Republican healthcare compromise???

Moderates chafe at Republican healthcare compromise

Tuesday Group lawmakers are wary of a deal one of its members cut with the Freedom Caucus, casting doubt about whether it can pass the House.

By KYLE CHENEY , RACHAEL BADE and KATIE JENNINGS

If the White House manages to resuscitate its flat-lining effort to replace Obamacare, President Donald Trump may owe it to a moderate New Jersey Republican and multimillionaire who only reluctantly backed his candidacy for president.

Rep. Tom MacArthur has singlehandedly kept the embers of the failed repeal-and-replace effort burning, huddling with the hard-line conservative Freedom Caucus to try to forge a deal. The negotiations have allowed the White House and GOP congressional leaders to insist that despite their embarrassing failure to pass health care legislation last month, they're still making progress.

But the MacArthur-as-Republican health care savior narrative has bothered some GOP moderates, who say the New Jersey lawmaker is flying solo in negotiations with the Freedom Caucus. Though he's one of three co-chairs of the Tuesday Group — a 50-member bloc of House Republican moderates — MacArthur has negotiated without the group's blessing in his quest to keep the health care talks alive, other Tuesday Group members say.

And many others say they’ve seen no details about the compromises the second-term lawmaker is offering or whether he’s getting enough concessions from conservatives.

Some in the group “are pretty hot about this thing right now,” said a Tuesday Group member. “MacArthur is kind of on his own.”

MacArthur acknowledged as much in an interview with The Hill, suggesting his effort to find compromise was not on behalf of the Tuesday Group.

As a result, it's not clear that any deal MacArthur strikes can actually deliver the votes of moderates that President Donald Trump and House Speaker Paul Ryan need to get their legislation, dubbed the American Health Care Act, across the finish line. That's a dangerous dynamic that could sink the revived health care discussion just as Freedom Caucus members are warming to the bill.

So far, House moderates have remained quiet about reports of progress between MacArthur and the Freedom Caucus, chaired by North Carolina Rep. Mark Meadows. The two were seen huddling daily in the back of the House chamber before lawmakers departed for their two-week Easter recess. But other Tuesday Group members have been wary of working with the Freedom Caucus, which came under fire from Trump and mainstream Republicans last month for rejecting the first iteration of the GOP health care plan.

At the time, Rep. Chris Collins, a Tuesday Group member and Trump ally, accused the Freedom Caucus of proposing negotiations simply to deflect blame for scuttling the first bill.

“The Tuesday Group will never meet with the Freedom Caucus. Capital N-E-V-E-R,” Collins said in late March.

As reports of a deal surfaced during the recess, moderates remained silent. Even MacArthur's Tuesday Group co-chairs — Reps. Charlie Dent and Elise Stefanik of New York — said they weren’t yet sold on the negotiations.

Dent suggested the talks seemed aimed mostly at securing a win for Trump, or at least showing progress, ahead of his 100th day in office.

Stefanik told constituents she had yet to see legislative language and would reserve judgment until she could read the details. "I believe my constituents deserve a representative who knows what that final bill is," Stefanik told a hometown crowd on Monday, according to the Albany Times Union.

Indeed, it's unclear whether MacArthur's efforts have moved any moderates closer to "yes" on the stalled health care bill. POLITICO reached out to the offices of more than two dozen moderate Republicans who had either signaled their opposition to the AHCA or hadn’t yet taken a position. Though many declined to respond, none said they had been swayed by the negotiations.

"The amendment doesn't address the things that I had concerns about — the things I think are detrimental to the people I represent," said Rep. Dan Donovan, a centrist, who added that he learned about the proposal when details leaked to the press Friday.

Other New Jersey Republicans, including moderates like Leonard Lance and Frank LoBiondo, say they don't have much insight into changes to the health care legislation that MacArthur is negotiating.

“I ran in support of a plan that lowers premiums, increases access and lowers health care costs across the board,” Lance said in a statement to POLITICO on Tuesday. “Until I see a Congressional Budget Office score that says the revised bill achieves those goals I remain a 'no' vote.”

LoBiondo tweeted Friday that he hadn’t seen the draft text of the amendment, but was "still a NO" because it didn’t address his “serious concerns.”

The highest ranking Republican in the New Jersey delegation, Rep. Rodney Frelinghuysen, who serves as chairman of the House Appropriations Committee, hasn’t signaled his views of the amendment yet. But the MacArthur-negotiated changes leave intact the AHCA’s rollback of Medicaid expansion, which Frelinghuysen said he would oppose.

At the heart of the negotiations is a trade-off. Conservatives are seeking a proposal that would let states opt out of Obamacare's regulatory framework, including provisions intended to keep costs down for people with pre-existing conditions. In exchange, MacArthur negotiated to reinstate Obamacare's minimum coverage requirements and to require that any state choosing to opt out of the Obamacare regulations must set up a high-risk pool intended to help cover sick patients whose premiums might surge.

Freedom Caucus sources indicated these changes could win over at least some of their holdouts, putting the AHCA tantalizingly close to passage. House leaders are hopeful they can nudge just enough moderates to back the bill to send it to the Senate. With no Democrats expected to support the bill, Republicans must secure support from 216 members of the 238-member caucus to pass it.

Since talks collapsed last month, House leaders and President Donald Trump have indicated they were heartened by continued negotiations among lawmakers. Vice President Mike Pence and White House Budget Director Mick Mulvaney continued shuttling to and from Capitol Hill in search of votes. Then, as Trump's 100-day mark in office approached, the White House began indicated it expected a vote on an amended health care package as soon as this week.

The Meadows-MacArthur talks were at the heart of it.

For MacArthur, the impromptu talks aren't just risky for the Republican agenda, they could imperil his own political future. He represents one of a few dozen swing districts. Though his district narrowly voted for Trump in November, it backed Barack Obama in 2008 and 2012. MacArthur's role in salvaging a health care plan that energized protesters on the left and drew poor marks across the political spectrum has only enhanced the target on his back for Democrats.

MacArthur's efforts have also put him on the president’s radar. Trump personally thanked MacArthur, a former insurance executive, the day before leaders pulled the legislation for lack of support.

But during the presidential campaign, MacArthur, 56, kept his distance from Trump, endorsing the GOP standard-bearer after his primary rivals quit the race. MacArthur survived his reelection campaign despite relentless efforts by Democrats to tie him to Trump.

In recent weeks, conservative and liberal activists squeezed MacArthur with attack ads in his district for his role in AHCA talks. But the conservative Club for Growth may help provide him some cover.

"We applaud the fact that Rep. MacArthur has negotiated with Rep. Meadows," said the group's spokesman, Doug Sachtleben.

MacArthur himself shrugs off the politics of his role.

“I am not thinking about this in political terms,” MacArthur said when asked whether his position made him vulnerable to a primary or general election challenge at a news conference earlier this month. “I am simply not going to evaluate the right thing to do based on whether people want to run ads against me.”