House will vote on health-care bill today

WASHINGTON -- The House will vote today on GOP legislation to repeal and replace Barack Obama's Affordable Care Act, as Republicans finally aim to deliver on seven years of campaign promises that helped them gain control of Congress and the White House.

But the move announced late Wednesday by GOP leaders also carries extreme political risk, as House Republicans prepare to endorse a bill that boots millions off the insurance rolls and may not survive the Senate.

"We will pass this bill," House Majority Leader Kevin McCarthy, R-Calif., confidently predicted after a day of wrangling votes and personal arm-twisting by President Donald Trump.

Pressed by reporters as he exited a meeting in Speaker Paul Ryan's office, McCarthy protested: "We're gonna pass it! We're gonna pass it! Let's be optimistic about life!"

After an earlier defeat when Republican leaders were forced to pull the bill for lack of votes, the decision to move forward indicated confidence on the part of GOP leaders. Failure would be catastrophic. But a successful outcome would make good on the GOP's No. 1 goal of undoing Obama's signature legislative achievement and provide a long-sought win for Trump, who has been in office more than 100 days without a significant congressional victory, save Senate confirmation of a Supreme Court justice.

The White House had pushed House leaders to act, and Trump got heavily involved in recent days, working the phones and agreeing to changes earlier Wednesday that brought two pivotal Republicans back on board.

Reps. Fred Upton of Michigan and Billy Long of Missouri emerged from a White House meeting with Trump, saying they now could support the bill, thanks to the addition of $8 billion over five years to help people with pre-existing conditions.

"'We need you, we need you, we need you,"' Long described as the message from a president eager for a victory.

Democrats stood united against the health bill.

The latest iteration of the GOP health-care bill would let states escape a requirement under Obama's law that insurers charge healthy and seriously ill customers the same rates.

Overall, the legislation would cut the Medicaid program for the poor, eliminate fines for people who don't buy insurance and provide skimpier subsidies.

The American Medical Association, AARP and other consumer and medical groups are opposed. The AMA issued a statement saying the changes sought by Upton and Long "tinker at the edges without remedying the fundamental failing of the bill -- that millions of Americans will lose their health insurance as a direct result."

If the GOP bill became law, congressional analysts estimate 24 million more Americans would be uninsured by 2026, including 14 million by next year.

When the health bill does come to a vote today, it will be without an updated analysis from the nonpartisan Congressional Budget Office about its cost and effect, a point Democrats complained about bitterly.

"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan," said House Minority Leader Nancy Pelosi, D-Calif. "But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable."

Even with Upton and Long in the "yes" column, GOP leaders had spent the day hunting for votes among wary moderates. More than a dozen opponents -- including Kentucky's Tom Massie, New Jersey's Chris Smith and Leonard Lance and Pennsylvania's Patrick Meehan -- said they still were "no" despite the changes. GOP leaders can lose only 22 from their ranks and still pass the bill, and an Associated Press tally found 19 opposed.

That suggests today's margin could be razor-thin, much like when "Obamacare" itself cleared the House in 2010 on a party-line vote of 219-212. The GOP has been trying ever since to repeal the law even as about 20 million Americans gained coverage under it. Today, Republicans might succeed for the first time in passing a repeal bill that may have a chance of getting signed into law.

As they have throughout the debate, Republicans argued Obama's health law is collapsing under its own weight, and they must intervene to save it. They argue their plan will provide consumers with lower premiums and more choices, removing the unpopular mandates that require most Americans to carry insurance or face fines. Several Republican lawmakers pointed to news out of Iowa this week the last carrier of individual health insurance policies in most of the state might stop offering them to residents.

"That's why we have to make sure this passes, to save those people from Obamacare that continues to collapse," McCarthy said.