Trump and Ryan don’t yet have the votes to pass health bill today | McClatchy Washington Bureau

On the day that House Speaker Paul Ryan had hoped to deliver a triumphant upheaval of former President Barack Obama’s Affordable Care Act, he doesn’t yet have the votes.

President Donald Trump and Ryan are still scrambling for enough support to give the nascent Trump presidency a narrow victory Thursday, hoping to stave off a conservative rebellion that could doom the president’s first major policy proposal. Trump meets with members of the conservative House Freedom Caucus at 11:30 a.m. in his third bid in as many days to cajole members into voting for his plan.

But a planned 9 a.m. meeting of the Republican conference was abruptly canceled, with some lawmakers getting to Capitol Hill early only to find the gathering wasn’t happening after all.

Ryan could pull the embattled health care plan for further revisions if he lacks the votes, but the defeat could imperil Congress’s legislative agenda and deliver a significant blow to Trump’s domestic policy agenda, along with the real estate tycoon’s insistence that he’s the ultimate deal maker. The House began debate early Thursday on a special rule that would allow a revised health care bill to be brought to the House floor at any point until Monday.

Congressional Republicans have been promising for seven years that they’d repeal the Affordable Care Act, but Trump has made it his mission in the closing days, traveling up to Capitol Hill in an attempt to sway to conservative lawmakers who believe the current plan doesn’t go far enough to erase Obamacare.

Administration officials late Wednesday were said to be talking with caucus members about eliminating the list of “essential health benefits” that the current law requires insurers to cover including emergency room visits, maternity care, mental health and substance abuse services and prescription drugs.

The current Republican plan does not eliminate those services and Democrats warned that slicing them out would make it impossible for the legislation to clear the Senate because it would violate Senate rules regarding what provisions can be addressed in the legislation.

“Any member of Congress who is intent on taking away essential benefits like maternity care, birth control coverage, and mental health services is in for a rude awakening if this bill ever gets to the Senate,” said Sen. Patty Murray, D-Wash., the ranking Democrat on the Senate Health Committee. “Democrats will fight back and these harmful measures will not survive.”

The struggle to nail down enough votes continued even as Trump and Vice President Mike Pence amped up the pressure on Wednesday, meeting at the White House with a key group of conservatives. Administration officials insisted they were bullish about the prospects for success, though White House Press Secretary Sean Spicer would not provide the administration’s count.

“Member by member, we’re seeing tremendous support flow in our direction and the count keeps getting stronger for us,” Spicer said.

But Republicans can only survive 22 defections, and nearly two dozen members expressed some form of opposition to the measure.

Rep. Mark Meadows of North Carolina, leader of the conservative Freedom Caucus, met late Wednesday with Ryan and later told Fox News he was “really optimistic that we can get there.”

He said he had talked with Trump and that lawmakers and the administration were “trying to make sure our agreement is something that can be executed.”

But other lawmakers cautioned that as the bill moves to the right, it risks alienating more moderate members. Moderate Rep. Charlie Dent, R-Pa., announced Wednesday night after meeting with Ryan that he is a no on the bill.

Many lawmakers continued expressed serious concerns with the legislation even as they said they hoped to eventually support it. Rep. Mario Diaz-Balart, R-Fla., who has the fourth highest number of marketplace enrollees in the country, said he’s worried about older people obtaining insurance.

“That population is not being dealt with yet in a way that is giving me a lot of comfort,” Diaz-Balart said. “I am still working on trying to get a bill that I feel comfortable with.”

He dismissed a New York Times report that he would trade support for a harder Trump administration stance on Cuba as “absolutely, categorically false.” But accommodations were being made: Rep. Lou Barletta, R-Pa., became a definite yes, after Trump and Ryan assured him that his idea to deny health care tax credits for undocumented immigrants will receive consideration next month.

Most of the Republican opposition came from the most conservative wing of the party, with the Freedom Caucus saying it could provide as many as 24 votes in opposition. Trump warned them that a “no” vote could risk their majority, but a bevy of conservative groups offered cover to lawmakers who opposed the legislation. The Heritage Foundation, Freedom Works, Club for Growth, Americans for Prosperity and Americans for Limited Government all criticized the legislation for leaving too many Obamacare elements in place and urged Republicans to keep working on the measure.

“Most all conservatives are opposed to it except those who are on the Trump payroll,” said Richard Viguerie, longtime leader in the conservative movement.

He said the Republican grassroots “don’t like this bill. They want to defeat it. They’re going to fight to defeat it in the House, the Senate. It’s a betrayal of the grassroots and we don’t like it.”

The North Carolina chapter of Americans for Prosperity, a political group funded by conservative mega-donors Charles and David Koch, launched a digital ad late Tuesday in support of Rep. Mark Meadows, R-North Carolina, whose outspoken opposition to the measure drew him a personal rebuke from Trump.

Like the other conservative groups, AFP said it would “key” votes on the bill, meaning it could consider pumping money into the mid-term political campaigns against incumbents who supported the measure.

Trump joked to Meadows that he’d “come after you big time” if he continued to oppose the measure.

Members of the House Freedom Caucus said the apparent threat backfired, solidifying their opposition to the legislation.

“People want representatives in Congress who will stand strong, no matter the opposition,” said Rep. Mo Brooks, R-Ala.

Other members said voters in their congressional districts may like Trump, but don’t expect lawmakers to vote for legislation they can’t support.

“He’s well liked in my district, this plan is not well liked,” Rep. Warren Davidson, R-Ohio, told CNN. “I think people can differentiate between the two.”

Some members said the give and take is to be expected.

“In the end, we promised to repeal Obamacare, we’re united on that,” said Rep. Mike Simpson, R-Idaho. “There is not a bill that we would all be united on to replace that. (House Speaker Paul Ryan) is trying to find that sweet spot and it’s kind of tough.”

He said Trump was “doing a good job of bringing people around,” but noted that if the legislation gets changed to attract conservatives, it risks losing more moderate members.

“That’s the challenge of leadership,” he said.

Simpson said he was considering a vote against the legislation, for unrelated issues, but concluded “I don’t like holding hostages.”

If the opposition was vexing to party leaders, most held their tongues. Rep. Pete Sessions, R-Texas, who presided over an hours-long Rules Committee, archly told reporters that the Freedom Caucus had been “awesome.”

“They have been consistent in their language, in their behavior, in their request, in their discussions,” he said.

With five vacant seats in the House and one Democrat out for bereavement leave, Republicans need 215 votes to pass the bill. The party holds 237 seats, so it can afford 22 “no” votes, assuming that every Democrat votes against the measure.

Supporters of the current system planned Thursday to mark the seventh anniversary of the day President Obama signed the health care bill into law by protesting Republican efforts to roll it back.

A group of activists planned to march by the Trump hotel on Pennsylvania Avenue and end the protest blocks away at the White House with acts of “civil disobedience.”

On the Senate floor, Senate Minority Leader Chuck Schumer chided Republicans for “desperately” trying to secure votes by “making sweetheart deals to sway recalcitrant members.”

And he and other Democrats charged that Republicans – who accused Democrats in 2010 of hastily muscling through the law – were rushing to jam through their legislation.

“Republicans are trying to do in two weeks what we spent one year on,” Schumer said. He noted that McConnell has said he’d like to pass the legislation by the end of next week.

“When you’re talking about a drastic reformation of our health care system, one sixth of our economy, that’s breathtakingly irresponsible and rankly hypocritical,” Schumer said.

He dismissed Republican hopes for a “third prong” of health care legislation that could iron out problems, saying Democrats will not help the party.

“This bill – TrumpCare – is your one shot,” he said. 　

Alex Daugherty, Anna Douglas, Katherine Glueck, Josh Magness and Franco Ordonez contributed to this report.