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Health care win could be shot in arm that Trump, GOP need

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Washington (CNN)It’s not the beginning of the end for the GOP’s bid to repeal Obamacare — but it might just be the end of the beginning.

If House Speaker Paul Ryan manages to finally muscle through the GOP health bill on Thursday, he will temper a damaging period of false starts, soul-searching and splits in his party that tarnished the start of Donald Trump’s presidency.
House Republicans will finally be able to go home to their districts for next week’s recess and tell their frustrated base they have at least made a down payment on their repeated campaign vows to kill the Affordable Care Act.
    Ryan, who was first forced to pull the bill in late March, will regain some luster for a speakership that had threatened to go down the same unprofitable path as his predecessor John Boehner — who was driven to distraction by the recalcitrant conservatives in his caucus.
    When he failed to make good on a push to pass Obamacare repeal the first time, Ryan had told reporters that moving from an opposition party, as the GOP was in the Obama years, to a governing party in control of Congress comes with “growing pains.”
    A narrow vote to pass the American Health Care Act on Thursday would not represent a coming of age for the Republican majority, but it will at least restore confidence that the GOP can come together to pass an agenda that had been assumed before the health care debacle, to herald a new era of conservative governance.
    And last, and certainly not least, a vote to move the bill to the Senate on Thursday would represent a much needed break for Trump.
    The President has struggled to assert his authority on Washington since taking office — after telling his fired up and loyal voters he would do just that and change the way the gridlocked capital works. It became a clich of the reviews of his first 100 days that the President was yet to celebrate a major legislative victory.
    The White House has had to endure a barrage of criticism as the conservative majority has fiddled over Obamacare repeal. Often the President has seem ill-informed about actually what is in the evolving bill, in a way that has undercut his claims to be the ultimate dealmaker.
    But all that could change Thursday.
    Some Republican House members were keen to play their part with a vote in sight on Wednesday, talking up the President for his role, even though some sources had previously described his frequent interventions as counterproductive.
    “He’s been all over this like a dog on a bone,” Rep. Bill Flores of Texas said.
    “I think the President’s done a pretty good job laying his cards on the table.”

    Before they celebrate…

    But the lesson of recent weeks means no House Republican will be complacent. They still need to pass the bill.
    Though GOP leaders said they would not put the measure on the floor if they weren’t sure they had the votes, there’s no cast iron guarantee it passes until the gavel slams down.
    One key Republican source close to the health care battle told CNN’s Jim Acosta that no one knows for sure if the 216 votes Ryan needs to pass the bill are secure. And the speaker can afford to lose no more than 22 members of his conference if the bill is to go through.
    Even so, Republican leaders, apparently relieved with forward movement, chose to put on an upbeat face on Wednesday night.
    “We’re gonna pass it. We’re gonna pass it!” Republican House Majority Leader Kevin McCarthy told reporters. “Let’s be optimistic about life.”
    White House Chief of Staff Reince Priebus told CNN’s Gloria Borger meanwhile he is “optimistic” about the vote.

    Ready to give vote and move on

    Despite their optimism, there’s an undeniable air of fatigue and desperation surrounding the vote.
    Many on the Republican side seemed so wrung out by weeks of tension and brinkmanship they are ready to offload the whole issue to the Senate.
    Forcing their hands was the knowledge that every week that the bill languished in limbo, it became more and more likely that Obamacare would survive in its present form.
    “We’re close here on this and then part of it is as the calendar ticks over another page or two, we either get something done or we live with Obamacare,” said Iowa Rep. Steve King, before the scheduled vote was announced.
    Flores said the bill had been tinkered with just enough to move some wavering members.
    “Some people think it’s moved enough to justify an affirmative vote,” he said.
    But the vote on Thursday will still be a leap in the dark for many Republicans.
    There’s no certainty that the hard won compromises on preserving coverage for pre-existing conditions will actually work, or even survive the overhaul the Senate is expected to perform when it picks up the legislation.
    Critics say the bill would deprive millions of people of coverage and roll back popular provisions of the Affordable Care Act. The bill is opposed by a long list of seniors and health industry lobby groups on the grounds that it curtails coverage.
    But it represents a delicate balancing act between conservatives who say the original bill was essentially “Obamacare Lite” and moderates who feared they would be blamed for signing away popular parts of the existing law.
    Even the White House admitted Wednesday that no one could know whether the $8 billion in extra cash for high-risk insurance pools used to buy wavering GOP votes was enough. Some independent analysts say it’s woefully short.
    But if the bill passes, Republican House leaders at least can feel their job is partly done and can begin to envisage more palatable items on their agenda, including a push for a generational tax reform.
    And they can wash their hands of health care for a while. They won’t for now at least think of the tough conference negotiations that are inevitable when the Senate has had its way.
    And Democrats are already setting up 2018 challenges.
    Minority Leader Nancy Pelosi, who helped shepherd Obamacare through the House when she was speaker, accused Republicans of gutting coverage and assurances that those with pre-existing conditions could get health care.
    “It’s a joke. It’s a very sad, deadly joke,” she said.
    Alongside Pelosi, Rep. Rosa DeLauro of Connecticut, an ovarian cancer survivor and Obamacare customer bore witness to the importance of health care coverage for those who have pre-existing conditions.
    “This is a very personal fight for me and we will continue this fight … this is about peoples’ lives,” she said. “This is about surviving.”

    Read more: http://www.cnn.com/2017/05/04/politics/health-care-analysis/index.html

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