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WASHINGTON, DC - MARCH 23: Speaker of the House Paul Ryan (R-WI) delivers very brief remarks and takes no questions following a meeting of the House Republican caucus meeting at the U.S. Capitol March 23, 2017 in Washington, DC. Ryan and House GOP leaders postponed a vote on the American Health Care Act after it became apparent they did not have enough votes to pass the legislation that would repeal and replace Obamacare. (Photo by Chip Somodevilla/Getty Images)

How the showdown vote over health care came to be

Friday in Washington dawns on a face-off between President Donald Trump and a small but influential wing of his own party, the Freedom Caucus. Republicans had hoped to launch their repeal plan on the anniversary of President Obama’s landmark legislation, but the Affordable Care Act managed to survive its seventh birthday. How did the GOP find itself embroiled in an internal showdown?

Republicans began Thursday with no compass, no schedule and too many no votes on their own health care bill. Twelve hours later, they emerged from a basement meeting room with cheers, backslaps and new changes to their plan. If not yet all the votes they needed.

Here’s what happened:

An ultimatum from the president

“This our moment in time,” Rep. Chris Collins, R-NY, told reporters as he left the late evening meeting Thursday. “The president is insisting on a vote tomorrow… We are done negotiating.”

Collins relayed a key moment in the Republicans’ closed-door meeting: Mick Mulvaney, director of the Office of Management and Budget, told GOP members of Congress that this bill would be their only opportunity to tackle health care.

“(The president) is moving on if for some reason it (fails),” Collins said. A reporter asked what that would mean for the Affordable Care Act, also known as Obamacare. “Obamacare stays,” Collins replied.

Rep. Matt Gaetz, a supporter of the bill, put the vote in stark political terms. “(If it fails), we will have the opportunity to watch a unified Democratic Caucus impeach President Trump in two years.”

The tactic – a kind of final offer – is not uncommon at the Capitol. President Obama and congressional Republicans both threatened to end negotiations in the past.

But it is a test of how the long-divided Republican conference reacts.

“I think it’s effective,” said Rep. Pete Sessions, R-TX, who chairs the Rules Committee.

A deal on the table

To sway more members, House leaders are adding two changes to their bill.

One would give states the power to determine what, if any, “essential benefits” go into health insurance plan. Under the Affordable Care Act, insurers must cover a variety of basic benefits from maternity care to prescription drugs.

Second, GOP leaders are now restoring a 0.9 percent Medicare tax on the wealthiest Americans (families earning over $250,000) for six years. The roughly $15 billion raised would go toward a State Stability Fund which aims to help those struggling for health care coverage.

“(That amendment) has had a profoundly significant effect on me, in a positive direction” said Rep. Trent Franks, R-AZ, a conservative member of the Freedom Caucus who had not yet declared his vote.

But they may not be there yet

“We need to figure out how to say yes to ourselves,” said Rep. Joe Barton, R-TX, another Freedom Caucus member, who told NewsHour he was now a yes vote for the original bill. But he was frustrated with his conference.

“We’re not real far apart… it’s just, democracy’s messy,” he surmised.

This makes for the extraordinary situation where House leaders have scheduled one of the most significant votes in years without knowing if it has the support to pass.

It could lead to a great deal of last-minute horse-trading and arm-twisting Friday.

“There’s always an opportunity for a trade, a promise, a calculation, an opportunity,” Rep. Dave Schweikert, R-AZ, a supporter of the bill told NewsHour. “So you just do it.”

But at the same time, several prominent conservatives and moderates made it clear they are still no votes.

The stakes

While many point to the stakes for the White House and for House Speaker Paul Ryan, there is risk for each Republican on Capitol Hill.


“This is a team exercise and we can’t have a small group left or right dictating to everybody particularly when president and leadership have worked in good faith to try and address everyone’s concerns,” stated Rep. Tom Cole, R-OK.

“It’s a test for us,” Cole said, “It’s not a test for anyone else. Can you govern? Or are you just an opposition party? We’re a hell of an opposition party but can we be a governing party? I think we can be but tomorrow is a hell of a decisive moment.”

What next?

Next, comes the roll of the dice. Republican leaders seem to believe they’ll get the votes, but speaking member to member, how is not yet clear.

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