At 11:30 on Thursday morning, about two dozen members of the House Freedom Caucus arrived at the Oval Office. The arch-conservative House members were there for the last of a series of sessions in which President Donald Trump would try to convince them to support his health-care bill. Just two days earlier, Trump had reportedly told the group’s leader, North Carolina’s Mark Meadows, that the White House would target him politically if he continued to oppose the bill. “I’m gonna come after you,” Trump reportedly said. Since then, several other more pragmatic Republicans had announced that they would vote against the bill. This meant that Trump likely needs the support of all but about eight members of the Freedom Caucus. The scene in the Oval Office was almost an exact reprise of the G.O.P.’s major intra-Party standoffs of the past few years (over the debt ceiling, and whether John Boehner should remain the Party’s leader), with Meadows holding out and bending the Party toward his faction. Trump, who promised to come at Washington from a new angle, was in the same position as Boehner and Paul Ryan before him, the face of the institutional Republican Party. With no Democrats supporting the bill, he needed Ryan’s whips to get it passed, and so he sank back into Ryan’s ideology.
Trump got a long standing ovation from the Freedom Caucus. He did not get a deal. By mid-afternoon, without the votes to pass the American Health Care Act, Ryan postponed the vote. Even if the White House and Speaker can find the votes to pass the House, the American Health Care Act seems much less likely to pass the Senate. But the final negotiations over the vote have been a study in Republican political identity. Trump’s final charm offensive began yesterday, with one-on-one meetings where he persuaded two holdouts—Steve King, of Iowa, and Lou Barletta, of Pennsylvania—to support the bill. “The ultimate closer,” Paul Ryan’s staff had called the President, which, who knows, could have been an effort to shift the blame to Trump if he can’t make the sale. But King’s nationalism probably comes closer to Trump’s than any other congressman’s, and Barletta was also an early and vocal Trump supporter. That two of the President’s most fervent supporters were, as late as Wednesday, wavering on his first major legislative proposal made clear how little Trump has been able to alter Capitol Hill. To win King’s vote, the President promised that he would lobby Senate Republicans to eliminate Obamacare’s standards for what a health-insurance plan had to offer consumers. (If those standards are eliminated, plans might not have to offer coverage for doctor’s visits, or for hospitalization.) To win Barletta’s support, Trump promised to include a provision that would deny health-care benefits to undocumented immigrants. In these conversations, the deal got a little worse for Americans, but it did not move much closer to passage.
The past few days are a reminder of why the Republican Party keeps winding up in this same scene, with Meadows (perhaps the savviest Republican tactician this side of Mitch McConnell) and his small faction of radicals controlling negotiations. Trump campaigned on a promise to improve health care, but he had no plan. In office, he has had to rely on Ryan’s bill, which mainly seems to be about cutting taxes; the Congressional Budget Office studied the plan and concluded that its passage would mean that twenty-four million Americans would lose their health insurance. The bill has become overwhelmingly unpopular: in a Quinnipiac poll released today, fifty-six per cent of respondents opposed its passage, and only seventeen per cent supported it. The major health-care lobbies and conservative policy experts almost all oppose the bill, and so do outside conservative groups like the Koch brothers’ network and their Club for Growth. The final version is being rushed toward a vote without having been scored by the Budget Office, and likely without most members having reviewed it. The proposal, the Times reported, “could mean plans that cover aromatherapy but not chemotherapy.”
It has been interesting to notice, this week, who has been talking about health policy and who has not. The representatives who have announced their opposition to the plan in the past few days have often emphasized the effect the bill would have on their constituents: “Many south Jersey residents would be left in financial hardship or without the coverage they now receive,” the Republican Frank LoBiondo wrote, in a statement declaring his opposition. The A.H.C.A.’s supporters have tended to talk about politics—about keeping the promises that Republicans have made to their voters. “It’s a very significant vote,” the veteran congressman Tom Cole, a Republican from Oklahoma, said. “It really is, ‘Can you govern or not?’ ”
If they wanted to be devilish, Democrats might consider introducing a single-payer plan. As it is, their unity against the bill has kept them offstage and on message. “The Trumpcare bill is not a health-care bill—it’s a cut-taxes-for-the-wealthy bill,” Chuck Schumer, the Senate Minority Leader, said at a press conference yesterday, and it has been obvious that is the Democratic line.* Today Nancy Pelosi pushed it a bit further, arguing that the bill would harm older and poorer people, who had, on the whole, voted for Trump. “That money will be taken away from red areas,” Pelosi said. “That money will probably all go to blue areas. Interesting, isn’t it? All terrible.”
The other day, Patrick McHenry, a North Carolina Republican who is Ryan’s chief deputy whip, walked past the anti-establishment conservative Dave Brat, of Virginia, who was giving an informal press conference. McHenry called out, “Hey, Dave Brat, another gaggle!” This has been the Party establishment’s position toward the insurgents ever since the rise of the Tea Party—a studied, ironic exasperation at the amount of press attention and leverage Meadows’s faction has been able to generate. For the moment, at least, the House Freedom Conference and its sympathizers have turned Donald Trump into John Boehner.
*An earlier version of this post incorrectly identified Chuck Schumer.