The Washington PostDemocracy Dies in Darkness

Trump and House conservatives say a new health-care deal is possible. We’ve been down this road before.

April 4, 2017 at 7:01 p.m. EDT
Vice President Mike Pence and White House Chief of Staff Reince Priebus depart after a Senate Republican luncheon at the Capitol on Tuesday. Pence and Priebus are both trying to broker a deal with House Republicans to revive efforts to repeal the Affordable Care Act. (Aaron P. Bernstein/Bloomberg)

Trump administration officials and arch conservatives in the House Freedom Caucus have gotten off to a rocky start, driven at least in part by their mutual tendency to hear what they want to hear from the other side.

Two weeks ago, as talks built to a dramatic failure of a Republican proposal to overhaul the nation’s health-care system, conservative lawmakers praised their discussions with President Trump’s top advisers. After each White House visit, these Republicans returned to the Capitol proclaiming that, deep down, the president was on their side in opposing key portions of a draft that had been assembled by House Speaker Paul D. Ryan (R-Wis.).

“I the administration actually wants a free-market solution to this,” Rep. Andy Harris (R-Md.) said on the evening of March 22, as his Freedom Caucus compatriots continued their push for “a conservative solution” to Ryan’s original proposal. “We’re on the same side as the administration.”

A day later, White House officials shut down negotiations and demanded that everyone fall in line — and Ryan scheduled a vote for the next morning, March 24. We all know how that ended — the vote never happened because support for the legislation collapsed. By last week, Trump and Freedom Caucus members were fully engaged in a Twitter war over which side was telling the truth.

It’s worth recalling this scenario now that administration officials, led by Vice President Pence and budget director Mick Mulvaney, have re-engaged the conservative caucus in talks to repeal the 2010 Affordable Care Act and replace it with new tax incentives.

It’s worth taking careful measure of optimism that doesn’t necessarily add up to 216 votes — the number needed to get a bill out of the House.

Late Monday night, after a huddle with Pence, Mulvaney and White House Chief of Staff Reince Priebus, Freedom Caucus members emerged preaching optimism. The White House trio had presented a “solid idea,” Rep. Mark Meadows (R-N.C.), the chairman of the Freedom Caucus, told reporters.

The latest negotiation is centered on allowing individual states to apply for waivers from mandates such as “essential health benefits,” which provide coverage in critical areas such as mental health, substance abuse and maternity care. This is a modified version of a key issue from the standoff two weeks ago, when the conservatives pushed for and won inclusion of a provision to eliminate the essential benefit coverage.

‘The closer’? The inside story of how Trump tried and failed to make a deal on health care

This effort is trying to thread the needle between conservatives who want to see lower premiums in the insurance markets, which they think would result once coverage mandates are lifted, and mainstream Republicans who balk at the idea of denying coverage for critical areas such as pregnancies.

Everyone says they’re open to finding common ground between the conservative and moderate flanks of the House Republican Conference, both of which recoiled at the Ryan legislation in late March and delivered an embarrassing defeat to the speaker and the new president.

The question is whether all sides are hearing one another’s concerns or, as they did in previous talks, are interpreting the discussions as evidence of a shift in their direction.

Ryan seems to think that the latter scenario is repeating itself. He has managed to keep a close watch on the renewed talks without attaching his credibility to them.

Taking a couple minutes’ worth of questions at his leadership media briefing, Ryan used some mix of “concept” or “conceptual” eight separate times to describe the stage of these Pence-led talks with the Freedom Caucus.

He dismissed talk of a vote this week by saying that it was “premature to say where we are” and declared that he would not set “an artificial deadline” for considering the legislation.

“We’re throwing around concepts to improve the bill. That’s occurring right now, but that is not to say that we are ready to go,” he said.

A political intelligence firm, the Cowen Washington Research Group, summed up the state of talks in a simple declaration in a communication to its investment firm clients: “Policy purgatory — don’t confuse commotion for motion.”

Republicans try to revive health-care effort as leaders seek to temper expectations

A few weeks back, the Capitol was filled with commotion.

Pence and Mulvaney were engaging in shuttle diplomacy, huddling at the White House with the conservative Freedom Caucus and the moderate Tuesday Group, then heading over to Ryan’s office at the Capitol for more meetings with the conservatives and then the moderates. The cycle repeated itself over and over, including trips up Pennsylvania Avenue for face-to-face meetings with the president.

Each side seemed to not fully grasp what the other was saying — or else some people simply couldn’t take yes for an answer. In the final 36 hours of those talks, the essential benefits issue remained a key focus as the conservatives demanded the legislation include language that would abolish those guaranteed portions of coverage.

Trump’s team agreed, and House GOP leaders began drawing up a new version to include this nod to conservatives. But no one had bothered to get a guarantee that this meant that the Freedom Caucus would come aboard.

The morning after Mulvaney, their former colleague in the caucus, declared that the negotiations were finished, the conservatives remained largely opposed to the legislation. And then moderates began jumping ship, announcing they were opposed to the more conservative legislation.

Fast forward to this week.

By Tuesday afternoon Meadows began expressing optimism about a renewed effort to get to yes and said that the approximately three dozen Republicans who had declared their opposition to the legislation might reconsider.

“Anything that gets changed substantially allows you to walk back those declarations,” he said.

Just don’t expect Ryan to take a stance on these new talks.

“It’s premature to say where we are or what we’re on, because we’re at that conceptual stage right now,” he said.

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