A little over a month ago, House Speaker Paul Ryan walked out of a basement room in the US Capitol and told the world that Obamacare was the “law of the land.” His party had failed to unite around a bill that would repeal and replace the health care law they hated so deeply, despite seven years of promises.
On Thursday, House Republicans gathered in that same basement room with the theme song from Rocky blaring through the speakers. House Majority Leader Kevin McCarthy took the podium with a picture of George Patton, the famed World War II general, projected behind him. The caucus was set to vote on a health care bill, and victory was at hand.
“‘Eye of the Tiger,’ ‘Taking Care of Business,’ I don’t know who choreographed the thing,” Oklahoma Republican Rep. Tom Cole said, recounting the meeting, “but they did a damn good job.”
It wasn’t a Jock Jams soundtrack that brought wayward Republicans together. It wasn’t an elegant policy solution either. The bill the GOP was set to vote on Thursday was a patchwork of policies, some of them conflicting. The vote came without an official analysis of its costs and consequences. Some members hadn’t fully read the text. Others openly hoped the Senate would fix it for them.
The resulting bill would likely lead to millions more people being uninsured, more than $800 billion in cuts to Medicaid, and an uncertain future for the protections that vulnerable Americans enjoy under Obamacare. Key senators were set to rip it up, effectively, once it arrived in their chamber.
None of that mattered, because policy was not the glue that held the majority — just barely — together this time. It was the opposite. The GOP succeeded by stitching together a thin string of fig leaves for the complaints holdout members had once raised, cutting side deals with a last wavering few, and, above all else, putting aside its ideological differences to focus on getting a win.
Later, to celebrate, a press conference turned frat party in the White House Rose Garden. Now, though, the music was blaring. It was time to vote. Paul Ryan was all smiles.
The House Freedom Caucus gets its win
In March, the tear in the GOP ranks seemed too large to mend. The party’s far-right contingent, the Freedom Caucus, was panning the health care bill for not being conservative enough, calling to scrap Obamacare regulations nationwide. Moderates were concerned the bill would cause too many people to lose health coverage, and they decried any further shifts to the right.
Legislating had proved to be much harder for Republicans than opposing Democrats had been under President Barack Obama, Rep. Chris Collins of New York admitted. “I don’t know if we could pass a Mother’s Day resolution right now,” Rep. Matt Gaetz (R-FL) said at the time. Ryan ended up pulling the bill before what would have been a stinging defeat of a vote.
After that failure, the White House’s directive was simple: Pass something. The holdouts heard it loud and clear.
“When you get a phone call from the president and that’s followed up by a phone call from the president, followed up by a phone call from the vice president — it needs to get done,” House Freedom Caucus Chair Mark Meadows said.
Meadows huddled with Tom MacArthur, a New Jersey Republican who is part of the moderate Tuesday Group — and possibly the one member of that group who was willing to negotiate with the conservatives. They started working on a plan shortly after the initial bill failed.
Together, they proposed giving states the option to waive key Obamacare provisions, such as requiring insurers to provide a comprehensive set of benefits and prohibiting them from charging sick people more than healthy people.
The White House had minimal demands. President Trump needed only two assurances to approve of the bill: that premiums would go down and that people with preexisting conditions would be totally protected, Meadows said. (The final bill, in the eyes of most expert analysts, wouldn’t even meet those minimal tests. It would be a step back from the protections provided to people with preexisting conditions under Obamacare.)
Trump decided to sell it anyway. Under the new plan, states were required to set up high-risk pools so that people with high medical costs could still get insurance and people couldn’t be charged more unless they had a gap in coverage. While experts say the bill doesn’t have enough specificity or funding to make sure those high-risk pools would work, it still gave Trump and House leaders a plan they could pitch.
The result was less than the Freedom Caucus had originally asked for, but enough for its members to accept. Last week, they voted to collectively endorse it in their private meeting — which meant at least 80 percent of the group’s three dozen or so members were on board. That swept as many as 20 votes into the “yes” camp. A few other hardliners were clinched with individual promises: Paul Gosar of Arizona said he was assured of a vote in the Senate on an antitrust insurance bill.
But MacArthur didn’t bring many or any moderate votes with him. Centrists were spooked by the amendment, which exposed them to the attack that they were undermining Obamacare’s protections for sick people. MacArthur started repeating to reporters that he had been negotiating only as an individual lawmaker, not as the co-chair of the Tuesday Group. The bill still looked short.
It took some last-minute maneuvering — and maybe a little political theater — to convince enough moderates to come on board.
The Congress member who saved the bill with $8 billion
For starters, moderates who supported the bill began to cast doubt on whether the Freedom Caucus’s victories would actually translate to a change in policy. Collins, a Tuesday Grouper who wanted the bill to pass, told a reporter that “maybe zero” states would actually want to waive the popular Obamacare protections. Other supporters went to work finding some small concession that moderates could cling to.
Rep. Fred Upton of Michigan found it.
Upton publicly came out against the bill two days before the eventual vote, citing concerns that it would erode protections for people with preexisting conditions. It was the same worry shared by many other moderates who were holding out against the bill. His defection was a stunner, given his experience as a health care legislator, and it was a blow to House leaders the same week they were supposed to vote.
But even as he announced his opposition, he was already working on a bridge back to “yes”: an additional $8 billion to help people adversely affected by the bill through the waivers states could obtain from Obamacare’s rules protecting people with high medical costs. Experts said it wasn’t enough money to ensure those people didn’t see their costs increase, and Upton himself admitted he didn’t know if it was. No matter. When leadership and the White House agreed to his amendment, he was back in the fold.
Upton’s move was a rapid defection-then-conversion. The Congress member let slip in a scrum with reporters that he had actually started working on his fix Monday. That raised the question — why did he publicly come out against the bill a day later?
Upton pulled out his cellphone to show reporters text messages, promising that his timeline made sense. But even some Republican staffers thought the whole ordeal seemed awfully convenient.
After Upton defected, Collins said he didn’t think more money would be enough to persuade moderate holdouts. MacArthur said the same. Their concerns were thought to be deeper, over the undermining of protections for vulnerable Americans. In the context of a bill with $800 billion in Medicaid cuts, $8 billion is a drop in the proverbial bucket.
But Upton seemed confident his amendment would do the trick. Never mind the dizzying policy mechanics, this new policy being the solution to a problem created by the initial concession to the Freedom Caucus. Never mind that moderates had earlier said states wouldn’t want these waivers anyway, but the Upton amendment actually incentivized states to pursue them because it set aside this new pot of money.
People would vote for it. That’s what mattered.
“My sense is that there are a number of folks that will come onboard now that we have this fix,” Upton told reporters. “I think there will be a number of ‘no’ votes before ... that will be okay with this bill.”
He was right. On Wednesday night, less than 24 hours before the House vote, Upton filed his amendment adding that $8 billion to the bill. Three critical swing votes co-sponsored it: David Young of Iowa, David Valadao of California, and Jeff Denham of California. All three had long been considered likely “no” votes.
As they had with the conservatives, House leaders picked off a few other centrists with individual promises.
Another moderate holdout, Daniel Webster of Florida, said shortly before the vote that he had received assurances from the White House and top House Republicans that his primary concern — how the bill would affect nursing homes in Florida that rely on Medicaid funding — would be addressed at a later time.
“I’m committed to working with you,” House Energy and Commerce Committee Chair Greg Walden, whose panel oversees many parts of the health care system, told Webster directly on the House floor.
Rallying the troops
Ryan closed the debate on the bill with a rousing floor speech, which earned a standing ovation from his Republican colleagues.
“Are we going to be men and women of our word? Are we going to keep the promises we made?” Ryan asked, rallying his members to a cheer.
The contents of the legislation seemed beside the point.
“This is a conscience vote,” Cole said before taking the House floor. “The team needs a win.”
For the first time in weeks, the intraparty fighting, the tense conversations and silences in the hallways, the bitterness over a failed attempt to pass a core campaign promise, had been replaced with camaraderie and pats on the back.
Meadows, whose gang of lawmakers has for so long been a thorn in Republican leadership’s side, was no longer the enemy. Instead, one of his colleagues pointed him out as “a celebrity” to a group of reporters, pretending to jump into the scrum to ask a question.
The vote was all that mattered
The floor vote held minimal drama, after whispers throughout the week that it could be an hours-long marathon, with aggressive arm twisting in the back caverns of the House chamber. It was over in under 10 minutes.
At one point, Patrick McHenry, the deputy whip who undertook much of the face-to-face discussions with wavering votes in the final week, walked over to Don Young of Alaska. Young is an iconoclast and unapologetic curmudgeon, who had said he worried the bill would be bad for his state.
Young hadn’t yet voted, and Republicans were still a few votes short. McHenry said a few words to him. Young slipped his voting card into the slot. He was a yes.
The AHCA passed the House with 217 Republicans in favor — one more vote than was absolutely necessary. Those relatively small gestures at the final hour proved to be just enough for just enough moderates.
As the final tally was read, Republicans cheered victory, and Democrats sang away their own defeat. “Na na na na, hey, hey, goodbye,” the left taunted, signaling that this vote would eventually lose Republicans their seats in the upcoming 2018 elections.
Outside, a line of party buses was eclipsing a row of progressive anti-AHCA protesters, waiting to take House Republicans to the White House for a press conference and celebration in the Rose Garden.
Rep. Diane Black (R-TN), who chairs the Budget Committee, made her way out of the Capitol building.
“Today’s a good day,” she said, with relief.
The bill was now in the Senate’s hands. It was a win, and that was enough.