White House, in gamble, demands make-or-break health vote

WASHINGTON - Abandoning negotiations, President Donald Trump demanded a make-or-break vote on health care legislation in the House, threatening to leave "Obamacare" in place and move on to other issues if Friday's vote fails.

The risky move, part gamble and part threat, was presented to GOP lawmakers behind closed doors Thursday night after a long and intense day that saw a planned vote on the health care bill scrapped as the legislation remained short of votes amid cascading negotiations among conservative lawmakers, moderates and others.

At the end of it the president had had enough and was ready to vote and move on, whatever the result, Trump's budget director Mick Mulvaney told lawmakers.

"'Negotiations are over, we'd like to vote tomorrow and let's get this done for the American people.' That was it," Rep. Duncan Hunter of California said as he left the meeting, summarizing Mulvaney's message to lawmakers.

"Let's vote," White House chief strategist Steve Bannon said as he walked out.

"For seven and a half years we have been promising the American people that we will repeal and replace this broken law because it's collapsing and it's failing families, and tomorrow we're proceeding," House Speaker Paul Ryan said, then walked off without answering as reporters demanded to know whether the bill had the votes to pass.

The outcome of Friday's vote was impossible to predict. Both conservative and moderate lawmakers had claimed the bill lacked votes after a long day of talks. But the White House appeared ready to gamble that the prospect of failing to repeal former President Barack Obama's health law, after seven years of promising to do exactly that, would force lawmakers into the "yes" column.

"It's done tomorrow. Or 'Obamacare' stays," said Rep. Chris Collins, R-N.Y., a top Trump ally in the House.

Collins was among those predicting success on Friday, but others didn't hide their anxiety about the outcome.

Asked whether Republicans would be unified on Friday's vote, freshman Rep Matt Gaetz of Florida said, "I sure hope so, or we'll have the opportunity to watch a unified Democratic caucus impeach Donald Trump in two years when we lose the majority."

Thursday's maneuvers added up to high drama on Capitol Hill, but Friday promised even more suspense with the prospect of leadership putting a major bill on the floor uncertain about whether it would pass or fail.

The Republican legislation would halt Obama's tax penalties against people who don't buy coverage and cut the federal-state Medicaid program for low earners, which the Obama statute had expanded. It would provide tax credits to help people pay medical bills, though generally skimpier than Obama's statute provides. It also would allow insurers to charge older Americans more and repeal tax boosts the law imposed on high-income people and health industry companies.

The measure would also block federal payments to Planned Parenthood for a year, another stumbling block for GOP moderates.

In a concession to the conservative House Freedom Caucus, many of whose members have withheld support, the legislation would repeal requirements for insurers to cover "essential health benefits" such as maternity care and substance abuse treatment.

The drama unfolded seven years to the day after Obama signed his landmark law, an anniversary GOP leaders meant to celebrate with a vote to undo the divisive legislation. "Obamacare" gave birth to the tea party movement and helped Republicans win and keep control of Congress and then take the White House.

Instead, as GOP leaders were forced to delay the vote Thursday, C-SPAN filled up the time playing footage of Obama signing the Affordable Care Act.

"In the final analysis, this bill falls short," GOP Rep. Jaime Herrera Beutler of Washington state said in a statement Thursday as she became the latest rank-and-file Republican, normally loyal to leadership, to declare her opposition. "The difficulties this bill would create for millions of children were left unaddressed," she said, citing the unraveling of Medicaid.

In a danger sign for Republicans, a Quinnipiac University poll found that people disapprove of the GOP legislation by 56 percent to 17 percent, with 26 percent undecided. Trump's handling of health care was viewed unfavorably by 6 in 10.

House Minority Leader Nancy Pelosi, D-Calif., who as speaker was Obama's crucial lieutenant in passing the Democratic bill in the first place, couldn't resist a dig at the GOP disarray.

"You may be a great negotiator," she said of Trump. "Rookie's error for bringing this up on a day when clearly you're not ready."

Obama declared in a statement that "America is stronger" because of the current law and said Democrats must make sure "any changes will make our health care system better, not worse for hardworking Americans." Trump tweeted to supporters, "Go with our plan! Call your Rep & let them know."

Unlike Obama and Pelosi when they passed Obamacare, the Republicans had failed to build an outside constituency or coalition to support their bill. Instead, medical professionals, doctors and hospitals - major employers in some districts - as well as the AARP and other influential consumer groups were nearly unanimously opposed. So were outside conservative groups who argued the bill didn't go far enough. The Chamber of Commerce was in favor.

Moderates were given pause by projections of 24 million Americans losing coverage in a decade and higher out-of-pocket costs for many low-income and older people, as predicted by the nonpartisan Congressional Budget Office. In an updated analysis Thursday, the CBO said late changes to the bill meant to win over reluctant lawmakers would cut beneficial deficit reduction in half, while failing to cover more people.

And, House members were mindful that the bill, even if passed by the House, faces a tough climb in the Senate.

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Associated Press reporters Alan Fram, Kevin Freking, Ken Thomas and Matthew Daly contributed to this report.