Roughly two hours into the House Budget Committee’s hearing on the Republican health bill on Thursday, Rep. Debbie Wasserman Schultz (D-FL) held up two slices of white bread.
“I have in my hand a wish sandwich,” she said — by which she meant two pieces of bread where you wish there was something in between. It was a partisan jab; Wasserman Schultz was claiming the American Health Care Act is an empty shell with no actual benefits inside.
The metaphor nicely summarizes the legislative uncertainty currently surrounding the bill, though not in the way Wasserman Schultz meant. The bill is drafted and has now passed out of three committees, but its final contents are almost certain to change before the House votes on it as early as next week, in order to win enough Republican support to pass.
The not-yet-amended bill now exists as a wish sandwich for House Republicans who are sitting on the fence.
More moderate members, and those in districts that could be Democratic targets in 2018, wish it would change to avoid reducing the number of Americans with health insurance by 24 million over the next decade, as the Congressional Budget Office now projects.
Members of the Freedom Caucus wish it would grow more conservative, in order to reduce government spending faster and lean more on market competition in health coverage. Their wishes appeared to be at least partly granted on Friday, when President Trump reportedly told GOP lawmakers he would back deeper cuts and bigger changes to Medicaid than the bill already would make.
In order to get the bill through Congress, Trump and GOP leaders will need to find a way to sew all those wishes together.
There are too many contradicting “wish sandwiches”
So far Republicans have been successful in speeding AHCA through committee, unanimously passing it in both Ways and Means and Energy and Commerce in overnight sessions, then barely clearing the Budget Committee.
Outside of those votes, the bill is struggling.
It received a devastating report from the CBO. Already panned by multiple factions of the Republican Party, it has also lost the support of key lobbies like the American Medical Association and AARP. Republican Sens. Susan Collins, Mike Lee, Ted Cruz, and Tom Cotton have all voiced concerns — enough to sink the bill in the Senate.
Trump has promised changes. Ryan has suggested proposing a managers package in the Rules Committee to amend the bill, but on such a short timeline, it’s unclear whether he can pull one together in time for the House floor vote that GOP leaders are promising next Thursday.
On Friday, Ryan’s spokesperson AshLee Strong tweeted that President Donald Trump’s negotiating prowess had gotten more House Republicans on board, but those most vocal against the bill weren’t in the meeting with the president.
On Thursday, three Republicans — Reps. Dave Brat (R-VA), Mark Sanford (R-SC), and Gary Palmer (R-AL), the Budget Committee’s three Freedom Caucus members — joined Democrats to vote against the health bill, almost stalling it. Other conservatives on the panel, like Rep. John Faso (R-NY) and Rep. Matt Gaetz (R-FL), voted in favor of the bill’s passage seemingly with the pretense that it would be changed.
Brat said he knows Ryan doesn’t have the votes to pass the bill in the House.
“It’s not just the Freedom Caucus, it’s not just the moderates — there’s not enough votes. It’s not 25 anymore, it’s 50, 60 [lawmakers against it].” Brat said Thursday.
The threats of defections have left members making, well, wish lists. On Thursday, Gaetz said “the wish sandwich is Medicaid,” proposing a motion to de-incentivize Medicaid enrollment. But moderate Republicans, especially those from states that have expanded Medicaid, would disagree.
“No one is saying it’s a perfect plan,” Rep. Rob Woodall (R-GA) said. “It’s not even a complete plan.” Several Republicans echoed Woodall, to emphasize that this was not the bill in its final form.
Procedurally, the bill is alive. That’s about it.
The Budget Committee wasn’t able to make any binding amendments to a budget reconciliation bill, so instead Democrats and Republicans proposed motions that, if passed, Chair Diane Black (R-TN) would then recommend in the Rules Committee. It was a symbolic debate over everyone’s dream bill.
Black said House leadership has encouraged committee chairs to come with ideas. Ryan has no choice, and everyone is waiting for the changes.
On Friday, the White House turned to cheerleading the plan. Trump said he was “100 percent behind this,” after a meeting with the House’s mainstream conservative caucus. As Vox’s Andrew Prokop explains, “While members had criticized the bill somewhat, they weren’t viewed as likely to seriously endanger its passage. The most consequential holdouts in the House did not attend the White House meeting.”
It’s the more conservative Freedom Caucus members that still need to be convinced, and in a way that won’t push out the party’s moderates concerned with coverage loss.
“We have to see how the bill does, and then we will come back,” Brat said, noting his negotiations are outside the committee. “We’re talking, negotiating right now.”