President Trump delivered an ultimatum to House Republicans on Thursday night: Vote to approve the measure to overhaul the nation’s health-care system on the House floor Friday, or reject it and the president will move on to his other legislative priorities.

The president, through his aides in a closed-door meeting, signaled that the time for negotiations was over with rank-and-file Republicans who were meeting late at night on Capitol Hill to try to find common ground on the embattled package crafted by House Speaker Paul D. Ryan (R-Wis.).

The move was a high-risk gamble for the president and the speaker, who have invested significant political capital in passing legislation that would replace the 2010 Affordable Care Act. For Trump, who campaigned as a skilled negotiator capable of forging a good deal on behalf of Americans, it could either vindicate or undercut one of his signature claims. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation and it may also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.

Defeat would also mean that Obamacare — something that congressional Republicans have railed against for seven years — would remain in place.

“Disastrous #Obamacare has led to higher costs & fewer options. It will only continue to get worse! We must #RepealANDReplace. #PassTheBill,” Trump tweeted from his official presidential account as the meeting was wrapping up Thursday night.

It was far from clear, however, that Ryan and Trump have the votes to muscle the package through the House after several members of the hard-line House Freedom Caucus refused to back it following a marathon session of negotiations Thursday with Trump and other top aides.

Post-meeting, a handful of Republicans announced they would back the legislation. But a larger number said they were still opposed or had yet to make up their minds.

“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,” Ryan said. “And tomorrow we’re proceeding.”

But the speaker refused to answer shouted questions from reporters after the meeting about whether he had the votes for passage.

“They’re going to bring it up, pass or fail,” said Rep. Mike Simpson (R-Idaho).

In the meeting with House Republicans on Thursday night, according to Rep. Chris Collins (R-N.Y.), Office of Management and Budget Director Mick Mulvaney told his former colleagues “the president needs this, the president has said he wants a vote tomorrow up or down.”

“If for any reason it’s down, we’re just going to move forward with additional parts of his agenda,” Collins described Mulvaney as saying. “This is our moment in time.”

A key moment inside the session, several lawmakers said, was when Rep. Brian Mast (R-Fla.), a freshman lawmaker who lost both his legs in 2010 while serving as an Army bomb disposal technician in Afghanistan, rose and called on his colleagues to unite behind the bill in the same way he and his comrades fought in battle.

A rowdy group of Republicans burst out of the meeting like explorers on a quest for glory. “Burn the ships,” one Republican shouted to House Majority Whip Steve Scalise (La.), invoking the command that Hernan Cortes, the Spanish conquistador, gave his men upon landing in Mexico in 1519.

The message was clear, to the GOP leaders now and the Spaniards in 1519, there was no turning back.

“Only way to do it,” Scalise told a packed elevator of lawmakers.

Leaders continued to plead with individual lawmakers to support the measure well into Thursday night, with the House Rules Committee slated to meet early Friday morning to consider the proposed changes.

Ryan got down on a knee to plead with Rep. Don Young, an 83-year-old from Alaska who is the longest-serving Republican in Congress and remains undecided.

When the speaker finished with Young, he spent about 10 minutes in an animated discussion with Rep. Mo Brooks (R-Ala.), one of the bill’s most outspoken critics. At one point, the speaker took his own arms and held them up, his hands at face level, then slowly lowered them to his waist — presumably trying to demonstrate his belief that the bill will lower costs.

The ongoing effort to whip the vote, Rep. Joe Barton (R-Tex.) said at one point, involved “back-patting and butt-kicking.”

“Democracy’s messy,” he added.

Ryan had intended to bring up his plan for a vote Thursday. But criticism — mainly from conservatives — caused that strategy to unravel after Freedom Caucus members rejected Trump’s offer to strip a key set of mandates from the nation’s current health-care law. White House Chief of Staff Reince Priebus and Trump chief strategist Stephen K. Bannon trooped up to Ryan’s office to make the case personally, warning recalcitrant conservatives that the only alternative would be to accept the ACA as the law of the land.

By evening, leaders adopted the proposed change conservatives had rebuffed earlier, eliminating the law’s “essential benefits” that insurers must offer under the ACA in an effort to reduce premium costs. Those benefits include covering mental-health treatment, wellness visits, and maternity and newborn care, and states would have the option of adding them back next year.

They also added one sweetener for moderates, a six-year delay in repealing a 0.9 percent additional Medicare tax on high-income Americans who earn above $200,000 if filing individually, or $250,000 if married and filing jointly. By keeping the tax in place, GOP leaders could provide an additional $15 billion to the states to help cover treatment for mental health and substance abuse issues, as well as maternity and infant care.

Meanwhile, a new analysis by the Congressional Budget Office released Thursday evening showed that changes House leaders made to the bill Monday do not alter a projection that 24 million more Americans would be uninsured by 2026 under the bill. In addition, the updated bill would cut the deficit by $150 billion over the next decade — nearly $200 billion less than the earlier version of the legislation.

Here's To Your Health
We're reporting in on the latest in health news, medical research, insurance coverage, plus managing your health and the health of the people you love.
We respect your privacy