All the Pitfalls of the Latest Republican Health-Care Proposal

President Trump desperately wants a deal on health care, and he wants the House to pass it next week before his first 100 days in the White House are out.

That much is clear from the reports of a tentative agreement between the leader of the conservative House Freedom Caucus, Representative Mark Meadows of North Carolina, and a co-chairman of the moderate Tuesday Group, Representative Tom MacArthur of New Jersey, to break a stalemate over the GOP’s American Health Care Act.

What’s also clear, however, is that the House Republican leadership—the lawmakers that both call and count the votes in Congress—shares neither the optimism nor the urgency of the White House. Speaker Paul Ryan said after a speech in London on Wednesday that Republicans were putting “the finishing touches” on a new proposal, after the party stumbled badly last month on its initial attempt to repeal and replace the Affordable Care Act. But on Thursday, a senior GOP congressional aide dampened expectations for the bill, which a senior White House official told The Washington Post could receive a House vote as soon as the middle of next week.

“The question is whether it can get 216 votes in the House and the answer isn’t clear at this time,” the aide wrote me in an email. “There is no legislative text and therefore no agreement to do a whip count on.”

These mixed signals are the latest example of the yawning expectations gap between Trump and Ryan over what Congress can achieve on the vexing question of health care. Reluctant to acknowledge defeat, the president has repeatedly insisted over the last several weeks that an agreement is close at hand, that the differences separating the hardliners in the Freedom Caucus from the more pragmatic and electorally vulnerable moderates are bridgeable. “It’s evolving,” the president said Thursday during a press conference, in which he denied there was ever “a give-up” on the issue. (His top aides had told House Republicans that Trump would move on from health care if they didn’t pass the bill last month.) “The plan gets better and better and better, and it’s gotten really, really good, and a lot of people are liking it a lot,” Trump said. “We have a good chance of getting it soon.”

But while Ryan has made a public show of confidence, his office has been much more skeptical about the prospects for reviving the AHCA, having seen first-hand how narrow the path is for writing a policy that can win the votes of conservatives without sacrificing the support of Republicans closer to the political center. Conservative activists also sense that the speaker is fearful of being burned again on a bill for which he expended significant political capital and lost.

The basic dynamics haven’t changed: Members of the Freedom Caucus want to…

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