House Republicans from Pa., NJ caught in the middle on GOP health care stumble

WASHINGTON -- When Charlie Dent and Tom MacArthur left a meeting in the U.S. Capitol on Thursday morning and set off toward House Speaker Paul Ryan's office, the two congressmen said they were just in the midst of "a family conversation."

But the usually talkative pair, the cochairs of the Tuesday Group, a group of moderate House Republicans, wouldn't share anything about that conversation.

The GOP's stumble Thursday in its push to repeal the Affordable Care Act and fulfill a promise to remake the U.S. health-care system put the two congressmen, and their fellow centrist colleagues from South Jersey and Pennsylvania, in an increasingly awkward, if familiar, position.

While saying they would like to back a bill that would deliver on a core GOP pledge, Republicans from moderate districts just outside Philadelphia found themselves increasingly repelled by the only proposal that could make it happen, and under intense pressure from President Trump.

By day's end, they were left contemplating a take-it-or-leave-it showdown vote that Trump wants Friday, and whether to support a bill that polls suggest is hugely unpopular and that could cost millions of people health coverage over the next decade, or stand in the way of a promise long made by their party, president, and speaker.

Two suburban Philadelphia lawmakers were left on the fence -- Reps. Ryan Costello of Chester County and Pat Meehan of Delaware County. Neither would say how he plans to vote.

"We'll see tomorrow," Meehan said Thursday night.

He and Costello both voted for the bill when it moved through their committees, but have since wavered as it moved further right, and as analyses predicted it would lead to a spike in the uninsured over the next decade.

Dent, MacArthur, and Costello were among a handful of centrists who met for roughly an hour with Ryan during the day and then hustled to the White House to sit with Trump as he tried to close the deal on one of his big campaign promises.

Three Republicans from the Philadelphia area had already announced earlier in the week they would oppose the plan embraced by Trump and Ryan, fearing the impact on their districts.

Dent and MacArthur were split: Dent, of Allentown, opposed the GOP bill, and MacArthur, of South Jersey, said he would support it after initially voicing concerns. He reiterated that support late Thursday.

As the talks played out, a Quinnipiac University poll showed dire numbers for the GOP plan: 17 percent approved of it, 56 percent disapproved.

And more controversial additions were coming. The Freedom Caucus, a bloc of hard-line conservatives critical to the bill's fate, sought to strip "essential benefits" to consumers that insurers are required to provide under the Affordable Care Act, better known as Obamacare. Making that change would allow insurance companies to offer plans that did not cover services such as maternity care or substance-abuse treatment.

Conservatives argued the move would cut premiums and allow people to forgo services they might not personally need. Critics said it could leave consumers with skimpy plans that don't cover critical services.

Substance-abuse treatment, in particular, has been a key benefit to Pennsylvania, Gov. Wolf has argued, saying that 125,000 Pennsylvanians have obtained treatment under the existing laws.

Some local Republicans worried about the change -- and that even if they voted for it, the Senate might move to restore those benefits.

Meehan argued that the revisions were likely to be made by the Trump administration anyway. He pointed to $15 billion directed toward states to help with coverage for maternity care, mental-health problems, and substance abuse.

The vote could weigh heavily on local Republicans. They represent moderate districts where they could face stiff election challenges if any health-care reform blows up in their faces, much as the Affordable Care Act did for Democrats in 2010.

GOP aides seemed increasingly confident that they could win the votes with the pressure on Friday -- support the bill, or get blamed for letting Obamacare survive.

As Costello left the late-night meeting, he strode down the hallway much like his colleagues Dent and MacArthur earlier in the day. He kept his hands in his pockets, shoulders tense, and said little to the reporters asking questions.