parts through the day, with White House officials insisting the vote would proceed and be carried, despite Trump's failure to convince the uber-conservative Freedom Caucus, dozens of whose members were hauled into the West Wing.

Meanwhile, Republican whips armed with colour-coded charts on which they juggled the numbers, were attempting to corral other defiant congressional Republicans – on the floor of the House and in the corridors of the Capitol.

More arm-twisting was expected through Thursday night.

With no support from Democrats, Speaker Ryan could afford only 22 defections from a fractious conference of 237 members. By the headcount of The New York Times, he had only 145 firm 'yes' votes; along with 45 'undecided,' 15 who were inclined to vote 'no, and 32 firm 'no' votes.

The leadership had been banking on opponents of the bill going to water. "When the president calls someone and says, 'I need your vote on this,' it's very hard to say no, when it torpedoes our entire conference, Trump's entire presidency, and we end up losing the Senate next year and we lose members in the House," New York Republican and Trump loyalist Chris Collins told reporters.

Florida Republican Dennis Ross agreed - "If we don't pass this out of the House, this is the beginning of the end for us as a Republican Party." But the Freedom Caucus was cocky; with spokeswoman Alyssa Farah claiming it had 25 solid "no" votes — enough to defeat the bill.

Trump's tweeted appeals for support didn't deliver the numbers. Nor did a video in which he sought to cajole members: "Go with our plan. It's going to be terrific".

Presidential and party credibility are on the line here. As the full impact of the health insurance makeover seeps in, voters have been walking away from Trump, whose approval rating is slumping into the mid 30s. And they are walking away from the GOP health plan by a factor of three to one among those who have made up their minds, according to a new Quinnipiac poll.

And the level of disapproval of the healthcare bill among two of Trump's core constituencies likely is causing alarm in the White House – it was underwater by 26 points among non-college whites; and by 46 points among voters aged 50-64. Only 13 per cent of women said they favoured the health proposal.

Trump won voters aged 45 to 64 by almost 30 per cent. But under a proposal which the President balks at calling Trumpcare, premium costs would rise by more than $US2300 ($3010) a year for a 55-year-old earning $US25,000; by more than $US4400 for a 64-year-old on $US25,000; and by $US5800 for a 64-year-old on $US15,000, according to research by the powerful American Association for Retired Persons.

The Kaiser Family Foundation, a health think-tank, produced electoral maps showing the added costs would be felt profoundly in Michigan, Pennsylvania and Wisconsin, states that were vital in Trump's victory.

"Generally, people who are older, lower-income, or live in high-premium areas [like Alaska and Arizona] receive larger tax credits under [Obamacare] than they would under [Trumpcare]," the foundation says.

Trump gave ground to the Freedom Caucus, agreeing to their demand that it be left to insurers and their clients to decide the terms of policies, rather than have Washington insist that all policies must include benefits like maternity care, emergency services, mental health and wellness visits.

But moderates dug in, with Pennsylvania Republican Charlie Dent, who heads a moderate block known as the Tuesday Group, declaring: "I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low- to moderate-income and older individuals."

Former president Barack Obama, who has been studiously quiet since leaving the White House in Late January, weighed in too, defending his legacy and urging bipartisan negotiation.

"I've always said we should build on this law, just as Americans of both parties worked to improve Social Security, Medicare, and Medicaid over the years," he said in an email to supporters. But we should start from the baseline that any changes will make our health care system better, not worse for hard-working Americans."

After the postponement of Thursday's vote members were warned that there could be another attempt on Friday – with White House Deputy Press Secretary Sarah Huckabee Sanders declaring: "We're very confident that the bill will pass tomorrow morning".

After so much angst and agony, that would be a remarkable outcome for Trump and the party. But if and when the bill clears the House, it faces even greater hurdles in the Senate where the GOP numbers are much tighter, 52-48.

Up to a dozen Republican senators reportedly oppose the Trumpcare bill, many of them fearful of the electoral repercussions of gutting Obamacare. Fears were expressed too that if Trump and the GOP congressional leadership can't win the healthcare battle, they'll face even greater fights on other priority items, like Trump's proposed $US1 trillion infrastructure plan and his promised tax cuts.

White House spokesman Sean Spicer stayed upbeat, telling reporters at one stage: "Let's get to the vote tonight". But questioned on Trump's responsibility for threatened failure of the legislation, he became defensive.

"I think the President has done a phenomenal job. There's no question, I think, when you look at the effort that he's put in, the number of meetings that he's had and the changes that have been [made] to the bill, there's no question how hard the President and his team, the Vice President, have worked to get this done," Spicer said.

"At the end of the day, we can't force somebody to vote."

He too seemed to be daring Republicans to defy Trump. "The President's made very clear that Republicans in particular have made a commitment to constituents, to the American people, that if given the opportunity to have a Republican President, a Republican Senate and a Republican House, that they would enact 'repeal and replace'.

"You've taken a bunch of these free votes when it didn't matter because you didn't have a Republican President… Well, this is a live ball now. And this is for real. And we're going to do what we pledged to the American people and keep our word."

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