Donald Trump and Republican leaders in Congress are poised for a high-stakes vote on healthcare reform on Thursday that could decide whether the president will achieve one of the key elements of his domestic legislative agenda following a rough first 100 days in office.
After three months of roller-coaster efforts to repeal and replace the Affordable Care Act — the healthcare law known as Obamacare that was signed into law by Mr Trump’s predecessor in 2010 — and a humiliating defeat on Capitol Hill in March, Republicans believe they finally have the votes to accomplish what has been one of their top goals for seven years.
“Do we have the votes? Yes. Will we pass it? Yes,” Kevin McCarthy, the Republican House majority leader, declared on Wednesday about the pending vote in the House.
The decision to hold a vote is a gamble for the White House. In March the House was about to vote on a bill when it became clear at the 11th hour that the Republicans lacked the numbers given internal divisions and unanimous opposition from Democrats.
“I simply have to believe they have the votes or they would never risk a gigantic embarrassment on the House floor — one that would define [House Speaker] Paul Ryan forever and severely damage Trump,” said Larry Sabato, a University of Virginia politics professor. “Famous last words, but it’s the only thing that makes sense.”
Mr Trump is desperate for any legislative victory. While he has begun deregulation efforts and largely pursued the trade agenda he outlined on the campaign trail, he has failed to pass any of the 10 legislative goals he set for his first 100 days.
The president and his top aides have spent the past few days trying to twist the arms of recalcitrant Republicans in the hope they could craft a consensus before Congress goes into recess at the end of the week.
The White House had also pinned its hopes on a repeal of Obamacare that would unlock funds that could be used to help pay for comprehensive tax reform, something Mr Trump is ultimately far more interested in achieving. Mr Trump ordered his aides to move quicker on tax reform after Steven Mnuchin, the Treasury secretary, told the Financial Times last month the original goal of passing tax reform by August was no longer realistic.
Repealing and replacing Obamacare would help serve two ends — giving Mr Trump a much-desired victory and easing the way for tax reform. But success in the House on Thursday by no means guarantees the bill would become law because of Republican resistance in the Senate.
“Republicans are going to try and claim momentum for the rest of their agenda but the reality is they are incredibly divided,” said Jim Manley, a former top Democratic congressional aide. “This bill has no almost no chance of getting through the Senate. Too many Republicans are opposed, so it’s going to be radically changed. I predict that conservative House Republicans won’t support the Senate revisions, which means it will ultimately die a slow, painful death.”
Republicans have redrafted the bill they pulled from the House floor in March. Arch-conservatives had argued that the original measure did not go far enough in removing the government from the health insurance system, while moderates worried about estimates that it would result in 24m Americans losing their health insurance.
In recent days, Republicans have haggled over the extent to which the bill would ensure that people with pre-existing medical conditions would be covered — which is guaranteed under Obamacare. Republican leaders pulled back several key defectors, who had been worried about coverage for such people, by creating an $8bn fund to subsidise for five years the higher premiums insurers would charge.
Democrats are adamantly opposed to the bill, which they argue will throw Americans off health insurance plans and raise premiums. Nancy Pelosi, the top Democrat in the House, tweeted that “every Republican who votes for #Trumpcare will have it tattooed on their forehead. They will be held accountable”.
The American Medical Association also opposes the bill, saying the recently proposed changes “tinker at the edges without remedying the fundamental failing of the bill — that millions of Americans will lose their health insurance as a direct result of this proposal”.
Mr Ryan and Mr McCarthy are expected to schedule a vote for 10am. The Republicans can only afford 22 defections if they are to obtain the 216 votes need for passage. Separately on Wednesday, the House passed a $1.1tn funding bill to keep the government open to September, and the measure is expected to be passed in the Senate.