Rep. Lou Barletta was one of President Trump’s early supporters, but even a personal plea by the president Tuesday wasn’t enough to sway the Pennsylvania Republican, who says he’s a “no” vote on Republicans’ Obamacare repeal-and-replace bill.
Mr. Barletta said he needs to see more safeguards written into the bill to block illegal immigrants from being able to get access to tax credits designed to help Americans afford health care.
He said he’s informed House Speaker Paul D. Ryan and his leadership team — and by extension Mr. Trump — that he’s not able to vote for the bill as-is.
“He may be totally unaware that this tax credit is in place,” Mr. Barletta said of Mr. Trump. “So hopefully by my raising the issue and moving from a lean ’no’ to a ’no’ — especially since I was one of the first to support the president — will get this issue before him.”
Mr. Barletta is one of the conservatives who’s holding out, denting Republican leaders’ hopes of passing the bill later this week.
On the other side, meanwhile, are a smaller but no less important group of moderate Republicans who worry the bill doesn’t do enough to cut costs for Americans, and does too much in curtailing the policies that have extended health care coverage to more than 20 million additional people.
Rep. Leonard Lance, New Jersey Republican, said he remained a “no” vote even after a White House meeting Tuesday with Mr. Trump and 15 other House Republicans.
“I don’t think that it provides a meaningful opportunity for those who need health care coverage to have health care coverage,” Mr. Lance said. “I think we do need to go to a different system, but I don’t think this bill is good enough in that regard.”
GOP leaders are seeking support from both the conservative and moderate Republicans, knowing they have a small margin in Thursday’s expected vote.
House Democrats say their entire caucus will oppose the bill.
With that as a backdrop, Mr. Trump has ratcheted up pressure on the holdouts.
He warned rank-and-file lawmakers at a closed-door meeting Tuesday that Republicans could lose their House and Senate majorities in 2018 if they do not get behind the bill.
Mr. Ryan and his leadership team, meanwhile, rolled out last-minute changes Monday night that appeased some holdouts and edged them closer to the 216 needed to pass the bill through the House.
The updated version of the bill included a carve out for New York that shifted Medicaid costs from upstate New York counties to the state government — alleviating localities outside of New York City from paying their share of Medicaid costs.
The move helped win the support of Republicans in the New York delegation that had been on the fence — leading Senate Minority Leader Charles Schumer, also of New York, to dub the change the “knickerbocker kickback” and others to call it the “The Buffalo Buyout.”
The biggest remaining stumbling block is the House Freedom Caucus, a group of very conservative lawmakers.
Rep. Mark Meadows of North Carolina, head of the Freedom Caucus, said Tuesday Mr. Trump has not closed the deal with him — even after singling him out at the closed-door meeting with lawmakers.
“For us, it is about repealing the insurance mandates and essential health benefits and replacing them with something that certainly protects pre-existing conditions and those issues that are important to all Americans,” Mr. Meadows said.
Rep. Trent Franks of Arizona, another Freedom Caucus member, said he is not ready to support the bill because of the culture wars.
“What would get me to ’yes’ is continued assurances that the pro-life components will remain throughout the process and to finish repealing Obamacare by including the repeal of the Obamacare [regulations] which are the drivers of the premium increases,” Mr. Franks said.
The standoff is creating a caustic mix of policy and politics.
Rep. Chris Collins of New York, another early Trump backer who pushed for the special exemption for his state, said lawmakers have a “binary” choice, warning that the “far right” lawmakers that are calling for a more dramatic change to the law could be left with “Obamacare for eternity” if they vote against the GOP bill.
“If this doesn’t get done, it is on those who voted ’no,’” he said “The political repercussions are we might well lose the House and Senate next year and we won’t do tax reform.”
Rep. Mo Brooks of Alabama, though, said the danger was in moving ahead on a bad bill.
“I think if we do do this we lose the majority,” he said.
• Tom Howell Jr. contributed to this report/
• Seth McLaughlin can be reached at smclaughlin@washingtontimes.com.
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