On Thursday, for the second time in a month, House Republicans announced that they were cancelling a vote on a bill to repeal and replace Obamacare. This time, the measure under consideration was a compromise bill, worked out over several weeks of negotiations between two Republicans: Mark Meadows, a North Carolinian and the head of the right-wing Freedom Caucus; and Tom MacArthur, a New Jerseyan who is co-chair of the Tuesday Group, a coalition of more centrist House Republicans. In late March, opposition from the Freedom Caucus torpedoed the G.O.P.’s initial push to replace Obamacare. The theory now was that if the leaders of these two groups—a right-winger from the South and a businessman from the Northeast—could reach a compromise on an amended version of the bill, then the measure would be able to attract the two hundred and sixteen votes it needs to pass the House.
Until just a few days ago, the White House was bullish. Last week, President Trump’s aides were pressing hard for action on a new bill before Trump’s hundredth day in office—this Saturday. “We are pushing for a Wednesday vote,” a top White House official told me last week. Wednesday came and went. Meadows and MacArthur did announce that they had reached a compromise, but Paul Ryan, the House Speaker, said the votes weren’t there to bring the bill to the floor. As has been the case on several policy fronts in recent weeks, the White House had overpromised and then underdelivered.
To understand why the Meadows-MacArthur deal failed, I talked to Charlie Dent, a Pennsylvania Republican and another co-chair of the Tuesday Group. Dent is the quintessential moderate Republican. He supports gay marriage, and in the later years of the Obama Administration, he became a vocal critic of the Freedom Caucus’s debt-limit brinkmanship, when the caucus so opposed raising the debt ceiling that it toyed with the idea of allowing the government to default and shut down.
Dent won his eastern Pennsylvania district by twenty points last year, while Trump carried it by only eight points. And he’s bucked the President on two big votes so far: he opposed repealing a rule that allows the federal government to give funds to health centers that provide abortions, and he voted against allowing Congress to use a process known as “budget reconciliation” to roll back parts of Obamacare.
Dent also opposed the original version of the Obamacare-repeal bill, and he believes the Meadows-MacArthur compromise was even worse. “I had concerns with the bill prior to this amendment,” he said. “The amendment doesn’t make the situation better.” The compromise negotiations laid bare the simple dynamics of health care among Republicans: every action to add votes on the right loses votes in the center.
“This amendment was developed to get members of the Freedom Caucus and some on the hard right to vote for the bill,” he said. “In the process, it made life more difficult for people in the center-right. I’m a co-chair of the Tuesday Group. I’m not aware of any Tuesday Group members who are previous nos and have flipped to yes. And I suspect there are some who were a yes and have now moved into the undecided and, perhaps, the no column.”
They won’t say so publicly, but many of the moderates in the Republican conference have quietly come to terms with the key provisions of Obamacare. For example, while Trump and most Republicans would be happy to simply reduce funding for Medicaid, which would push millions of poor and disabled Americans out of the program, Dent is among the Republicans who want to keep most aspects of the Medicaid expansion that Obamacare brought about. Dent and several of his colleagues also object to what they see as the repeal measure’s insufficient support to help low-income Americans buy insurance in the private market.
“Say you lose your Medicaid coverage,” he told me. “You go into the exchange. The maximum tax credit is four thousand dollars, so a lot of people aren’t going to be able to afford insurance.”
On a fundamental level, Dent believes the repeal proposals, including the compromise bill, would leave too many people without health insurance. Dent also opposes how the compromise bill would allow states to deregulate insurance markets to allow insurers to deny coverage to people with preëxisting medical conditions. The preëxisting-conditions provision was a core part of Obamacare, and it was one of the few provisions of the law that Trump and Republican leaders promised to retain.
There’s a political dimension to consider as well. Dent seems relatively safe in his district, but for other Republicans—there are some two dozen districts that voted both for Hillary Clinton over Trump and for a Republican House member—it could be disastrous to support a bill that could either be dramatically changed in the Senate or simply die there. “The exercise was to get people in the Freedom Caucus from no to yes,” Dent said. “That’s what the purpose of this thing is. But if you are in a marginal district and you were a yes before, well, your yes vote just got harder as a result of this amendment.” And, if the bill were to change in the Senate, there’s a possibility that the Freedom Caucus will abandon the effort all over again. “You can’t just load up the bill and send it over there knowing that the folks on the hard right who are being appeased and placated on this first launch won’t be there in the end when it matters.”
The Meadows-MacArthur bill is not officially dead yet. Ryan might still be able to find enough votes. But that appears unlikely, and, even if it happened, there is little support for the bill in the Senate, where, among both Republicans and Democrats, the Freedom Caucus is held in low regard. If Obamacare repeal officially dies, Dent said that Trump has one other option: “Start over, deal with health care from the center out, and work with some Democrats.”