President Still Short On Votes For Health Care Bill

WASHINGTON - Despite President Donald Trump's personal appeals to lawmakers, the fate of the Republican health care bill remained uncertain Tuesday, as the fraught relationship between the president and congressional Republicans faces what could be a defining test.

"Honestly, a loss is not acceptable, folks," Trump warned lawmakers, bluntly telling fellow Republicans that failure to pass the bill to repeal much of the Affordable Care Act could cost the GOP its majorities in the House and Senate.

The morning strategy session at the Capitol was the first time in his two months as president that Trump had met with the full House Republican conference. The membership reflects the disparate coalition of Republicans that aligned to make him their standard bearer last year. The question for the party now is whether that ideologically diverse group can govern.

Before Trump spoke, House Speaker Paul Ryan, R-Wis., made a characteristically wonky presentation of changes that had been made to the legislation in hopes of winning over both conservatives and centrists.

After Ryan spoke, the president followed with a presentation that attendees described as trademark Trump, focused less on the substance of the bill than on the consequences should he and his party stumble out of the gate on an issue on which they had long promised to deliver.

He came into the room armed with an index card identifying specific lawmakers, some he singled out for praise after they were persuaded to support the legislation, and others still holding out. Among the latter were Rep. Mark Meadows of North Carolina, leader of the conservative Freedom Caucus and also an early Trump backer in the contentious GOP primaries.

"Mark, I'm gonna come after you," Trump said in a remark interpreted by some as a joke, by others as a threat, and by still more as potentially a little of both.

Trump "certainly put all of the elements of the 'Art of the Deal' together in one speech," said Rep. Tom McClintock, R-Calif.

But by day's end, vote tallies indicated that the White House could still not firmly count on a majority in the vote, which is scheduled for Thursday.

"I think we'll continue down the path to get the votes," White House press secretary Sean Spicer said. But, he conceded, "We've got a ways to go."

How much Trump's appeals or the changes in the bill have done to shift skeptics from "no" to "yes" remained unclear. Assuming all Democrats vote no, Republican leaders can afford to lose no more than 21 votes on their side.

"I haven't heard anyone who changed their mind after this morning," said Rep. Warren Davidson, R-Ohio, a member of the conservative Freedom Caucus, who remains opposed.

"The president's a persuasive guy, and he's well liked," said Davidson, adding that most of those who plan to vote against the bill "worked hard to see our president elected."

But he added, "I didn't run on a pretty slogan like 'repeal and replace.' I ran on fixing the problem."

Outside groups were adding pressure, with Heritage Action and the Club for Growth, both influential conservative groups, opposing the bill and the Chamber of Commerce supporting it. All the groups promised the vote would be counted in their annual score cards of lawmakers' performances.

Congressional aides concede some members remain skeptical about just how full-throated a case Trump would ultimately make for the legislation and how much political capital he would spend to see it through.

But Ryan and other GOP leaders have worked with Trump since just after his election to lay out their legislative agenda in an order they believe gives them the greatest likelihood of success. For both procedural and policy reasons, health care emerged at the top of the list.

The changes that GOP leaders made in the bill Monday include giving states new authority to limit who qualifies for Medicaid, the government health plan for the poor, and to impose work requirements for some aid recipients.

For more centrist lawmakers, changes were made to make subsidies that would help older Americans buy insurance more generous. The proposal, however, punted many of the toughest issues to the Senate, where Majority Leader Mitch McConnell of Kentucky promised to take up the bill as soon as next week.

But on Tuesday, neither those tweaks nor Trump's appeals appeared to have quite closed the deal. Some of the most conservative Republican lawmakers remained deeply skeptical despite the president's hard sell. On the other end of the GOP caucus, some centrists also said they would oppose the bill.

Rep. Walter Jones, R-N.C., a conservative who has often bucked the party leadership, said he was taken aback by Trump's behavior. It did not win his vote.

"For me, I'm raised in the South, I've learned to say 'thank you, no thank you,' " said Jones. "That's no way - you shouldn't single anybody out. They're not up here to represent a president or an administration. They're up here to represent the people of their district."

Democrats, clearly relishing the tensions within the GOP, spent the day stirring the pot.

Senate Minority Leader Chuck Schumer, D-N.Y., said the late changes that Republican leaders had made in the bill were no better than "putting a fresh coat of paint on an old jalopy." Republicans were "walking the plank," he said, by taking votes on a bill that will not pass the Senate.

michael.memoli@latimes.com

Credit: By Michael A. Memoli and Lisa Mascaro - Washington Bureau