Republicans are looking to President Trump to use his address to Congress Tuesday evening to define the party's path forward on how to deliver on the long-promised pledge to repeal and replace Obamacare.
The White House has, so far, ceded the decision-making to congressional leaders who are trying to unify competing moderate and conservative lawmaker demands behind a plan that can pass with narrow majorities in both chambers.
The only legislative proposal on the table at the moment is being crafted by House Republicans and guided by House Speaker Paul Ryan. Senate Republicans have not authored a plan, nor has the White House publicly outlined much in the way of policy specifics.
White House aides who briefed reporters on Monday evening would not say how specific the president would be about health care in his address. They said the speech is being crafted with input from listening sessions the president has held, including on that issue. On Monday, Trump met with health insurance executives, and the president held his latest of several meetings with top congressional leaders.
A GOP proposal that's still coming together on Capitol Hill would end the Medicaid expansion enacted in 31 states and eliminate the individual mandate, as well as other taxes created by the Affordable Care Act. It would replace the mandate with a tax credit to encourage individuals to buy insurance instead. It would also allow higher contributions to health savings accounts, but it would eliminate minimum coverage standards established by the Obama administration and let states decide what services must be covered by insurance.
"There are serious problems with what appears to be our current path to repeal and replace Obamacare," Rep. Mark Walker, R-N.C., said in a statement in regards to the draft proposal. Walker chairs a bloc of influential conservatives in the House, and he said he could not "in good conscience" recommend any conservative vote for it in its current form. One of Walker's complaints is the proposal does not do enough to contain costs.
However, Health and Human Services Secretary Tom Price has privately told congressional Republicans that the White House is fully on board with the emerging proposal.
White House spokesman Sean Spicer told reporters Monday that Trump will speak to health care and his "patient-centered alternative" in his Tuesday address. Spicer said the White House wants to see a legislative proposal "within a matter of weeks."
Ryan and Senate Majority Leader Mitch McConnell, R-Ky., also huddled with Trump at the White House on Monday. The speaker has maintained that the House will act on Obamacare repeal-and-replace legislation in March. "We're going to be rolling out our plan very soon," Ryan pledged.
A focal point of Tuesday's address will be just how far the president goes in embracing the emerging House GOP plan. Trump and his senior aides have at times made promises about the overhaul that Congress is unlikely to keep--such as a pledge to cover more people, with better coverage and at a cheaper cost.
Trump spoke candidly about the complexities of U.S. health care policy on Monday in remarks at a meeting with the nation's governors. "It's an unbelievably complex subject. Nobody knew that health care could be so complicated," Trump said.
One governor who does understand the complexity is Ohio GOP Gov. John Kasich, who is lobbying Trump to keep the Medicaid expansion in place. Kasich's efforts underscore the many divides within the GOP over the best policy solution that comes with the least amount of political risk.
Dozens of Republicans lawmakers have in recent weeks faced large, angry crowds at town hall meetings largely driven by concerns about how the repeal-and-replace effort would affect coverage. It's unclear still how this public pushback could affect GOP strategy.
Democrats are unanimous in opposition to GOP repeal-and-replace efforts. In a Monday "prebuttal" to Trump's address, Senate Minority Leader Chuck Schumer noted the GOP's failure to coalesce around a single plan or pick up any Democratic support.
"I predict the discord in their party will grow as Republicans return to Washington after a week of angry town halls," said Schumer, who added another prediction: "I believe the odds are very high that we'll keep the ACA. It will not be repealed."
Obamacare has provided coverage to about 20 million Americans. About 6% of Americans receive insurance on the individual market. The vast majority of Americans are covered by insurance provided by their employer.
AUDIE CORNISH, HOST:
President Trump heads to Capitol Hill tonight for his first address to a joint session of Congress. Republican lawmakers want Trump to sign a number of big items into law this year, including bills on health care and taxes. And tonight, they'll be listening for cues from the president about how to tackle those issues. Joining us from the Capitol is NPR congressional correspondent Susan Davis. And, Sue, what have Republican lawmakers told you so far about what they want to hear from the president tonight?
SUSAN DAVIS, BYLINE: You know, I've talked to lawmakers all day, and the one heard - one word I've heard repeatedly from them is optimism. They want to hear a president who has a positive message, an upbeat message. And what they don't want to hear is sort of a rehashing of the election or a criticism of his political opponents. The other word I hear a lot is specifics. They want to hear President Trump articulate his vision, not just on what he wants Congress to accomplish this year but what is the grander vision for the country, and that this is often the time and place to do that in this joint address.
The president, I think, is fair to say has been fairly flexible about his policy ideas. And I think there is a real hunger to hear from him to put maybe a finer point on some of those policies, specifically on health care, and to make his case to the public for those Republican ideas.
CORNISH: Right. On health care, I can imagine that they want more detail when it comes to their plans to repeal and replace the Affordable Care Act because, at this point, are they on track?
DAVIS: Right. You know, as recently as this morning, House Speaker Paul Ryan told reporters that he's very optimistic that they'll be able to get it done, that it's on track and that the public could see a bill very soon in a matter of weeks. But, you know, there's very significant and growing division among Republicans that can't be ignored. There is a group of influential conservatives in the House known as the Freedom Caucus and a trio of Republican senators - very well-known names like Rand Paul of Kentucky and Ted Cruz of Texas - who have already come out against early ideas for how to repeal and replace, saying they will not vote for it because it's not conservative enough, which means as of right now, as we sit here before this address, Republicans do not have the votes to pass anything on health care.
And they're going to need a significant amount of presidential leadership to try and get something done. The White House has been kind of coy about how specific the president's going to get tonight about health care. But I would say at least from this end of Pennsylvania Avenue, there is a significant amount of interest from Republicans to hear it from the president directly on what they're going to do on health care.
CORNISH: What are the other issues that came up that they're hoping the president might spend some time on?
DAVIS: The two things I hear most mentioned by lawmakers going into the address are the tax - reforming the tax code and immigration. There are - is a significant effort, I'd say - but it's probably the other major priority of this Congress - to overhaul the tax code, both on the business side and the individual side. But again, like health care, it's one of those issues where they don't have a majority support for any one idea. And there's not a lot of consensus on the path forward. Now, senior White House aides, including Jared Kushner and Steve Bannon, have been meeting regularly with congressional staff and in the speaker's office on this very topic.
So that would suggest there is some at least emerging consensus at the top of what the direction is they want to go in. We'll see tonight - anything the president says on tax reform, it will be very eager to hear - lawmakers very eager to hear that. And the president's also expected to make a request soon for millions of dollars to start building that - the border wall on the U.S.-Mexico border. I talked to Republicans who say they'd like to hear a little bit more robust immigration policy outlined tonight.
CORNISH: Now, when it came to the inauguration, you had Democrats who didn't want to show up. Do we have any sense of what they might do tonight?
DAVIS: There's always a good amount of theater around these events. I would say that Democrats are inviting guests to make a political point, people that they say have been marginalized by the Trump administration, including Muslims and immigrants. And there's a couple of lawmakers who are well-known to maybe hug the aisles to always try and get a meet and greet and a handshake with the president, people like Eliot Engel of New York. But they have announced tonight that they are not going to do that in past years and they are making a point tonight to not shake the president's hand. So at least half the room tonight is going to be fairly hostile to what the message the president has to say.
CORNISH: That's NPR's Susan Davis at the Capitol. Sue, thanks so much.
DAVIS: Thanks, Audie. Transcript provided by NPR, Copyright NPR.