At a rally in Kentucky last week styled after President Donald Trump’s boisterous campaign events, the president’s supporters donned his now ubiquitous “Make America Great Again” ball cap and waved signs that proclaimed: “Promises made, promises kept.”
In Trump’s first true test of his mettle as a prodigious dealmaker, the president failed to deliver on his pledge to quickly and decisively repeal Obamacare. The president reportedly asked House Republicans to pull the bill just before it was supposed to go up for a vote.
The move to scrap the bill minutes before lawmakers were to vote marked a stunning defeat for Trump and House Speaker Paul Ryan (R-Wis.), both brought together by their apparent disdain for Obamacare and long-held promise to kill the Affordable Care Act. The controversial legislation was billed as a palatable replacement to Obama’s legacy health legislation. The bill would have needed 216 votes to pass.
Speaking to reporters from the Oval Office late Friday afternoon, Trump said he was open to pursing new legislation in the future, predicting that Democrats would hop on board once Obamacare “explodes.”
“The best thing that we can do politically speaking is let Obamacare explode, it’s exploding right now,” Trump said.
“This is a disappointing day for us,” Ryan said shortly after the American Health Care Act was pulled under his recommendation.
“Obamacare is the law of the land and it’s going to remain the law of the land until it’s repealed,” he added, while characterizing their failure to reach a consensus as “growing pains.”
The debate over the bill has made apparent a deep-seated ideological split within the Republican Party. House Republican leaders acquiesced to a small minority in the party called the House Freedom Caucus. But some concessions, particularly the elimination of an ACA provision mandating “essential benefits,” proved too tough a pill for moderates to swallow. The party spent much of the last week in open revolt despite years of campaigning against Obamacare.
More than 20 million Americans have gained health insurance through the Affordable Care Act, including 334,000-plus living in Nassau and Suffolk counties.
The GOP plan would have dismantled much of Obamacare while absorbing popular aspects of the law that allows adults to stay on their parent’s plans until 26 and prohibits insurers from dropping people based on pre-existing conditions. Republicans also hoped to eliminate a part of the law mandating that all Americans have insurance or face a tax penalty and would do away with government subsidies. In an updated report issued Thursday, the Congressional Budget Office determined that 24 million people would lose health insurance by 2026 under the GOP alternative.
House GOP leaders postponed a scheduled Thursday vote that they hoped would deal a satisfying and symbolic deathblow to Obamacare on the seventh anniversary of its implementation. Later in the evening, Trump ceased further negotiations and issued a take-it-or-leave-it ultimatum: support this bill or Obamacare will remain the law of the land.
On Friday, the bill’s survival remained in doubt with Ryan and other Republicans still deal making. While the House debated the measure on the floor, Ryan rushed to the White House to reportedly inform the president that they did not have the votes.
“We are confident that we’ve done everything,” White House spokesman Sean Spicer said during his daily press briefing. Apparently, it was not enough.
House leaders sought to mollify obstinate Freedom Caucus members by agreeing to additional modifications to Medicaid and eliminating the “essential benefits” provision under the ACA. Meanwhile, moderate Republicans whose states expanded Medicaid under Obamacare pushed back at cuts to Medicaid amid concerns that the measure would not benefit their constituents.
The full-court press for votes included the president himself. He held private meetings with various members and warned that failure to support the bill would make them vulnerable at the ballot box.
As Republican lawmakers dealt with the blow of failing to bring the bill to the floor Thursday night, the Congressional Budget Office released yet another unfavorable outlook on the bill. The report found that savings would be less than originally predicted while the number of people who would lose health insurance remained mostly unchanged.
It’s unclear where Republicans go from here. Spicer, the White House Press Secretary, has said there is no alternative option, as the administration fully expected the vote to end up in their favor. Ryan on Friday said his members would reflect on the failed effort and consider their next step.
Republicans for years have tried to repeal Obamacare despite the former president holding veto power while in office. The November election turned out to be a game changer. Not only did Republicans secure control of Congress, but also Trump’s ascension to the White House gave them the edge they needed to push ahead with their grandiose plan to repeal Obama’s legacy health care legislation.
Republicans interpreted Trump’s election victory as national rebuke of Obamacare, given then-candidate Trump’s characterization of the health care law as disastrous. House GOP leaders seemed to have dismissed Trump’s popular vote defeat by three million or rising approval of Obamacare over the last several months.
A Congressional Budget Office report that found as many as 24 million Americans would lose insurance under the GOP plan was the first signal that the bill was in trouble.
The number of Long Islanders potentially in danger of losing health insurance was estimated at 133,324 and 152,631 in Nassau and Suffolk counties, respectively. In New York State, the estimate was 2.7 million—the equivalent of roughly the entire population of Long Island.
Just as Republicans were whipping votes to get undecided lawmakers on board, Quinnipiac released a gloomy poll that found only 17 percent of people support the health care bill, with 56 percent of Americans in opposition. A survey released a day earlier reported that Trump’s approval rating stands at a ghastly 37 percent.
The fight for an alternative to Obamacare took on greater urgency in New York after two upstate House Republicans pressed for an amendment that would shift county funding of Medicaid to the states.
The provision provoked a firestorm in Albany. Gov. Andrew Cuomo slammed the GOP members as traitors to their constituents in order to draw favor with the Speaker and other Republican leaders on Capitol Hill.
Cuomo’s office throughout the week disseminated gloomy outlooks if the bill were to pass, including a loss of millions to nursing homes and hospitals on Long Island. In the South Shore district of Rep. Peter King (R-Seaford), for instance, Cuomo’s office said three hospitals would lose a combined $14.6 million in funding. According to the governor’s office, under the Trumpcare proposal, New York would lose $6.9 billion over the next four years.
Rep. Lee Zeldin (R-Shirley) disputed Cuomo’s findings while accusing the governor of resorting to scare tactics.
The long-promised Obamacare repeal worried some health industry experts on Long Island. Since the ACA was passed, the Island’s health care economy has increased by more than 25,000 jobs, with 218,000 people currently employed in the industry. Northwell Health, with more than 61,000 employees, is the largest private employer in New York State.
“We’re going to be living with Obamacare for the foreseeable future,” a visibly disappointed Ryan said.