‘It’s an insane process’: How the health care bill failed

WASHINGTON – Vice President Mike Pence arrived at the National Governors Association summer meeting with one mission: to revive support for the flagging GOP plan to rewrite the nation's health-care laws.

He failed.

Instead of rousing cheers on the Providence, Rhode Island, waterfront, Pence was greeted with an icy air of skepticism Friday as he pitched the legislation, which would reduce federal Medicaid funding and phase out coverage in dozens of states.

By Monday evening, when President Donald Trump and Pence gathered a cluster of Republicans senators in the Blue Room of the White House over plates of lemon ricotta agnolotti and grilled ribeye, the measure was all but dead.

"The president talked about France and Bastille Day," Sen. Steve Daines, R-Mont., said in an interview on Tuesday, recalling the president's tales during dinner of parades and pomp from his recent trip to Paris.

[Murkowski says no to repealing Affordable Care Act without replacement]

Daines described the group's conversation, which also touched on issues ranging from health care to the debt limit, as loose – as if Trump "sat down and went out to dinner with friends, acquaintances, people you work with. It was just dinner to talk about what's going on."

As the dinner ended, reality returned. Two more Republican senators had suddenly bolted from supporting the health-care bill, lifting the total number of Republicans opposed to four and effectively killing it.

"I was very surprised when the two folks came out last night," Trump told reporters Tuesday. "We thought they were in fairly good shape."

Yet the dramatic collapse of the GOP proposal in the Senate was hardly a shock to most, especially those intimately involved in a venture that has been deeply troubled since the House passed its version in May.

The upheaval on Monday night was a tipping point after weeks of burbling discontent within the party about whether passing the legislation made sense. Nearly every GOP senator was eager to check the box of repealing and replacing the Affordable Care Act they had long opposed – but many were also distressed by the possible costs of upending a law that has grown deep roots in states, risen in popularity and is relied upon by some Republican governors.

Moderates were always skittish about the drastic Medicaid cuts opposed by many of their governors. Conservatives were always unhappy with the scope of the Senate's legislation, which they felt did not go far enough to gut the law.

And Trump was frequently disengaged, sporadically tweeting and making calls to on-the-fence senators but otherwise avoiding selling the bill at the kind of big rallies that he often holds on issues he champions.

"It has been obvious to me for some time, and likely obvious to the leaders, that up to 10 Republicans were uncomfortable with the bill and were thinking about voting against the motion to proceed," Sen. Susan Collins, R-Maine, a critic of the bill, said in an interview on Tuesday. "So it's surprising to me that after the administration failed to win over the governors this past weekend, there wasn't more of a recognition of the fact that the bill was probably in fatal trouble."

McConnell, who has long cultivated a reputation as a canny Senate operator, found it nearly impossible to wrangle together his conference amid the mounting concerns. He could offer them tweaks and adjustments but not the political cover that they coveted.

Neither could the White House, which kept tabs on GOP senators but did not drive the negotiations at all.

"None of us knew what the meeting was about last night. We just were invited to the White House," Daines said. "There was no topic given to us."

Still, a false sense of confidence from the White House and Senate GOP leadership came to define the entire process. Each day seemed to bring a wave of new assertions that Senate Republicans were committed to fulfilling what has been the party's signature pledge for nearly a decade – and then there would be new twists that threatened that ambition.

With Trump engulfed in the fallout from investigations of Russian interference in the 2016 campaign, Pence became the Trump administration's main advocate for the legislation. He went to Senate lunch after Senate lunch, and eventually to the governors' meeting.

But Pence, like the bill, never caught on.

[Republicans left scrambling after health bill sinks again]

While Pence has clout with conservatives nationally, he drew blank stares from those in front of him in Rhode Island – despite being a former Indiana governor himself. When he targeted Ohio Gov. John Kasich, R-Ohio, who opposed the bill, he sparked outrage for appearing to incorrectly link waiting times for disabled people in Ohio to the expansion of Medicaid.

Kasich was newly furious about the hardball tactics. Other influential GOP critics of the bill, such as Nevada Gov. Brian Sandoval, also would not budge, in turn keeping Sen. Dean Heller, R-Nev., almost certainly in the "no" camp.

"This is a dramatic change to what most of us have reacted to within the last four years," Sandoval told reporters over the weekend. He likened the health-care push to shaking an Etch-a-Sketch.

Connecticut Gov. Dan Malloy, D, who attended the governors' conference, summed up the Democratic view in a Tuesday interview: "If he's treating a Republican governor in Ohio that way, how would he treat me?"

Malloy singled out a private breakfast session Saturday, in which administration officials sought to win over governors on the Senate legislation, as particularly problematic for the White House's sale. He said one official sought to discredit the Congressional Budget Office; less than a minute later, another official cited a CBO statistic to defend his argument.

"It was heavy handed. It was ham-handed," Malloy said of the administration's efforts at the summit.

The CBO had been set to release another report as soon as Monday on what the bill would do to insurance coverage levels, premium costs and the federal budget deficit, but it ended up not being released. A CBO report on an earlier version of the legislation projected that it would result in 22 million fewer Americans with insurance by 2026 than under current law. It predicted that the measure would reduce the budget deficit by $321 billion over the same period.

Inside the West Wing, Pence and Trump advisers continued to operate as if passage was possible, in spite of the unsuccessful turn in Providence. When the dinner convened Monday, Pence was scheduled to have dinner at his residence later that week with undecided Republicans.

Despite the negative feedback, the White House believed the Providence meetings went as well as they could have expected considering that the governors were expected to be clamoring for more federal money than the bill would provide. Pence and Health and Human Services Secretary Tom Price – both former House members – teamed up on the call list, wooing Sunday and Monday by phone.

Among the members who were being monitored closely by Pence was Sen. Mike Lee, R-Utah, according to a person familiar with the negotiations. In multiple discussions with Pence, Lee indicated that he had reservations but was not a firm "no" and was open to further talks.

But it was Lee and Sen. Jerry Moran, R-Kan., who ended up announcing their opposition on Monday night as Pence and Trump dined with other lawmakers at the White House – a final, vivid reminder of how the rosy view among many senior Republicans rarely if ever tracked with the actual state of play.

Lee and Moran made it four Republican "no" votes. They joined Sen. Rand Paul , Ky., and Collins, who had declared their opposition days earlier. With a 52-seat majority, Republicans could afford to lose only two votes to pass the bill since all 46 Democrats and two independents were expected to vote against the proposal, with Pence as the potential tiebreaker.

One sign that the White House and McConnell didn't see it coming: the senators who were in the Blue Room on Monday night. They were not holdouts but mostly heavyweights of the Republican leadership: Sens. John Cornyn, Texas, Lamar Alexander, Tenn., and Roy Blunt, Mo., among others.

Trump, impatient with the Senate's glacial pace, asked for a candid assessment of the legislation's status from the veteran lawmakers, according to officials familiar with the meeting. He implored them to hurry up and get the bill to his desk. But it was Paris and the flag-waving festivities he had witnessed alongside French President Emmanuel Macron on Thursday and Friday that occupied much of his attention during the conversation, the officials said.

As difficult as the health-care debate had been, there was a pervasive feeling that McConnell would somehow prevail.

"I wouldn't put it on him," Sen. Marco Rubio, R-Fla., said on Tuesday about Trump. "The bottom line is there are members here who understood the president's preference and were willing to vote against it anyways."

Some Senate Republicans said McConnell's strategy of working an inside game and largely leaving Trump to observer-cheerleader status was misguided from the start. Sen. Ron Johnson, R-Wis., said the public should have been far more informed about the bill.

"We didn't have the courage to lay out exactly what caused premiums to increase," Johnson said. "We don't even have the (CBO) score on this latest version. It's an insane process. If you don't have information how can you even have a legitimate discussion and debate?"

Tuesday only brought more tension. There was finger-pointing and faction-forming as Pence and White House chief of staff Reince Priebus worked to repair relationships with senators, many of whom saw the president and his team as perhaps well-intentioned but fumbling in their understanding of Congress.

When McConnell broached voting Wednesday on a bill that would simply repeal Obamacare during a Senate lunch, he was met with resistance, according to aides familiar with the meeting. McConnell had speakers lined up to support his plan but a number of senators, fuming over the Monday drama and other issues, asked for a pause rather than quick legislative action.

After the lunch, McConnell did not say when a health-care vote would happen, other than the "near future." By the end of the day, he said it would happen "early next week."