Donald Trump warned that there may be political consequences for House Republicans if they fail to repeal and replace the Affordable Care Act, members acknowledged after a closed-door meeting on Capitol Hill on Tuesday.
Trump’s message to Republicans was “if you don’t pass the bill there could be political costs,” said North Carolina Republican Walter Jones.
Sean Spicer, the White House press secretary, backed up his boss’s warning.
“I think when you realise the component to this bill and that the president worked with the House and the Senate to put something together that achieved a promise that was made to voters, yeah, I think there’s going to be a price to be paid but it’s going to be with their own voters,” he told reporters on Tuesday.
“They’re going to have to go back and explain to them why they made a commitment to them and then didn’t follow through.”
The House speaker, Paul Ryan, said Trump “knocked the ball out of the park” in his pitch to members on Tuesday morning, just hours after the Republican leadership unveiled an array of changes to the healthcare proposal in an effort to placate wary conservatives and moderates.
“President Trump was here to do what he does best and that is to close the deal,” Ryan said. “He is all in and we are all in to end this Obamacare nightmare.”
Ryan said he agreed with the Trump that the party risked losing control of Congress if they did not succeed in passing the bill, calling the vote a “rendezvous with destiny”.
Trump descended to the bowels of the Capitol on Tuesday morning to deliver his closing pitch to restive House Republicans.
During the meeting, he singled out the conservative Freedom Caucus chairman, Mark Meadows, who has threatened for weeks to derail the proposal.
“He asked Mark Meadows to stand up, and he recognized Mark Meadows, and said: ‘Mark, if we remember correctly you were supporting me even before I was a candidate. You’re a great guy, we’ve worked together, I’m counting on you and your group to help get this over the line,’” New York representative Chris Collins told reporters after the meeting. “Now Mark Meadows certainly did not agree to that on the spot. The president is very adroit at putting somebody on the spot.”
Following the meeting, Meadows said he was still not persuaded by the president’s pitch and that he was confident there was “more than enough” opposition to block it from passage. Meadows refused to provide a hard count but on Monday night he said the conservative coalition had more than the required 21 votes needed to derail the plan if all Democrats remained opposed.
Meadows said the president was aware of the coalition’s opposition to the proposal and was still in discussion with administration officials over the healthcare law as of Tuesday afternoon.
“If this was a personality thing, we wouldn’t be having these discussions,” Meadows said of his support for the president. “But this is a policy debate.”
Ryan disagreed with Meadows’s assessment of voting intentions, predicting that the House would muster the support to pass the healthcare overhaul.
“We have a lot of Freedom Caucus members who are supporting the bill,” Ryan said during a morning press conference, adding: “A lot of the members’ concerns have been incorporated in this process.”
The proposed revision to the Republican plan, known as the American Health Care Act, included changes to Medicaid as an overture to conservatives and additional tax credits for older Americans, which would be an olive branch to moderates worried by an analysis that predicted people aged 50 to 64 would see dramatic increases in their premiums under the current proposal.
But the bill continues to face opposition on multiple fronts. Hard-line conservatives remain unconvinced that the bill still does not do enough to repeal Obamacare and lower premiums.
It would allow states to impose work requirements on Medicaid recipients, grant a lump sum of federal Medicaid funding to states to do with as they wish, and immediately prohibit any additional states from expanding the Medicaid program. The initial proposal allowed states to expand Medicaid until January 2020.
One change hastens the repeal of ACA tax provisions – such as increases on higher earners and the medical industry, among others – from 2018 to 2017, a win for conservatives who want to see them removed as quickly possible.
But after the amendment was released, the Heritage Foundation, an influential conservative group, said it still opposed the bill and would negatively score lawmakers who back the legislation unless it underwent substantial changes.
The AARP, which represents older Americans, said the amendment, which proposes directing $85bn in aid to those aged 50 to 65, does not do enough to address their concerns.
“Older Americans would be worse tomorrow if this bill passed today as they would see much higher healthcare costs,” said John Hishta, a senior vice-president at AARP.
Representative Tom MacArthur, a New Jersey Republican, said he was swayed by the tax credits for older Americans included in the amendments. He said on Tuesday that he had decided before the meeting with the president that he would support the legislation.
New York representative Peter King, who is undecided on the plan, said Trump pointed to him during the meeting as a fellow Queens native.
“He grew up in Jamaica Estates, I grew up in Sunnyside,” King told reporters. He said after Trump played the hometown ties “it would be hard for me to vote ‘no’”.
King said Trump made an “effective” case “given the circumstances”. The president stressed that for three election cycles Republicans ran on the promise that when they had the chance, they would repeal Obamacare.
“If we don’t pass it, it will look like we can’t get our act together,” King said, characterizing Trump’s remarks.
As Trump left the meeting, he told reporters that he was confident the bill would have enough support to pass the House in a planned vote on Thursday.
“There are going to be adjustments made, but I think we’ll get there on the Thursday,” Trump said.
But by Tuesday afternoon, several Republicans said they were opposed to the legislation – or still unconvinced.
“I’m a no,” New Jersey representative Leonard Lance told reporters after a meeting in the Oval Office on Tuesday afternoon with the president, vice-president and other wavering Republican members of Congress.
“The word is a simple two-letter word – the word is no.”
Representative Dan Donovan, a Republican from Staten Island, left the meeting still undecided.
“Nobody jumped up and said ‘you know what, I was a no and now I’m a yes,’” Donovan said.
During the hour-long meeting, Trump sat with lawmakers in the Oval Office – as opposed to at his desk – and listened carefully to their concerns, Donovan said.
“He was very open-minded,” the New York Republican said. “He was listening more than directing, he would like people to get to ‘yes’ but he listened more than he spoke.”
The House vote is expected to be extremely close after a Congressional Budget Office report said that 14 million people would lose their insurance in the next year under the plan. On Wednesday, the bill and the proposed changes go before the House rules committee for what is expected to be a dramatic showdown.
Asked on Tuesday about the uncertain future of the healthcare proposal, the Senate majority leader, Mitch McConnell, said Republicans had a responsibility to their constituents to repeal Obamacare.
He concluded: “We’ll either pass something that will achieve a goal that we’ve been working on – or not.”
