GOP Leaders Struggle To Secure Votes On Health Care

NPR takes a look at how political deals are made and what conversations are likely happening on Capitol Hill Thursday to get some "no" votes on the Republican health care bill to switch to "yes."

AUDIE CORNISH, HOST:

To help us unpack what's happening on Capitol Hill is NPR's Ron Elving. Welcome to the studio, Ron.

RON ELVING, BYLINE: Hey there, Audie.

CORNISH: So we just heard the Congressman Donovan there speaking. What do you make of what happened today? This was supposed to be a symbolic day, right?

ELVING: If you ask them at the White House, they will tell you everything is fine. It just got a little late in the day. There wasn't time to get the actual vote done before midnight or the wee hours of Friday, so they decided to put it off until Friday. If you go back up Pennsylvania Avenue to the Capitol, you will hear a different story.

They don't have the 216 votes that constitute a majority of the House with the current membership. So they have to punt and see if they can work out their differences tonight - and I suspect that the midnight oil will burn in the Capitol - and whether they will get the votes to vote tomorrow.

CORNISH: President Trump had gotten behind this bill, brought in the bowling, brought in the handshakes. How much is at stake for him?

ELVING: A lot. He has had to back off a lot of promises that he made during the campaign about what would happen when he had repealed Obamacare and installed a plan, never specified, that would somehow give better coverage to more people for less money with better care. And he had to back off of that and adopt a plan that obviously makes a lot of tough choices, as we just heard the congressman say. Paul Ryan's ideas here are tough ideas in some respects. They may lead to a better system down the road, but in the short term, there would be some pain.

CORNISH: Now, this is not about Democrats versus Republicans at this point, right? This is about the House's most conservative Republicans. So what's on the table to convince them to come over and vote for this bill?

ELVING: They have been wrangling largely about the list of provisions there would need to be in a standard health care plan, what the government would require to consider a health care plan to be adequate. And that was quite a long list under Obamacare and included drug treatment as well as maternity care and many other things. And that list is very much on the chopping block here. And the Republicans would like to change that list, but they would like to do it later on. The reason is a little complicated, but it has to do with the Senate.

The House conservatives are afraid that will never get done. And unless they get an ironclad guarantee that that would get done and that their constituents are not going to get stuck with some higher bill under Trumpcare, Ryancare, Republicancare, whatever you want to call it - until they get that guarantee, they're afraid that their necks are going to be a little too stretched.

CORNISH: And you mentioned the Senate reminds us that there are also a good deal of moderate Republicans here who have demands - right? - that you have to balance as well.

ELVING: That's right. Now, they may think that Obamacare is terrible, as we just heard the congressman say. They may think it's a bad law. But they don't want something worse for their constituents. They're not going to just look at the overall numbers here. And Paul Ryan, to his credit, is trying to take a 35,000-foot view of it all.

But each individual member - and the Republicans have (laughter) 237 of those - each one of those people has to think about this in terms of the political math back in his or her district. That's what matters to them. And they are worried in many cases that the changes to Medicaid and some of the other changes are going to have too much of a ill effect and that some of their constituents might start saying, hey, Obamacare was bad; this might be worse.

CORNISH: At the same time, talking more about that political math, you had President Trump on the Hill earlier this week making a pretty aggressive case, saying, look; if you House Republicans do not get this done - repeal and replacement of the Affordable Care Act - expect to lose your seats. Is that message resonating?

ELVING: Oh, yes. They are always concerned about losing their seats. Now, let's say that 75 percent of the members of the House win in a landslide, 20 percent or more. So what a lot of these Republicans are really worried about - what they're really worried about is a primary opponent, especially one who had the support of President Trump and his Twitter account and perhaps his bank account.

And also they are worried down the road about losing to a Democrat in November. But for many of these landslide Republicans, they're more worried about a primary. And that's where Donald Trump could really hurt them. So he has a big stick.

CORNISH: That's NPR's Ron Elving. Ron, thanks so much.

ELVING: Thank you, Audie.

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