Tag Archives: Affordable Care Act

U.S. Republican leaders hunt for votes for healthcare bill

U.S. House Speaker Paul Ryan speaks about healthcare at his weekly press briefing on Capitol Hill in Washington, U.S, April 27, 2017. REUTERS/Yuri Gripas

By Susan Cornwell

WASHINGTON (Reuters) – House Republicans were making headway in efforts to build support for a reworked plan to overhaul the U.S. healthcare system, but have not decided when to vote, House Speaker Paul Ryan said on Thursday.

Ryan spoke as Republican leaders scoured the U.S. Capitol in search of centrist Republican backing for the amended measure after it gained the approval on Wednesday of a group of hard-right Republican conservatives who had helped to sink the original version last month.

“We’re making very good progress,” Ryan told reporters at a news conference, saying the changes endorsed by conservative Freedom Caucus Republicans on Wednesday would also appeal to moderate Republicans.

The House could vote as early as this week on the legislation, aides said, meaning it could pass the House in time for President Donald Trump’s 100th day in office on Saturday.

It remained unclear whether the amended bill could attract the 216 votes needed to pass the House, given the united Democratic opposition. Its future is further clouded in the Senate.

“We’re going to go when we have the votes,” Ryan said.

Republicans in Congress have made repealing and replacing the Affordable Care Act, commonly known as Obamacare, a central campaign promise for seven years. Republican President Donald Trump made it a top campaign promise.

But House Republicans are not keen to repeat last month’s debacle, when their leaders acquiesced to Trump’s demand for a floor vote on the bill, only to unceremoniously yank the measure after determining it could not pass.

The Republican healthcare bill would replace Obamacare’s income-based tax credit with an age-based credit, roll back an expansion of the Medicaid government health insurance program for the poor and repeal most Obamacare taxes.

The nonpartisan Congressional Budget Office had estimated 24 million fewer people would have insurance under the original version.

The new amendment that has won over a number of conservatives, drafted by Representative Tom MacArthur, would allow states to seek federal waivers to opt out of some of the law’s provisions. That includes the highly popular provision mandating that insurers charge those with pre-existing conditions the same as healthy consumers, and that insurers cover so-called essential health benefits, such as maternity care.

Some centrists say the changes do not address their worries that the bill would hurt poor Americans in the Medicaid program. Others, including Republican Representative Dan Donovan of New York, said the loosening of protections for people with pre-existing medical conditions was a major problem.

“It’s going to cost people with pre-existing conditions even more money to have coverage … It’s something that we shouldn’t be doing,” Donovan said on CNN.

House Democrats on Thursday threatened to oppose a short-term government funding bill if the Republicans try to bring the healthcare bill to the floor this week.

Ryan brushed off this threat, even though Republicans are expected to need some Democratic votes to pass the funding bill.

House Democratic Leader Nancy Pelosi told reporters that Trump was making Republicans “walk the plank” on a healthcare bill that was “wildly unpopular.”

Ryan dismissed the idea that some Republican lawmakers’ House seats were at risk if they vote for the healthcare bill. “I think people’s seats are at risk if we don’t do what we said we would do” and repeal Obamacare, he said.

(Reporting by Susan Cornwell and Susan Heavey; Additional reporting by Amanda Becker and Will Dunham; Editing by Jeffrey Benkoe)

Trump, Republicans face tricky task of averting U.S. government shutdown

FILE PHOTO: U.S. President Donald Trump's overview of the budget priorities for Fiscal Year 2018 are displayed at the U.S. Government Publishing Office (GPO) on its release by the Office of Management and Budget (OMB) in Washington, U.S. on March 16, 2017. REUTERS/Joshua Roberts/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – President Donald Trump and his fellow Republicans who control Congress face their first major budget test next week, with the threat of a U.S. government shutdown potentially hinging on his proposed Mexican border wall as well as Obamacare funding.

With Republicans controlling the White House and both chambers of Congress, keeping the federal government operating is a basic test of their ability to govern, but their task could become even more complicated if they insist on using the spending legislation to bring about contentious policy changes.

Not only must Republicans overcome intraparty ideological divisions that stopped major healthcare legislation last month, but they will have to win over some opposition Democrats with provisions that could be distasteful to conservatives.

With the Senate reconvening on Monday and the House of Representatives on Tuesday after a two-week recess, lawmakers will have only four days to pass a spending package to keep the government open beyond April 28, when funding expires for numerous federal programs.

“I think we want to keep the government open,” Trump said on Thursday, adding he thinks Congress can pass the funding legislation and perhaps also a revamped healthcare bill.

Democratic support depends on what provisions Republicans demand in the bill. Democrats have signaled they would not cooperate if it contains money for one of Trump’s top priorities, a southwestern border wall intended to combat illegal immigration, or if it ends federal subsidies to help low-income people buy health insurance under the Affordable Care Act, known as Obamacare, which Republicans want to repeal.

Democrats also want federal funds maintained for Planned Parenthood, which many Republicans oppose because the women’s healthcare provider performs abortions. Another obstacle would be if Trump demands large defense spending increases coupled with deep cuts to domestic programs Democrats want to protect.

BALANCING ACT

Late on Thursday, leading House Democrats were voicing skepticism a deal could be reached by the deadline. In a telephone call for House Democrats, Representative Nita Lowey, the senior Democrat on the House Appropriations Committee, said: “I don’t see how we can meet that deadline” and avoid having to pass a short-term extension, according to an aide on the call.

The second-ranking House Democrat, Representative Steny Hoyer, told his fellow Democrats that they should only support such a short-term measure if a deal on long-term bill is reached and only finishing touches remained, the aide said.

Republican leaders face a familiar balancing act: satisfying the party’s most conservative members while not alienating its moderates.

Rules in the 100-seat Senate mean Trump’s party also would need the support of at least eight Democrats even if the Republicans remain unified, giving the opposition party leverage. House Republican leaders would need some Democratic votes if the most conservative lawmakers object to the bill, as they did to the healthcare plan championed by Speaker Paul Ryan.

With congressional elections looming next year, Republicans acknowledge the stakes are high.

“Even our most recalcitrant members understand that if you shut down the government while you’re running it and you control the House and the Senate, you can’t blame anybody but yourself,” said Representative Tom Cole, a senior House Appropriations Committee Republican.

White House budget director Mick Mulvaney said the Trump administration was willing to talk to Democrats about funding for Obamacare subsidies in exchange for their agreement to include some Trump priorities such as the wall, the defense hike and more money for immigration enforcement.

“It is ripe for some type of negotiated agreement that gives the president some of his priorities and Democrats some of their priorities. So we think we’ve opened the door for that,” Mulvaney said.

Democrats reacted negatively.

“Everything had been moving smoothly until the administration moved in with a heavy hand. Not only are Democrats opposed to the wall, there is significant Republican opposition as well,” said Matt House, a spokesman for Senate Democratic leader Chuck Schumer.

FURLOUGH ‘LADY LIBERTY?’

The government was last forced to close in October 2013, when Republican Senator Ted Cruz and some of the most conservative House Republicans engineered a 17-day shutdown in an unsuccessful quest to kill Democratic former President Barack Obama’s healthcare law.

“These kind of bills can’t pass without a reasonable number of the party of the minority in the Senate, and we are optimistic we will be able to work all that out,” Senate Majority Leader Mitch McConnell said at the start of the spring recess.

A deal is needed because Congress was unable to approve funding for the entire 2017 fiscal year that ends in September and has relied on stop-gap spending legislation.

Congress has passed no major legislation since Trump took office in January, and he has ambitious hopes for major tax-cut legislation, infrastructure spending and other bills.

With the difficulty passing a bill with so many divisive elements, lawmakers next week might need to buy time by passing a short-term bill lasting possibly one to three weeks, maintaining current spending levels.

“That would be a setback: not catastrophic, but not a good thing, and a sign that you can’t govern,” Cole said.

A federal closure would shutter National Park Service destinations like the Statue of Liberty, Yellowstone and the Grand Canyon. Government medical research would be suspended. Thousands of federal workers would be furloughed with thousands more working without pay until the shutdown ends, including homeland security personnel. Some veterans benefits could be suspended.

Time would stand still in the U.S. Capitol with nobody on duty to wind the 200-year-old “Ohio Clock” just outside the Senate chamber.

(Reporting by Richard Cowan and David Morgan; Editing by Kevin Drawbaugh and Will Dunham)

Insight: Ballooning bills – More U.S. hospitals pushing patients to pay before care

FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S. March 23, 2017. REUTERS/Mike Blake/File Photo

By Jilian Mincer

(Reuters) – Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice.

The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.

Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime.

Since U.S. hospitals do not want to end up footing the bill, they are now experimenting with pre-payment strategies for patients, with a growing number requiring payment before scheduled care and offering no interest loans, according to interviews with more than two dozen hospitals, doctors, patients, lenders and healthcare experts.

“Most patients are appreciative that we’re telling them up front,” said David Muhs, chief financial officer for the Henry County hospital, which provides a discount for early payment. The discussion leads some patients to skip care, others to delay it or use a no interest loans available through the hospital, he said.

The ACA extended insurance to 20 million Americans, which initially helped hospitals begin to shrink debt from uninsured patients who could not pay their medical bills. But more and more, people in Obamacare plans or in employer-based health plans are choosing insurance that features low monthly payments. The trade-off is high out of pocket costs when they need care. (For a graphic, click http://tmsnrt.rs/2oCzePS)

If President Donald Trump dismantles Obamacare as promised, these plans won’t disappear. Republicans also believe high-deductible plans curb spending, and Americans faced with medical costs that rise faster than inflation and wages will look for premiums they can afford.

The trend is expected to accelerate this year because unpaid bills are creating massive bad debt for even the most prestigious medical centers. U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills.

The largest publicly-traded hospital chain, HCA Holdings Inc, reported in the fourth quarter of 2016 that its ratio of bad debt to gross revenues of more than $11 billion was 7.5 percent.

One of the first to test this new payment strategy was Novant Health, headquartered in North Carolina with 14 medical centers and hundreds of outpatient and physician facilities. It saw patient debt increase when more local employers started adopting high deductible plans, including one that made its executives pay $10,000 in out-of-pocket expenses.

“To remain financially stable, we had to do something,” said April York, senior director of patient finance at Novant, whose patient default rate dropped to 12 percent from 32 percent after it started offering no interest loans through ClearBalance.

“Patients needed longer to pay. They needed a variety of options,” she said.

IMPACT ON PATIENTS

These prepayment strategies are being rolled out by hospitals across the country because the financial equation has changed so much for patients – even the insured ones.

Almost half of Americans – 45 percent – polled by the Kaiser Family Foundation said they would have difficulty paying an unexpected $500 medical bill. The average deductible this year for the least expensive of the widely used Obamacare health plans is $6,000 for an individual – an 18 percent spike since 2014 – and more than double that for a family, according to government data.

Jessica Curtis, a senior advisor at Community Catalyst, a consumer advocacy group in Boston, said the impact on patients stretches beyond personal finance.

“They delay procedures, they don’t follow advice on prescription drugs, and when they see care, they usually are for more expensive procedures because they’ve waited,” she said

Brian Sanderson, managing principal of Crowe Horwath’s healthcare services group, said communicating with patients and providing longer repayment options is a good strategy since hospital margins have shrunk, thanks to growing unpaid medical bills from consumers.

“A well informed patient is more likely to meet their obligations,” he said. “It’s just good patient relations and it helps to minimize bad debt.”

Hospitals are doing what they can to retain patients while helping them pay medical bills that could run thousands of dollars. Many are expanding charity eligibility, and hiring companies like ClearBalance, AccessOne and Commerce Bank to provide loans to patients no matter what their credit. Most carry no interest rate for the patient, and could be extended far longer than the few months that hospitals once required before sending a bill to collections.

“People are more likely to pay a bank than a hospital,” said Mark Huebner, director of Health Services Financing at Commerce Bank, which offers its line of credit at more than 200 hospitals.

“People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed,” he said.

Wake Forest Baptist Medical Center in North Carolina had seen its bad debt creep up in recent years as more patients saw out of pocket expenses soar, with some deductibles reaching $15,000.

“We’ve seen that many patients are unaware of the increases in their deductibles,” said CFO Chad Eckes. Wake Forest now asks for payment before non-emergency services are provided but also offers zero interest, longer repayment options.

“It’s a challenging position,” he said. “It’s a discussion no one wants to be in, and none of us enjoy.”

(Editing by Caroline Humer and Edward Tobin)

Ryan opposes Trump working with Democrats on healthcare

House Speaker Paul Ryan speaks during his news conference after Republicans pulled the American Health Care Act. REUTERS/Yuri Gripas

WASHINGTON (Reuters) – U.S. House of Representatives Speaker Paul Ryan, the top Republican in Congress, said he does not want President Donald Trump to work with Democrats on new legislation for revamping the country’s health insurance system, commonly called Obamacare.

In an interview with “CBS This Morning” that will air on Thursday, Ryan said he fears the Republican Party, which failed last week to come together and agree on a healthcare overhaul, is pushing the president to the other side of the aisle so he can make good on campaign promises to redo Obamacare.

“I don’t want that to happen,” Ryan said, referring to Trump’s offer to work with Democrats.

Carrying out those reforms with Democrats is “hardly a conservative thing,” Ryan said, according to interview excerpts released on Wednesday. “I don’t want government running health care. The government shouldn’t tell you what you must do with your life, with your healthcare,” he said.

On Tuesday, Trump told senators attending a White House reception that he expected lawmakers to reach a deal “very quickly” on healthcare, but he did not offer specifics.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

Trump said after the failure of the Republican plan last week that Democrats, none of whom supported the bill, would be willing to negotiate new healthcare legislation because Obamacare is destined to “explode.”

(Reporting by Lisa Lambert and Eric Beech; Editing by Leslie Adler)

Trump tells lawmakers he expects deal ‘very quickly’ on healthcare

U.S. President Donald Trump and First Lady Melania Trump host a reception for Senators and their spouses at the East Room of the White House in Washington, U.S., March 28, 2017. REUTERS/Carlos Barria

WASHINGTON (Reuters) – U.S. President Donald Trump told a group of senators on Tuesday that he expected lawmakers would be able to reach a deal on healthcare, without offering specifics on how they would do it or what had changed since a healthcare reform bill was pulled last week for insufficient support.

“I have no doubt that that’s going to happen very quickly,” Trump said at a bipartisan reception held for senators and their spouses at the White House.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

A Republican plan backed by Trump to overhaul the U.S. healthcare system was pulled on Friday after it failed to garner enough support to pass the Republican-controlled House of Representatives.

Trump, a Republican, did not mention that failure at the reception nor did he offer specifics on how he planned for lawmakers to reach a consensus on a healthcare bill that would repeal and replace the Affordable Care Act, familiarly known as Obamacare.

Trump told lawmakers at the reception that he would be talking about infrastructure and investing in the military, without offering a time frame or details.

“Hopefully, it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love,” he said.

(Reporting by Ayesha Rascoe; Editing by Leslie Adler, Toni Reinhold)

House speaker tells Trump healthcare bill lacks votes: CNN

U.S. House Energy and Commerce Committee Chairman Representative Greg Walden (R-OR) (center L, at table) and Ways and Means Committee Chairman Representative Kevin Brady (R-TX) (center R, at table) testify at an early-morning Rules Committee hearing as Congress considers health care legislation to repeal Obamacare at the U.S. Capitol in Washington, U.S., March 24, 2017. REUTERS/Jonathan Ernst

By Richard Cowan and Dustin Volz

WASHINGTON (Reuters) – Republicans in Congress said they lacked the votes needed for passage of their U.S. healthcare system overhaul and a key committee chairman came out in opposition after Donald Trump demanded a vote on Friday in a gamble that could hobble his presidency.

Amid a chaotic scramble for votes, House of Representatives Speaker Paul Ryan, who has championed the bill, met with Trump at the White House. Ryan told the president there were not enough votes to pass the plan, U.S. media reported.

The showdown on the House floor follows Trump’s decision to cut off negotiations to shore up support inside his own party, with moderates and the most conservative lawmakers balking. On Thursday night he had issued an ultimatum that lawmakers pass the legislation that has his backing or keep in place the Obamacare law that Republicans have sought to dismantle since it was enacted seven years ago.

“We’ll see what happens,” Trump said at the White House, adding that Ryan should keep his job regardless of the outcome.

The White House said the vote was set for about 3:30 p.m. (1930 GMT) on Friday on the bill to replace Democratic former President Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act, widely known as Obamacare.

“There’s nobody that objectively can look at this effort and say the president didn’t do every single thing he possibly could with this team to get every vote possible,” White House spokesman Sean Spicer told reporters.

Republicans control Congress and the White House but have deep divisions over the first major legislative test since Trump became president on Jan. 20.

In a blow to the bill’s prospects, House Appropriations Committee Chairman Rodney Frelinghuysen announced his opposition, expressing concern about reductions in coverage under the Medicaid insurance program for the poor and the retraction of “essential” health benefits that insurers must cover.

“We need to get this right for all Americans,” Frelinghuysen said.

Representative Rodney Davis, a member of the House Republican team trying to win passage, said the bill was short of the needed votes, and White House budget director Mick Mulvaney added it was unclear if enough support was present.

Vice President Mike Pence, a former House member and influential among Republican lawmakers, postponed a planned trip to Arkansas and Tennessee to help secure passage.

“I’m still optimistic,” Spicer said. “I feel like we’re continuing to work hard. But at the end of the day you can’t force somebody to do something.”

Trump and House Republican leaders cannot afford to lose many votes in their own party because Democrats are unified in opposition, saying the bill would take away medical insurance from millions of Americans and leave the more-than-$3 trillion U.S. healthcare system in disarray.

Republican supporters said the plan would achieve their goal of rolling back the government’s “nanny state” role in healthcare.

FOREHEAD TATTOO

House Democratic leader Nancy Pelosi said, “What’s happening today is a lose-lose situation for the Republicans. It’s a lose-lose for the American people, that’s for sure. But the people who vote for this will have this vote tattooed to their foreheads as they go forward.”

Failure of the measure would call into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

“If it doesn’t pass, this issue is dead,” Republican Representative Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. “This is the one shot.”

Even if the legislation passes in the House, it faces an uncertain future in the Senate, where Republicans have expressed misgivings.

Healthcare was the first major test of how Trump, a real estate magnate who touted his deal-making prowess in the 2016 presidential campaign, would work with Congress. Days of negotiations led to some changes in the bill but failed to produce a consensus deal.

U.S. stocks were mixed on Friday in early afternoon trading, having pared earlier gains, while U.S. treasuries were mostly higher.

Leading Republicans had taken to the House floor to make their case to pass the bill and implored conservatives to seize the opportunity to make good on the party’s long promise to get rid of Obamacare.

‘ONLY OUR FIRST STEP’

“Today we are faced with a stark choice,” said Republican Diane Black, who heads the Budget Committee. “While no legislation is perfect, this bill does accomplish some important reforms.”

Black called the bill “only our first step.”

Trump added on Twitter, “This is finally your chance for a great plan!”

Democratic Representative Debbie Wasserman Schultz, a breast cancer survivor, called the bill “an immoral piece of legislation” that would gut medical coverage and patient protections.

A Quinnipiac University poll released on Thursday found 56 percent of U.S. voters opposed the House bill, with only 17 percent supporting it. Quinnipiac said its poll had a margin of error of plus or minus 3 percentage points.

Replacing Obama’s signature health care plan was a key campaign pledge for Trump and Republicans, who view it as overly intrusive and expensive.

Obamacare boosted the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The nonpartisan Congressional Budget Office said under the Republican legislation 14 million people would lose medical coverage by next year and more than 24 million would be uninsured in 2026.

The House plan would rescind a range of taxes created by Obamacare, end a penalty on people who refuse to obtain health insurance, end Obamacare’s income-based subsidies to help people buy insurance while creating less-generous age-based tax credits

It also would end Obamacare’s expansion of the Medicaid state-federal insurance program for the poor, cut future federal Medicaid funding and let states impose work requirements on some Medicaid recipients.

House leaders agreed to a series of last-minute changes to try to win over disgruntled conservatives, including ending the Obamacare requirement that insurers cover certain “essential benefits” such as maternity care, mental health services and prescription drug coverage.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans’ views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, Susan Cornwell, Jeff Mason, David Morgan, David Lawder, Amanda Becker, and Doina Chiacu; Writing by Will Dunham; Editing by Bernadette Baum and Bill Trott)

Obamacare supporters rally against congressional repeal efforts

Protesters demonstrate against U.S. President Donald Trump and his plans to end Obamacare as they march to the White House in Washington, U.S., March 23, 2017. REUTERS/Kevin Lamarque

By Ian Simpson

WASHINGTON (Reuters) – Supporters of Obamacare staged rallies across the country on Thursday denouncing efforts by President Donald Trump and Republican congressional leaders to repeal the landmark law that has extended medical insurance coverage to some 20 million Americans.

Hundreds of demonstrators turned out in Washington, Chicago and Los Angeles marking the seventh anniversary of enactment of Obamacare, as the Affordable Care Act (ACA) has become widely known.

Many talked about a very personal stake in the outcome of the healthcare debate roiling Capitol Hill.

“I feel sick today, but I came here because I’m terrified,” said Steve Martin, 27, an unemployed Los Angeles resident who was diagnosed with cancer a year ago. “The legislators have the best healthcare in the world, and we deserve the same.”

The ACA, considered former Democratic President Barack Obama’s premiere domestic achievement, has drawn unrelenting scorn from Republicans, with promises to repeal and replace it a centerpiece of Trump’s presidential campaign.

Thursday’s rallies coincided with planned action in the House of Representatives on a Republican-backed bill to begin dismantling Obamacare, but the vote was indefinitely postponed as Republican leaders and the White House scrambled to muster enough votes for passage.

Many moderate Republicans as well as Democrats have raised concerns that repeal-and-replace would leave too many Americans without health coverage.

Supporters of the bill say it would lower premiums, but critics counter that those savings would in many cases be more than offset by higher co-pays and other out-of-pocket costs.

Obamacare backers also worry about the fate of millions who gained insurance under the bill’s major expansion of Medicaid, the federal-state program providing coverage for the needy, the elderly and the disabled.

In the nation’s capital, several hundred chanting protesters gathered at Freedom Plaza, a few blocks from the White House, carrying signs with slogans such as “We Fight Back” and “Keep America Healthy.”

Robinette Barmer, 61, a former seamstress and caterer from Baltimore now on a disability pension, said that without Obamacare she could not afford the various medications she takes for ailments such as asthma and high blood pressure.

“It’s co-pay this, co-pay that. I can’t pay that. I’m struggling as it is right now,” she said.

After the rally, protesters marched a block to the Trump International Hotel on Pennsylvania Avenue, where several dozen sprawled on the sidewalk in a “die-in” symbolizing the effect of rolling back Obamacare. Some 24 protesters were arrested in front of the White House after they refused get off the ground, organizers said.

Protest organizers said smaller gatherings were also held outside the congressional district offices of various Republican lawmakers around the country.

(Additional reporting by Olga Grigoryants in Los Angeles and Robert Chiarito in Chicago; Writing by Steve Gorman; Editing by Leslie Adler and Michael Perry)

Republicans scramble for health bill votes after Trump ultimatum

U.S. House Speaker Paul Ryan (R-WI) (C) walks to the House floor for the opening of a morning session as Congress considers health care legislation to repeal Obamacare at the U.S. Capitol in Washington, U.S., March 24, 2017. REUTERS/Jonathan Ernst

By Susan Cornwell and Richard Cowan

WASHINGTON (Reuters) – U.S. Republican lawmakers struggling to overcome differences over new healthcare legislation confronted a stark choice after President Donald Trump delivered an ultimatum: pass the bill on Friday or keep Obamacare in place.

Trump, a real estate magnate who touted his dealmaking prowess in the 2016 presidential campaign, faced the first major test of how well his skills would translate in Congress. Days of negotiations failed to produce a deal amid opposition from moderates and conservatives in his own Republican Party, and it was far from clear the bill had enough support to pass.

Financial markets, which have been buoyed by Trump’s plans to cut taxes and boost infrastructure spending, are watching closely. U.S. stock markets fell on Thursday as Republican leaders delayed a vote, and European stock markets opened lower on Friday, although the U.S. equity market looked set for a higher open.

The House of Representatives was set to vote late Friday afternoon on the Trump-backed bill to replace Democratic President Barack Obama’s 2010 Affordable Care Act.

“Lawmakers will have to be accountable as to why they didn’t vote to get rid of Obamacare when they had the chance, and that chance is today,” White House budget director Mick Mulvaney told CBS “This Morning.”

The House Rules Committee, which sets the duration of the debate on legislation and decides whether amendments will be allowed to be offered, was expected to formally send the Republican healthcare bill to the House floor on Friday morning.

Democrats uniformly oppose the bill, and it appeared to lack the needed Republican support as well, despite last-minute changes intended to broaden its appeal.

At least 35 Republicans still plan to vote against the bill, according to CBS News. If all House members were to vote, Republicans can only afford to lose 21 votes.

The American Health Care Act is the first foray into legislation for Trump, a New York businessman and reality television star who took office on Jan. 20.

The vote had been set for Thursday, the seventh anniversary of the signing of Obamacare. In an embarrassing setback, it was postponed because of tepid support.

By Thursday evening, Trump signaled he was done negotiating and demanded lawmakers back the bill, or face the consequences.

“The message is … it’s done tomorrow, or Obamacare stays,” said Representative Chris Collins of New York, a Trump ally.

KEY CAMPAIGN PLEDGE

Replacing Obama’s signature health care plan was a key campaign pledge for Trump and Republicans, who viewed it as overly intrusive and expensive.

Obamacare aimed to boost the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The House replacement plan would rescind taxes created by Obamacare, repeal a penalty against people who do not buy coverage, slash funding for the Medicaid program for the poor and disabled, and modify tax subsidies that help individuals buy plans.

Conservatives believe the Republican bill does not go far enough to repeal Obamacare and moderates think the plan could hurt their constituents.

House leaders agreed to four pages of last-minute amendments, including allowing states to choose which “essential benefits” are required in insurance plans, keeping a 0.9 percent surcharge on Medicare for high-income Americans for six years, and giving states more money for maternal health and mental health.

It was unclear whether that was enough to win over skeptics.

Trump has indicated an eagerness to move on to tax reform, trade deals and infrastructure, but a defeat in Congress will cast doubt on his ability to deliver.

If Republicans manage to ram the legislation through the House, it faces a tough fight in the Senate. It could draw opposition from moderate Senate Republicans who do not like the House measure’s new restrictions on federal funding for women’s healthcare provider Planned Parenthood.

Many senators, especially those who represent poor, rural states, worry that constituents who for the first time have health insurance because of Obamacare, will lose that coverage and not be able to afford the Republican replacement.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans’ views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, David Morgan, David Lawder, and Amanda Becker; Writing by Roberta Rampton and Doina Chiacu; Editing by Simon Cameron-Moore and Bernadette Baum)

Vote looming, Trump struggles to win Obamacare repeal

U.S. President Donald Trump walks from Marine One as he returns to the White House in Washington. REUTERS/Joshua Roberts

By Roberta Rampton and David Morgan

WASHINGTON (Reuters) – U.S. President Donald Trump on Thursday was set to make a final push on Thursday to secure the votes to begin dismantling Obamacare in the House of Representatives, with signs that enough Republicans might defect to jeopardize one of his top legislative priorities.

Trump has mounted an intensive campaign to garner support for the initiative and the effort is seen by financial markets as a crucial test of his ability to move his legislative agenda, including planned tax cuts, through Congress.

Republican leaders hoped to vote on Thursday but there were signs the deadline could be pushed back. Trump scheduled an 11:30 a.m. ET/1530 GMT meeting with members of the conservative House Freedom Caucus at the White House.

“We’re still open for negotiations,” Representative Ted Yoho, a member of the conservative group, told CNN. “There is still time.”

Democratic Representative Steny Hoyer said the majority Republicans clearly did not have enough votes to pass the bill, which has been championed by House Speaker Paul Ryan.

Trump and Ryan need strong support from their side of the aisle and can only afford to lose 21 Republican votes.

As part of his effort, Trump urged Americans in a tweet early on Thursday to press their representatives to vote for the bill, known formally as the American Health Care Act.

Uncertainty over the bill has rattled financial markets and a failure just two months into Trump’s presidency would be a setback for the White House, which as late as Wednesday had cautioned there was “no Plan B” for the healthcare measure.

Stocks on Tuesday posted their biggest one-day drop since the Nov. 8 presidential election on concerns about the healthcare drama.

Failure to pass the legislation would cast doubt on Trump’s ability to deliver other parts of his agenda that need the cooperation of the Republican-controlled Congress, including ambitious plans to overhaul the tax code and invest in infrastructure.

The House vote had been expected by about 7 p.m. (2300 GMT). But by midnight on Wednesday, lawmakers had not yet settled on the timing of the vote as conservative and moderate Republicans split on whether there should be additional changes to the proposal.

House Rules Committee Chairman Pete Sessions said the vote could happen as early as Thursday or as late as Monday.

Democratic representatives are united against the bill, which seeks to repeal and replace Democratic President Barack Obama’s 2010 Affordable Care Act.

Conservative Republicans have complained the replacement is too similar to Obamacare, and some moderate Republicans are concerned it will weaken health coverage for millions of voters.

An aide to the Freedom Caucus said at one point on Wednesday that more than 25 of its members opposed the plan. The chairman of the group, Representative Mark Meadows, said negotiations late on Wednesday were making headway.

Moderate Republicans huddled late into the evening in Ryan’s office. Afterward, Representative Charlie Dent issued a statement saying he could not back the bill.

Trump and fellow Republicans campaigned during 2016 elections on a promise to repeal and replace Obamacare, a program that aimed to boost the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies.

Their replacement plan would rescind the taxes created by Obamacare, repeal a penalty against people who do not buy coverage, slash funding for the Medicaid program for the poor and disabled, and modify tax subsidies that help individuals buy plans.

The nonpartisan Congressional Budget Office estimated 14 million people would lose medical coverage under the Republican plan by next year. It also said that 24 million fewer people would be insured by 2026.

Even if the legislation passes the House, it faces a second hurdle in the Senate, where a number of Republicans have spoken out against that version.

(Additional reporting by Susan Cornwell and Jeff Mason; Editing by Michael Perry and Bill Trott)

Trump warns Republican lawmakers of backlash for healthcare failure

U.S. President Donald Trump (C) and Health and Human Services Secretary Tom Price (L) enter the U.S. Capitol in Washington, U.S., March 21, 2017. REUTERS/Kevin Lamarque

By Susan Cornwell

WASHINGTON (Reuters) – U.S. President Donald Trump warned Republican lawmakers on Tuesday that voters could punish them if they do not approve a plan he favors to dismantle Obamacare, as pressure grew on the businessman-turned-politician to win the first major legislative battle of his presidency.

In one of the few visits he has made to the U.S. Capitol since taking office, Trump told fellow Republicans in the House of Representatives they would face “political problems” for opposing the bill that takes apart Obamacare and partially replaces it.

“The president was really clear: he laid it on the line for everybody,” House Speaker Paul Ryan, the leading proponent of the bill, told reporters. “We made a promise. Now is our time to keep that promise … If we don’t keep our promise, it will be very hard to manage this.”

While Republicans control both chambers of Congress, the party’s leaders face a difficult task in uniting their members behind the healthcare bill, just the first of a series of reforms that Trump has promised including overhauls of the tax system and business regulations.

U.S. stocks turned sharply lower on Tuesday, led by a fall in financial shares, as investors began to question how quickly the Trump administration can implement pro-growth policies.

Sectors that could benefit from policies of lower taxes and fiscal stimulus were weaker as investors perceived those plans may take longer to implement if the Trump administration has to expend more time and energy to get a healthcare plan passed.

Some conservatives believe the healthcare bill does not go far enough, while moderate Republicans worry it goes too far and that millions of Americans will be hurt by dismantling the 2010 Affordable Care Act, former President Barack Obama’s signature healthcare legislation.

Party leaders hope to move the bill to the House floor for debate as early as Thursday. But the administration and House leadership can afford to lose only about 20 votes from Republican ranks or risk the bill failing since Democrats are united against it.

Repealing and replacing Obamacare was one of Trump’s main campaign promises and has been a goal of Republicans since it was enacted. Trump, who took office two months ago, has yet to push any major legislation through Congress.

Republican Representative Walter Jones said Trump told lawmakers in a closed-door meeting that if the Republican bill does not pass, they would face “political problems.” Jones said he thought Trump meant lawmakers could lose their seats.

While Trump predicted that Republicans could face challenges in primary contests ahead of the 2018 midterm elections if they do not gut Obamacare, there is also danger to them in doing so. Millions of voters might lose their healthcare coverage if the Republican bill is passed.

The Congressional Budget Office said last week that 14 million people would lose coverage under the House bill over the next year, although that number could change based on the most current version of the legislation.

CRITICS REMAIN

Republican leaders recrafted the bill on Monday to satisfy critics, mainly fellow Republicans, in part by proposing major changes to tax credits and provisions to alter the Medicaid publicly funded insurance program for low-income people.

Representative Bill Flores said Trump singled out one critic on the right flank of the party, Mark Meadows, chairman of the conservative House Freedom Caucus, during his Capitol Hill visit, saying Meadows would eventually come around to vote for the bill.

“Mark Meadows, he called out two or three times,” Flores told reporters. “The reaction, when he said, ‘Mark Meadows, I’m coming after you’, was pretty loud cheers … I think he was tongue-in-cheek, half joking.”

Despite Monday’s changes, the Wall Street Journal reported the House Freedom Caucus has enough votes to block the bill.

Trump, who has not offered Obamacare repeal legislation of his own, did not talk “a whole lot about the healthcare bill except to vote for it,” Jones said.

The Club for Growth, an influential conservative lobby group, said it would spend at least $500,000 for ads on television and digital platforms urging members of Congress to defeat the bill.

The Senate will also vote on the legislation and more changes could still be made.

At a rally in Kentucky on Monday night, Trump said he wanted to add a provision to the bill to lower prescription drug costs through a competitive bidding process. There was no such provision in Monday’s changes.

Republican chairmen for two key committees said late Monday they proposed more funding for tax credits, which conservatives have opposed, that would give the Senate flexibility to help older people afford health insurance. Additionally, Obamacare’s taxes would be eliminated in 2017 instead of 2018.

Monday’s amendments also addressed Medicaid, which is the country’s largest health insurance program and covers about 70 million people, mostly the poor. The changes would allow states to implement work requirements for certain adults and to decide how they receive federal funds.

The nonpartisan Congressional Budget Office, which said last week the original bill would cause 24 million people to lose coverage over the next decade, is expected to update its analysis of the legislation to include the proposed changes.

Democrats oppose Republicans’ plan, saying it would throw millions off health insurance and hurt the elderly, poor, and working families while giving tax cuts to the wealthy.

(Additional reporting by Jeff Mason Susan Heavey, Yasmeen Abutaleb and Richard Cowan; Writing by Alistair Bell; Editing by Bill Trott and Frances Kerry)