President Donald Trump’s health care reform died on a Friday in March, but Trump decided by the following Sunday that he wanted to quietly resuscitate the bill. “I’m going back to it. I’m not going to give it up,” he said the last weekend of March, according to a person close to the President.
That decision weeks ago set in motion a series of quiet maneuvers that have paid off in the new legislation now taking shape – which on Wednesday won the endorsement of the House Freedom Caucus, the conservative Republican group that tanked the first initiative.
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It’s still unclear whether Republican leaders have enough votes to pass the revised bill through the House, let alone the Senate. Republicans on Wednesday gave themselves same-day authority to fast-track any bill at the last minute, through Saturday. But the progress toward a deal has come just as Trump approaches his 100th day in office, a marker he’s eager to celebrate with a win.
Interviews with 12 White House and Hill aides revealed clear differences between the brute-force approach Trump took the first time around and the second effort, which has been led from the White House by Vice President Mike Pence. It’s featured less Presidential involvement, a softer sell to all sides and no fixed deadline – just the clear hope of getting a bill to the floor before Trump’s first 100 days were up.
In a series of conversations with Bannon, chief of staff Reince Preibus, Office of Management and Budget director Mick Mulvaney, and Vice President Mike Pence in the wake of the failed March health care negotiations, Trump conveyed that they should reach out to the Freedom Caucus, the moderate Tuesday Group, and House leadership to see if there was a way to save the bill.
But first, there was a cooling-off period, with no contact between Trump administration officials and Freedom Caucus chairman Mark Meadows, according to a staffer. The Thursday after the collapse of the first bill, the president singled out Meadows and two other prominent Freedom Caucus members in a tweet: “If, and would get on board we would have both great healthcare and massive tax cuts & reform.”
Meanwhile, White House legislative affairs director Marc Short was doing soul-searching with his team, which included drafting a memo on lessons learned from the first health care push. For future battles, they decided that the White House would have to drive the agenda, rather than letting Republicans in Congress take the lead. They also needed better coordination with outside conservative groups, which opposed the first bill and made clear to members of Congress that they would support anyone who bucked the president.
“I think a lot of people had the sense of not accomplishing our goal,” said Short. “I think there was a collective interest to revisit it.”
At the same time, Freedom Caucus chairman Mark Meadows was opening talks with Tuesday Group co-chairman Tom MacArthur, according to another Freedom Caucus staffer. “When the president said we’re moving on, we just didn’t,” this person said.
One White House official involved in the second attempt described the evolution of the new bill as more of a creep back into existence, driven by the Freedom Caucus and nudged along by Pence and the White House legislative team. Ryan took a back-seat role, according to a Leadership aide. “The speaker was involved but not very hands on in this process,” said the aide. “We were monitoring the situation, from the speaker’s perspective, he was encouraging them to make progress.”
But Ryan’s health care advisor Matt Hoffmann was key in mediating between Meadows and MacArthur and making sure they were on track, according to the aide.
On Monday, April 3, Meadows invited Pence to speak to the Freedom Caucus on Hill. The vice president floated the idea of a waiver for states to opt out of insurance regulations that drive up premiums. The following night, Pence met with the Tuesday Group on the Hill where they insisted on including a high-risk pool to deal with patients with pre-existing conditions—a politically palatable way to preserve one of the most popular elements of Obamacare.
Just before the Easter Recess, House Majority leader Kevin McCarthy, Ryan, Pence and senior White House aides met in Priebus’ office, where they agreed to put the amendment proposed by Freedom Caucus members David Schweikert (R-Ariz.) and Gary Palmer (R-Ala.), before the rules committee the next day as a way to show that progress was being made.
Before they left for recess, Ryan committed to Trump that if they had the votes, he would bring the bill back to the floor after recess.
As the talks progressed, the White House abandoned its earlier high-pressure sales tactics in favor of a softer approach.
Before the first deadline, Trump used the Oval Office to woo lawmakers who were on the fence about the bill, bringing members of Congress in for meetings. But instead of engaging with their policy concerns, the President was focused on striking a deal, according officials who were in the room for the meetings.
In one particularly tense episode, Trump had a back-and-forth with Tuesday Group chairman Charlie Dent, who said, “Honestly, I’m still not there, I’m not there.”
“The President was saying, ‘We have to get a win,’ and that was his pitch,” the official said. “He said ‘No one is getting what they want here, but we have to get a deal, we have to get a win.’”
At one meeting in the Oval Office attended by the Republican Study Committee included deputy whip Patrick McHenry, members went around a circle where they had to commit to the bill before the President. Rep. Robert Aderholt (R-Ala.) was hesitant because of CBO scoring that would show premiums rise for the elderly. “I want to hear the president say he needs my support for the bill,” said Aderholt, whose district voted overwhelmingly for Trump, according to three people who were in the room.
Trump acceded, but when that wasn’t enough, McHenry said: “Now look at the president and tell him you’re going to vote the for the bill.” Aderholt came out for the bill.
The second attempt at repealing and replacing Obamacare included fewer meetings with small groups of individual members, which had been perceived as an attempt to sow division inside the Freedom Caucus and the Tuesday Group. Meetings at the White House were more casual with chats on the Chief of Staff’s patio hosted by Pence rather than high-pressure roundtables in the Oval Office.
Pence and his legislative team made frequent trips to the Hill, as well as last-minute calls as he toured through Asia in mid-April.
“The president overestimated his ability to get people into the Oval office and make some deals, and over-estimated how it would work for principled conservatives,” said another White House official.
House members encountered anger from constituents over the Easter recess, seeding support for a redux, but the game changer for the bill was approval from outside conservative groups – which came late last week. Deep-pocketed conservative groups like Heritage Foundation, Americans for Prosperity and the Club for Growth signaled to the Hill and Pence that they wanted to see a deal. Club for Growth even ran an ad attacking moderates who might oppose the new bill.
“I think Vice President Mike Pence has taken a personal interest in this issue, he’s been relentless on the phone and in meetings with members of Congress from all stripes,” said Americans for Prosperity president Tim Phillips. “He’s been persistent about keeping outside groups in the loop and talking about potential compromise language.”
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