(The Washington Post)

President Trump is pushing Congress toward another dramatic showdown over the Affordable Care Act, despite big outstanding obstacles to a beleaguered revision plan and a high-stakes deadline next week to keep the government running.

The fresh pressure from the White House to pass a revision was met with skepticism by some Capitol Hill Republicans and their aides, who were recently humiliated when their bill failed to reach the House floor for a vote and who worry now that little has changed to suggest a new revision would fare any better.

The effort reflects Trump’s sense of urgency to score a victory on Obamacare replacement and move on to other legislative objectives, notably tax restructuring. Passing an Affordable Care Act revision would also allow the president to show progress toward a major campaign promise as he completes his first 100 days in office.

“The plan gets better and better and better, and it’s gotten really good, and a lot of people are liking it a lot,” Trump said at a news conference Thursday. “We have a good chance of getting it soon. I’d like to say next week, but we will get it.”

Congressional Republicans also worry that they must attract Democratic support to fund the government past the month’s end — a step they must take by midnight April 28 to avoid a shutdown. That could become difficult if Democrats grow alienated by the effort to alter former president Barack Obama’s key domestic policy achievement, which some White House officials said they hope will come up for a vote as early as Wednesday.

(Reuters)

Several congressional GOP aides, who spoke on the condition of anonymity to talk openly about the ongoing negotiations, said they worry that the rushed process threatens to create another embarrassing public failure over health care. The schedule would also make it nearly impossible for lawmakers to finish their work in time for official scorekeepers to provide a clear estimate of how much the legislation would cost or how it would affect coverage numbers.

House GOP aides in Washington worked furiously to scale back expectations for a quick vote on the legislation, citing the fact that lawmakers have not been fully briefed on the discussions. There was no deadline for finishing the legislation as of Thursday evening, and GOP leaders have not committed to plans for a Wednesday vote, according to one House GOP leadership aide.

The fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates that the measure can pass in the House. White House officials said language would be circulated among members in the next few days, and the modifications will be discussed Saturday in a conference-wide call as Republicans prepare to return to Washington next week.

The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have demanded.

As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states.

House leadership and committees are taking a secondary role in the negotiations, which are being largely carried out by MacArthur, head of the moderate Tuesday Group, and Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. Members from both groups had balked at voting for the bill last month, forcing leaders to pull it from the floor at the last minute.

Meadows was silent Thursday on whether he supports the proposed changes.

Apart from the publicly embarrassing struggle to reach consensus on an Affordable Care Act revision, some Republicans are also uncomfortable with refocusing on health care just as they are trying to build goodwill with Democrats to pass a stopgap budget plan to keep the government open past April 28.

Republican leaders have already admitted that they are unable to craft a spending bill that can appease the far-right flank of the GOP, and they have turned to Democrats to deliver votes instead. Democrats have so far been willing to work with Republicans to avoid a government shutdown, but any effort to schedule a vote to repeal the Affordable Care Act could destroy those talks and threaten a government shutdown that Republicans have vowed to avoid.

“There isn’t going to be a warm, fuzzy feeling,” House Democratic Caucus Chairman Joseph Crowley (D-N.Y.) said of the impact a health-care repeal effort would have on spending talks.

Congress has five days next week to pass a spending bill, a tight timeline under the most generous of circumstance that would be nearly impossible to meet if House leaders also try to force a vote on the repeal legislation. Several Republican and Democratic aides said there is a chance that both parties could agree to pass a very short-lived spending bill — one that kept the government open one week, for instance — to give negotiators time to carefully complete a broader spending agreement. But Democrats are already warning that they could walk away if GOP leaders push for repeal.

“It doesn’t really bode well in terms of negotiating with us that they’re going to try to push off the vote on the [spending bill] to accommodate them on a bill we think is disastrous,” Crowley said.

Asked whether a health-care bill or funding the government should be Congress’s top priority next week, Trump said Thursday that he believes both could get done.

“I think we want to keep the government open, don’t you agree?” Trump said. “So I think we’ll get both.”

Trump’s position on a health-care overhaul appears to have shifted in the weeks since the House GOP’s proposal, called the American Health Care Act, failed last month. Then, the president indicated that he was ready to move on to his next priorities, notably tax reform.

Now, Trump is bringing a new urgency to the task of delivering one of his central campaign promises. Additionally, with the 100-day mark of his presidency approaching, he and his senior aides are eager to show a concrete legislative achievement.

Trump would like to show progress on health care by Day 100 of his administration but is not overly concerned about the exact day a bill might pass the House, said a senior administration official, who was not authorized to speak publicly and spoke on the condition of anonymity. The official acknowledged that House passage of a bill next week is ambitious and said prospects will be clearer once more members have had an opportunity to review the legislative language.

The confirmation of Neil M. Gorsuch to the Supreme Court — after Republican senators used a rule change to muscle the nomination through — remains Trump’s sole major accomplishment on Capitol Hill as the 100-day mark nears.

His ambitious legislative agenda has been stalled by divisions within the White House and among Republicans in Congress, despite their control of both chambers.

As a candidate for president, Trump promised that he would work with Congress to pass legislation that would dramatically cut taxes, spur $1 trillion in infrastructure investments, significantly expand school choice and make it easier to afford child care. And he promised he would get started on all that — and six other pieces of legislation — in his first 100 days, according to a “Contract with the American Voter” released shortly before Election Day.

The only one of those 10 legislative items introduced to this point is the House health-care bill, which Trump embraced.

While the Gorsuch confirmation buoyed conservatives both on and off Capitol Hill — providing a taste of victory — the manner in which it was rammed through further poisoned Trump’s relationships with Democrats, whose support he’ll need on many of his other initiatives.

Meanwhile, White House Office of Management and Budget Director Mick Mulvaney said Thursday that the White House would be open to funding some Democratic priorities — potentially including paying insurance subsidies as part of the Affordable Care Act — if Democrats would agree separately to fund parts of the White House’s agenda in upcoming budget talks.

Mulvaney’s comments suggested that the White House could try to use the Obamacare subsidy payments as leverage to extract funding to create a wall along the U.S.-Mexico border.

“This is the first real test of whether the Democrats, specifically in the Senate, are interested in negotiating, interested in compromising,” Mulvaney said.

Meadows and MacArthur are gauging their members’ support for the proposed changes, according to aides and lobbyists. Moderate Republicans worry about depriving consumers of certain health-care benefits, and some conservatives say they think the GOP plan leaves too much of the Democrats’ health-care law in place.

Yet some moderates said Thursday that they view the MacArthur amendment as more of a concession to conservatives, as it would allow states to opt out of some of the Affordable Care Act’s insurance regulations they view as crucial.

“I don’t think the Tuesday Group has discussed, approved or has prior buy-in,” said one senior aide to a moderate Republican House member. “I don’t see how this gets either the Freedom Caucus or the Tuesday Group.”

[Republicans try to revive health-care effort as leaders seek to temper expectations]

[Trump delivers ultimatum to House Republicans: Pass health-care measure on Friday or he’ll move on]

Robert Costa and Damian Paletta contributed to this report.

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