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McClatchy Washington Bureau
McClatchy Washington Bureau
National
William Douglas, Anna Douglas and Katie Glueck

The big health care players: Trump, Ryan � and Mark Meadows

WASHINGTON _ Despite threats from President Donald Trump and the pleas of House Speaker Paul Ryan, Republican leadership has failed to forge a deal that would get the GOP health care bill passed. At the center of this war within stands Mark Meadows.

Little known to the voting public outside North Carolina just weeks ago, this third-term Republican congressman has emerged as the decision-maker for enough members of Congress to derail the president's first, and perhaps most symbolically important, initiative.

That's why, over the last 72 hours, every word from Meadows has been dissected and every meeting has been analyzed by his colleagues and the national media for hints of what will happen to Trump's health plan.

"He's negotiating with the speaker, he's negotiating with the White House, he's also talking with lots of other members _ he's about as busy was you can get right now," said Adam Brandon, president of FreedomWorks, a conservative activist group that has been lobbying members to reject the Trump-Ryan plan. "He's a central person in this whole deal coming together."

The stakes couldn't be higher for Meadows. He is now the most influential conservative in the Republican conference and the man who will undoubtedly be publicly pilloried by Trump, and probably challenged for his seat next Election Day, if he refuses to fall in line.

As chairman of the House Freedom Caucus, a group of roughly 30 conservatives who effectively have veto power over the House's effort to repeal and replace the Affordable Care Act, Meadows is faced with the politically perilous task of deciding what is conservative enough for his members and the outside interest groups, such as FreedomWorks, who grade these members on their ideological purity and then fund challengers against the members found lacking.

So far, Meadows has decided the Republican leadership plan doesn't move far enough away from Obamacare. As a result, a vote the House had hoped to take Thursday is off until Friday. And the outcome's still not certain. Republicans can only afford to lose 22 votes, and that means the health care legislation's fate is up to Meadows.

Trump elevated Meadows' stature Tuesday, when House Republicans began engaging in serious deliberations over the bill. The president called out Meadows in a closed-door House GOP health care meeting, made him stand up, and jokingly _ or not _ told him, "I'm gonna come after you big time" if he didn't support the bill.

And just like that, Meadows has catapulted from backbencher to vote broker.

Here's how it happened:

_10 p.m. (EDT) Monday

Meadows was the voice of optimism changes were coming to the health care bill. He emerged from a lengthy Freedom Caucus meeting, where the group vented its opposition to the GOP repeal and replace plan and heard from Sens. Rand Paul, R-Ky., Mike Lee, R-Utah, and Ted Cruz, R-Texas, who also dislike the plan.

"I am confident that we have enough concerns that a vote of 216 votes in the House would not happen today," he told reporters after the meeting, adding, "This is a defining moment for our nation but it's also a defining moment for the Freedom Caucus."

_9:15 a.m. Tuesday

Trump took notice. The president wasn't in a mollifying mood when he met with House Republicans in a Capitol basement room. Get behind the bill, Trump said, or you could face tough re-elections in 2018.

The president singled out Meadows, asked him to stand up, and told him "Oh, Mark, I'm gonna come after you big time."

_1:30 p.m. Tuesday

At the White House, press secretary Sean Spicer insisted that Trump was joking with Meadows.

Back at the Capitol, Meadows was unrattled. "In terms of calling me out, the president and I have a good relationship, so I don't see anything that is of great concern from that standpoint," he said.

"It's not personal with Mark," said Andy Yates, a founding political consultant of Red Dome Group in Charlotte and Wilmington, N.C., and past Meadows adviser.

The Trump exchange only boosted Meadows' stature in the conservative community.

"That sort of thing is troubling, for somebody in a leadership position to threaten the chair of the House Freedom Caucus for wanting to repeal Obamacare," said Donald Bryson, North Carolina state director for Americans for Prosperity.

_Tuesday afternoon

The White House badly wanted Meadows on its side. The congressman met with Vice President Mike Pence.

Meadows later huddled with House Majority Whip Steve Scalise, R-La., and Rep. Patrick McHenry, R-N.C., Scalise's deputy who has been trying to mollify moderate Republicans over their concerns with the bill.

But, Meadows wasn't budging.

"I'd prefer repeal with a replacement voted on the same day but two separate vehicles. I've been consistent," Meadows says.

_Early morning Wednesday

Meadows told reporters he remained firm. "The opposition is still strong. They need to start over," he said.

_11 a.m. Wednesday

Freedom Caucus members met again with Pence and senior adviser Kellyanne Conway.

_Wednesday afternoon

Trump and Meadows speak by phone. Trump says he's willing to eliminate the so-called essential benefits provisions regarding coverage such as emergency room visits and maternity care. Meadows now says he sees encouraging signs from the White House.

_7:30 p.m. Wednesday

Meadows is measured. "Tonight is an encouraging night, and yet," he tells reporters. "I don't want to be so optimistic to say that the deal is done, but I do think there is a framework to work with our leadership, leadership in the Senate and certainly the administration to find some common ground."

_10:42 p.m. Wednesday

Meadows tells Fox News' Sean Hannity that he and Trump have reached "an agreement in principle."

"I think what we're trying to do now is make sure that our agreement is actually something that can be executed in a way that passes the Senate, really gets to a point working with his staff. I can tell you we were on the phone with his staff just a few minutes ago before coming on. And so there's still work to be done, but I can tell you that the president is engaged. I've talked to leadership this evening. I know they were meeting with some of the moderates."

_Thursday morning

Republican moderates in Congress are unhappy with the essential benefits plan.

Meadows, though, is upbeat. Before heading to the White House for a Freedom Caucus meeting with Trump, Meadows sounded upbeat that things were moving in the conservative group's direction.

"We've started to see some language, we've started to see some real details in terms of what may or may not be (in the bill)," Meadows told reporters. "Really right now, we're still negotiating in good faith, desperately trying to get to a 'yes' for the president and the American people."

_11:30 a.m. Thursday

Meadows and Freedom Caucus members meet with Trump at the White House.

"We're certainly trying to get to 'yes,' Meadows said to reporters after the meeting. "Indeed, we've made very reasonable requests and we're hoping those reasonable requests will be listened to."

_3 p.m. Thursday

The Freedom Caucus huddled privately in the Rayburn House Building in a second-floor meeting room. An hour later, Meadows emerged to an overflowing hallway of nearly 75 reporters and TV cameras clamoring for an interview.

"We are hopeful, as we start this next process ... with some of the things that the White House has shared with us. Let me be clear: We would not be where we are today even considering this had it not been for President Trump's personal involvement," Meadows said. " ... He's moved this a very long way."

"We believe that some of the text and some of the things that we're being asked to consider at this point are not in enough of a form to make a good informed decision."

No victory yet, but no loss, either. And, Meadows is still very much in the spotlight.

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