House Republicans Still Short on Obamacare Votes

House Republicans Still Short on Obamacare Votes
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House Republicans remain gridlocked in their effort to repeal Obamacare. 

GOP leaders inched closer to securing the necessary votes to repeal and replace the Affordable Care Act this week with newfound support from many hard-line conservatives in the Freedom Caucus. But the effort fell flat with a number of centrist Republicans wary of the impact the legislation would have on their constituents’ health care, and it became increasingly clear Thursday that enough Republicans remain opposed to the measure to prevent it from passing. 

Ultimately, while the vote count improved significantly for Republicans in recent days, the biggest change may have been that the members now stalling the effort -- and potentially taking the blame for the failure -- are not the conservatives, but rather the so-called moderates. And in many cases, the members who remain opposed have the most to lose politically from the ongoing health care debate

Several of the lawmakers who opposed the measure in March said they remained opposed for similar reasons, but some also said recent changes added even more areas of concern. The amendment that brought the Freedom Caucus on board -- negotiated with centrist Tuesday Group Co-chair Tom MacArthur -- would give states the ability to request waivers to opt out of some Obamacare regulations that would remain in place under the GOP plan. They would include a regulation preventing insurance companies from charging people with pre-existing conditions more for insurance plans, which several Republicans balked at. 

While that amendment didn’t appear to win any moderate votes, it may have caused trouble with some members who had been supportive previously. 

Rep. Mario Diaz-Balart of Florida supported the legislation in March but said the new changes put him back in the undecided category. 

“I’m trying to figure out now what the real effects are,” he told reporters Thursday. “There’s a lot of red flags.”

Rep. Adam Kinzinger, who also supported the bill in March, was undecided as of Thursday, a spokeswoman confirmed. 

Speaker Paul Ryan argued during his press conference Thursday morning that the amendment added protections that moderate Republicans should support. But he also made clear Republicans won’t move forward on a vote until they have enough support to pass the legislation, and that hasn’t happened yet. 

“We’re making very good progress,” Ryan said. “We’re going to go when we have the votes, but that’s the decision we’ll make when we have it.”

Politically, however, the new direction health care took could be a problem for Republicans. Polling shows the legislation is deeply unpopular, but Ryan argued there would be more repercussions for failing to repeal Obamacare than there would for voting for the bill. 

“I think people’s seats are at risk if we don’t do what we said we would do,” Ryan said.

Rep. Tom Cole, a close ally of leadership, made a similar point. He argued that despite some members’ concerns about the political implications of voting for the bill -- given the pushback they've gotten in their districts in recent weeks – the Republican base would extract an even higher political price if they fail to act on health care. 

“This is a business where you either all hang together or you all hang separately,” he said. “If we don’t produce, we don’t actually deliver on a product, I think at the end of the day the majority will very much be at risk.”

But, somewhat paradoxically, Cole also pointed out that many of the members of the Tuesday Group who oppose to the legislation are also the most vulnerable to political backlash in next year’s midterms. 

“Some of our colleagues forget that the Tuesday Group is the group that holds the toughest seats for us,” Cole said. “They really are the difference between us being the majority and the minority. So what they had to say is extremely important for everybody to listen to because that’s where our losses will tend to come in a midterm.”

Yet despite Cole’s point, the bill has moved decidedly away from Tuesday Group members and toward the Freedom Caucus, whose members mostly represent deeply red districts that would be safe even in a wave midterm next year. Rep. Chris Collins, a Tuesday Group member and close ally of President Trump who supports the health care bill, said there is some frustration within the group at the direction of the legislation.

“There’s no question this is to appease the Freedom Caucus,” Collins said of the amendment this week. But, he added, “That’s the frustration that now the Tuesday Group has the hot potato and right or wrong, life’s not fair. Maybe this isn’t fair, but it is what it is." 

Still, some see this as a pattern. Rep. Charlie Dent (pictured above), a Tuesday Group co-chair, said often bills become more conservative in the House to bring right-wing members on board, only to see them abandon the final product if it gets moderated in the Senate -- an outcome he predicts on health care. 

“That dog isn’t hunting anymore,” he said of the tactic of appeasing the right wing. Asked if the party had gone too far with its changes to the health care measure, Dent responded: “Hell yes.”

The dynamics make tough negotiating for Ryan and other leaders, which is only further complicated by the pressure from the White House to see results on health care, particularly as Trump approaches his 100th day in office. 

In fact, the focus, and pressure, on health care was so heavy this week that the measure to fund the government ahead of a Friday shutdown deadline -- normally a divisive and contentious vote for the House GOP -- floated almost under the radar as health care negotiations continued. The two were briefly fused when Democrats threatened to vote against a measure keeping the government open for a week to continue negotiations if Republicans moved forward on an Obamacare vote. But by Thursday evening that scenario seemed extremely unlikely. 

Still, even if Republicans avoid a government shutdown, the lack of a health care vote remains a major source of frustration across the conference. Cole admitted there was a lack of trust within the conference associated with their failures on health care, and that it could have a crippling effect on the conference. 

“Trust is a big part of it,” Cole said. “If we’re successful in this, we’ll develop a lot of it. If we’re not, then I think there’ll be a lot of recriminations.”  

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at jarkin@realclearpolitics.com. Follow him on Twitter @JamesArkin.

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