Republican leaders worked frantically Wednesday to salvage their healthcare overhaul, warning naysayers in the party to join or risk being blamed for breaking the GOP's promise to repeal and replace Obamacare.
House Speaker Paul D. Ryan (R-Wis.) insisted that President Trump was on their side and he sharpened his tone to push reluctant Republicans to embrace "what we've all been dreaming about," rather than doom the bill over their differences.
Ryan said he had "no doubt" the bill would pass, brushing off discontent from opponents as the "inevitable growing pains" of tackling a difficult policy now that Republicans control the White House as well as Congress.
"This is the choice we face: Are we going to stay with Obamacare and ride out the status quo?" Ryan said. "Or are we going to do what we said we'd do? Are we going to repeal and replace Obamacare with something better?"
Ryan and Senate Majority Leader Mitch McConnell (R-Ky.) are trying to build momentum to fast-track the legislation past a groundswell of opposition from Democrats, small-government conservatives, moderate Republicans and healthcare groups who have created an unlikely coalition against it.
The question now is whether Trump will put the power of the White House behind the bill, the American Health Care Act.
Republicans are counting on Trump to begin strong-arming lawmakers. The president is expected to personally call resistant Republicans; he has already invited some lawmakers to the White House. On Wednesday, he had dinner with one of the bill's staunch critics, Sen. Ted Cruz (R-Texas), and his wife.
Trump singled out another critic, Sen. Rand Paul (R-Ky.), on Twitter, saying he was "sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!"
"President Trump is very confident about the passage," Trump advisor Kellyanne Conway said on Fox News, echoing the with-us-or-against-us tone adopted by GOP leaders.
"At some level, there is going to be a binary choice," she said. "You are either making good on the promise to repeal and replace Obamacare or you're not."
Implicit in such comments are fears that lawmakers could face the wrath of the White House or worse — efforts to unseat them at the next election.
So far, though, conservative Republicans do not appear moved by the White House outreach and have been emboldened by outside groups, including the Koch network's Americans for Prosperity, that are pouring money into ad campaigns against the bill.
Conservatives have formed an indirect alliance with moderate Republicans, and they predict Trump will abandon the legislation once he understands their concerns.
"I don't think he wants to own this bill," said Rep. Dave Brat (R-Va.), a member of the conservative Freedom Caucus. "This bill's not going to pass."
Opponents want to make changes to the bill, but substantive amendments seem unlikely under the condensed schedule and strict procedural rules that will allow the legislation to be approved in the House and Senate with a simple majority vote.
In fact, two House committees were on track to approve the legislation after grueling daylong hearings on Wednesday.
Votes on the amendments fell along party lines in both hearings — one at the Energy and Commerce Committee and one at the Ways and Means Committee. Nearly all of the amendments were offered by Democrats, as Republicans stuck together to block them.
Democrats have shown almost no interest in helping Republicans pass the bill, arguing that it will dump millions of Americans off their health insurance plan and shift costs to consumers and states.
The hearings got off to a contentious start as Democratic lawmakers complained Republicans were rushing the process and sought delays to allow more time to review the legislation.
"What's the rush?" asked Frank Pallone Jr. (D-N.J.), as Energy and Commerce Committee Democrats scheduled more than 100 amendments and demanded that the bill be read out loud, a traditional delaying tactic.
At the Ways and Means Committee, which handles tax policy, Democrats demanded a review of Trump's tax returns to see whether his business interests would benefit from the bill's repeal of various Obamacare taxes, including one on tanning salons.
Democrats took particular aim at a provision in the bill that will lift the $500,000 deduction cap on insurance executive pay to $1 million, calling it a Robin Hood-like move that will transfer revenues that the federal government had been using to provide healthcare to the needy and send it back to corporations.
Rep. Sander M. Levin (D-Mich.) called it a "giveaway to insurance executives."
Opponents also noted that the legislation was moving without an independent analysis from the Congressional Budget Office, which is evaluating how much it will cost and how many Americans may gain or lose coverage under the plan.
Meanwhile, many conservative Republicans complained the bill preserves too many features of Obamacare, including a modified version of the subsidies that currently help 8 million low- and moderate-income Americans buy health coverage.
And while the Republican-friendly U.S. Chamber of Commerce backed the bill, a growing number of leading healthcare groups representing patients, physicians and hospitals have come out against the House plan, citing concerns that the legislation's outline for scaling back subsidies and dramatically cutting Medicaid would leave millions of vulnerable Americans without health insurance. The powerful seniors lobby AARP also came out against the bill.
"We ask Congress to protect our patients, and find ways to maintain coverage for as many Americans as possible," American Hospital Assn. President Richard Pollack said in a letter to House Republicans.
The Affordable Care Act, as Obamacare is formally known, has extended coverage to more than 20 million previously uninsured people and driven the nation's uninsured rate to the lowest levels ever recorded. For years, Republicans have promised to dismantle the law, and leaders expect to pass the bill through Congress by the spring recess in April.
Their bill would revamp the Affordable Care Act, replacing the current subsidies with age-based tax credits of $2,000 to $4,000 a year.
Under the current system, the subsidies would be linked to consumers' income and the price of health plans. That offers the most protection to low-income people who live in regions of the country with very expensive health insurance.
But the new subsidies would be scaled back for many consumers, particularly lower-income, older residents who face high premiums. They would phase out slowly for wealthier Americans making more than $75,000 a year and couples making more than $150,000 a year.
It would also phase out federal funds for Medicaid, which was expanded in some states under Obamacare to provide insurance for more Americans. Under the House bill, that money would be capped.
The bill keeps a coverage guarantee that prohibits insurers from turning away sick people, but patients can be charged more if they have gaps in insurance coverage.
3:55 p.m.: This article has been updated with a Twitter post from President Trump and reaction from AARP.
3:10 p.m.: This article was updated with more background and reaction.
8:25 a.m.: This article was updated with comments from House Speaker Paul D. Ryan and Rep. Lloyd Doggett.