House Republicans say they have the votes to pass health-care bill

House Republicans are set to pass a controversial plan to revise key parts of the Affordable Care Act on Thursday, capping weeks of fits and starts to fulfill a signature campaign promise.

"We'll have the votes. This will pass," House Majority Leader Kevin McCarthy (R., Calif.) vowed on Thursday morning.

Final passage of the bill that would dramatically reshape the nation's health-care system is expected by early afternoon. Attention will then shift to the more closely divided U.S. Senate, where formal debate isn't expected to begin until June.

Several White House aides began Thursday morning by texting each other and reporters with two words: "game day." Passage of the bill would be an achievement for President Trump, who has pledged to repeal and replace the Affordable Care Act, but has struggled to secure legislative wins early in his presidency. And Thursday's vote would be a relief for House Republican leaders, especially Speaker Paul Ryan (R., Wis.), who have failed over several years to unite their ideologically disparate caucus.

The vote caps a haphazard debate that included few public hearings and the hasty revision of key sections of the bill during closed-door meetings at both ends of Pennsylvania Avenue designed to secure votes from skeptical conservatives and moderates initially unwilling to support the legislation.

Despite more than six years of campaign pledges to undo the ACA and the recent changes to the legislation, several Republican lawmakers admitted Thursday that they have not read the bill or ignored questions about their understanding of the bill that were shouted by reporters. Republicans have accused Democrats in the past of ramming their health-care bill through without giving members a chance to absorb it — but on Thursday they insisted that they are not doing the same thing.

They argued that their health-care bill is only several hundred pages long, compared with the size of the Affordable Care Act, which ran several thousand pages.

Democrats "put a 2,000 page bill on the table they knew no one had time to read, and we're not doing that," Rep. Morgan Griffith (R., Va.) said.

"This is a rough and tumble exercise that the Founding Fathers anticipated," he added.

House Freedom Caucus Chairman Mark Meadows (R., N.C.) said he was willing to abandon his previous demands that leaders allow hearings and discussion of the legislation because members had opportunities to weigh in on amendments over the past several days. The decision marks a significant shift for hard-line Freedom Caucus members who have insisted that leaders give them ample time to read legislation and weigh in before a bill comes up for a vote.

"We've had members working with members to come up with real amendments that are getting adopted today," Meadows said. "I can tell you that I have read the bill no less than six times. If they haven't read the bill it is because they haven't spent the time to do that."

Much of the recent contention among Republicans resolved around how to protect patients with expensive, preexisting conditions, prompting several amendments to the bill. Energy and Commerce Chairman Greg Walden presented those changes as improvements to the bill, in a slide presentation Thursday morning to his colleagues.

According to the slides, insurers could charge such patients more only if a number of conditions were met. States would have to get a waiver from the federal government and the individual would have to be uninsured and buying their coverage on the individual market.

Republicans also disregarded the absence of a final cost estimate from the nonpartisan Congressional Budget Office — Congress's official scorekeeper - on how much the bill would cost and how many people would receive health-care coverage. Several said that last-minute changes to the legislation won't significantly change the final estimates.

"We're still comfortable we're saving billions and billions of dollars," Rep. Chris Collins (R., N.Y.) said.

If the bill passes, it will face a steeper climb in the Senate, where widespread disagreement remains among Republicans about how to proceed on health care. First, the Senate's parliamentarian — or rules-keeper — cannot review the legislation and determine the rules of debate until the CBO submits its official estimate, which could take several more weeks to complete, according to congressional aides. That would mean that official Senate debate on the bill could not begin until June.

Even then, the issue of health care reform is expected to be treated much more skeptically by Republican senators.

"A bill — finalized yesterday, has not been scored, amendments not allowed, and three hours final debate — should be viewed with caution," Sen. Lindsey Graham, (R., S.C.) tweeted on Thursday ahead of the House vote.

Among many other concerns, GOP senators from states that have expanded Medicaid under the ACA have voiced concerns about rollbacks to that program included in the House bill. A trio of conservative senators — Ted Cruz (R., Texas), Mike Lee (R., Utah) and Rand Paul (R., Ky.) — who often buck GOP leaders are another wild card. With just a 52-48 advantage over Democrats, Senate Republicans have a smaller margin for error than their House counterparts.

The House measure may run into other procedural roadblocks in the Senate. The original proposal initially left many of the ACA's insurance regulations alone — with the goal of ensuring it would pass muster with the Senate parliamentarian — but not all of them. The version of the bill the House plans to vote on Thursday would undercut the ACA's insurance regulations even more. That might make it difficult for Republican senators to pass the measure under a procedural maneuver known as "reconciliation," which is usually reserved for budget legislation.

The House bill would also allow insurers to charge older Americans five times what they charge younger people, as opposed to three times as much under current law. And it would enable insurers to hike premiums by 30 percent for people who don't remain continuously covered. Health policy experts, including conservative ones, have noted that the parliamentarian may decide those provisions need to be stripped out to pass it under reconciliation.

No matter when and how Senate debate begins, House Republicans exhibited a palpable sense of relief Thursday that the issue is off their plates — at least for now.

"It wasn't fun," Rep. Lou Barletta (R., Pa.) said.

Meadows, who struggled for weeks to rally his caucus around the measure, said the Senate will make changes he might not necessarily back.

Collins added that "only time will tell" whether the bill will have a chance in the House once the Senate changes it.

David Weigel, Kelsey Snell, Robert Costa and Paul Kane contributed to this report.

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