WASHINGTON - Undaunted by fellow Republicans' defiance, GOP leaders and the White House redoubled their efforts Tuesday to muscle legislation overhauling America's health-care system through Congress following a sobering report about millions being shoved off insurance coverage.
President Trump, whose strong Election Day showing in GOP regions makes him the party's ultimate Capitol Hill vote wrangler, discussed the legislation by phone with the House's two top Republicans. He also dispatched Vice President Pence and Health Secretary Tom Price to hear GOP senators' concerns.
With leaders hoping to move the measure through the House next week so the Senate can debate it, changes in the measure seemed all but certain. Trump's spokesman acknowledged they were open to revisions to win support. "This has never been a take it or leave it," said press secretary Sean Spicer.
The GOP bill is the party's response to seven years of promising to repeal President Barack Obama's 2010 health-care overhaul. It would undo that law's individual mandate, which requires most people to have coverage, by ending the tax penalty on those who don't.
It would also provide age-based tax credits instead of the subsidies geared to income in Obama's statute, end that law's expansion of Medicaid and curb its future spending, and let insurers boost rates for seniors.
On Monday, the Congressional Budget Office said the Republican legislation would reduce the ranks of the insured by 24 million in a decade, largely by cutting Medicaid recipients and people buying individual policies. That would be more than the 20 million who've gained coverage under Obama's overhaul - and attach a big number to a problem haunting GOP governors and members of Congress whose states have benefited from Obamacare.
"I plan to vote NO" on the GOP bill, Rep. Ileana Ros-Lehtinen (R., Fla.) tweeted Tuesday. "As written the plan leaves too many from my #SoFla district uninsured."
The budget office report also said the measure would reduce federal deficits by $337 billion over the next decade, largely by cutting Medicaid, the health insurance program for the poor, and eliminating Obama's subsidies for low- and middle-income people. The report said that the bill's changes would result in federal subsidies that would fall to half their current size in a decade and that older, lower-earning people would be hit especially hard.
Those findings further energized Democrats, who already were unanimously opposing the GOP repeal effort and showing no sign of relenting.
"Of course you can have savings if you cut off millions of people from access to health care," said House Minority Leader Nancy Pelosi of California. She said the measure's shift of billions of dollars from lower- to higher-earning families actually would effectively transfer money from GOP to Democratic regions, and, seemingly taunting Republicans, she added, "Explain that to your constituents."
Pence and Price discussed the legislation over lunch with GOP senators at the Capitol. Participants said senators suggested targeting the bill's new tax credits more at lower-earning people, improving benefits for seniors and protecting the expansion of Medicaid, the federal-state program that helps lower-income people afford care.
Senate Majority Leader Mitch McConnell (R., Ky.) all but acknowledged the widespread assumption that the measure will be reshaped, saying, "It will be open to amendment in the Senate."
Emerging from the senators' lunch - which included two House committee chairmen as well as Pence and Price - Sen. Pat Roberts (R., Kan.) said, "All four of them are open to suggestions and change."
Even so, criticism cascaded from both ends of the GOP political continuum, suggesting leaders face a festering problem.
Freshman Rep. John Faso (R., N.Y.), from a closely divided district in the Catskill Mountains, said he was concerned the bill would hurt hospitals and was undecided about supporting it. He's a member of the House Budget Committee, which is expected to sign off on the bill Thursday in what Rep. Tom Cole (R., Okla.) said could be "a bumpier ride" than last week's approval by two other panels.
Citing the bill's projected increase in uninsured people, Rep. Leonard Lance (R., N.J.), from another close district, said he opposed the bill. Rep. Mark Amodei (R., Nev.) said he was leaning no because of people losing coverage, saying of CBO's projections, "If the numbers are in the ballpark, it sounds like we've gone back to where we started after seven years."
Conservatives continued complaining that the Republican measure doesn't fully repeal Obama's law, as they and Trump promised in last fall's election campaigns. Their demands include voiding the law's requirement that policies cover 10 specified benefits such as mental health services, which they say drives up consumers' costs.