The Republican rush to repeal Obamacare came to an abrupt halt on Thursday after negotiations between two different wings of the party stalled. As a result, Speaker of the House Paul Ryan and his leadership team announced that they had canceled a vote on the American Health Care Act that was supposed to take place on Thursday evening. Multiple reports suggest that House leaders hope to hold the vote on Friday, but no definite schedule has been released at this writing.
The AHCA's prospects have long been in doubt as far-right members of the House Freedom Caucus have resisted Ryan's efforts to ram through the bill. The Freedom Caucus has successfully extracted several concessions from the GOP House leadership but ultimately they have not been enough.
In a last-ditch effort to save the bill, President Trump and senior House Republicans held a meeting on Thursday morning with many Freedom Caucus members. That meeting ended without any sort of agreement.
After the meeting, White House press secretary Sean Spicer said at his daily news briefing that the administration was confident that an accord could be reached.
"We walked out with more members in support of the American Health Care Act today than we started the day with,” Spicer said. “I continue to see that number climb hour by hour. And I anticipate that we will get there.”
Ryan and his lieutenants had scheduled the vote on the bill for Thursday to coincide with the seventh anniversary of the Affordable Care Act which was signed into law by former president Barack Obama on March 23, 2010.
The Freedom Caucus has not released a list of its members but it appears to represent about 40 of the 237 Republican House members.
The House Republican delegation has long been fractured by a handful of members from extremely conservative areas whose only re-election fear is a primary challenge from the far right. These members have made it exceptionally difficult for Ryan, and former Speaker John Boehner before him, to pass legislation.
The current head of the Freedom Caucus is Rep. Mark Meadows of North Carolina. He was voted into his position after he successfully orchestrated Boehner's ouster in 2015.
Freedom Caucus members have continuously criticized the GOP's proposed Obamacare replacement as wasteful and have said it did not remove enough regulations to bring down premiums for people purchasing insurance in the private sector. Some of those existing restrictions include rules prohibiting insurance companies from charging higher prices to people based upon their medical condition or sex.
Ryan and his lieutenants insisted that they could not insert such provisions into the bill without running afoul of a Senate rule that allow measures to avoid having to reach a 60-vote threshold if they are limited to revenue and spending questions. Meadows and his allies have been arguing in response that the GOP, which controls both houses of Congress, could dispense with the custom which is commonly referred to as "Byrd Rule."
Meadows told reporters he still wanted to vote for the measure but could not without additional changes.
“I’m desperately trying to get to yes,” said Meadows. “I think we need to make sure that it lowers health care costs.”
Right-wing groups such as Heritage Action for America and the Koch-funded Americans for Prosperity have also urged the House to oppose the bill.
At the same time the House leadership has been trying to placate its far right members, it has also been striving to fend off concerns from more moderate Republicans who have been spooked by a March 13 analysis from the Congressional Budget Office (CBO) which found that up to 24 million Americans would lose their health insurance under the first version of the bill released by the House GOP.
The non-partisan legislative evaluation agency released an updated report on Thursday claiming that the Republican leadership's latest revision of the American Health Care Act would still leave about 24 million uninsured over 10 years. The CBO projected the updated bill would reduce the federal deficit only by $150 billion over the same time period; the first version was projected to reduce it by $337 billion.
According to reports, the second CBO analysis did not reflect changes to the legislation that have been made within the past several days.
The Republican majority in the House is small enough that if 22 or more GOPers refuse to vote for a bill, it cannot pass. All of the chamber's Democrats have indicated they will refuse to vote for the AHCA.
Updated 6:15 pm ET.
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