Tag Archives: Healthcare

Trump talks healthcare with Republican critic on golf course

Senator Rand Paul (R-KY) speaks to an aide after playing golf with U.S. President Donald Trump at the White House in Washington, U.S., April 2, 2017. REUTERS/Joshua Roberts

By Jan Pytalski

STERLING, Va. (Reuters) – President Donald Trump golfed with a vocal Republican critic of his healthcare push on Sunday, as he insisted efforts to repeal and replace President Barack Obama’s signature healthcare law were not dead.

Senator Rand Paul and Office of Management and Budget Director Mick Mulvaney joined the president at Trump National Golf Club outside of Washington. The trio was “discussing a variety of topics, including healthcare,” said White House Deputy Press Secretary Stephanie Grisham.

The outing came hours after Trump tweeted that talks to rework the nation’s healthcare law were still under way.

“Anybody (especially Fake News media) who thinks that Repeal & Replace of ObamaCare is dead does not know the love and strength in R Party!” Trump tweeted early on Sunday.

“Talk on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck,” he added in a second message.

Republican-led efforts to replace Obama’s healthcare law were thrown into disarray 10 days ago after Republican leaders in the House of Representative had to withdraw their own legislation ahead of a vote due to insufficient support from conservative and moderate members of their own party.

Trump had worked towards the bill’s passage, but Paul had been a prominent critic and had aligned himself with the conservative House Freedom Caucus, a group that helped torpedo Trump’s first major legislative effort.

On Thursday, Trump had threatened to defeat members of the group in next year’s congressional elections if they continued to defy him.

In an interview published on Sunday by the Financial Times, Trump was adamant he wanted to get a healthcare bill passed, and said he would turn his back on the Freedom Caucus and negotiate with Democrats if that is what it took.

“If we don’t get what we want, we will make a deal with the Democrats,” he said.

(Writing by Pete Schroeder; Editing by Mary Milliken and Andrea Ricci)

Ryan opposes Trump working with Democrats on healthcare

House Speaker Paul Ryan speaks during his news conference after Republicans pulled the American Health Care Act. REUTERS/Yuri Gripas

WASHINGTON (Reuters) – U.S. House of Representatives Speaker Paul Ryan, the top Republican in Congress, said he does not want President Donald Trump to work with Democrats on new legislation for revamping the country’s health insurance system, commonly called Obamacare.

In an interview with “CBS This Morning” that will air on Thursday, Ryan said he fears the Republican Party, which failed last week to come together and agree on a healthcare overhaul, is pushing the president to the other side of the aisle so he can make good on campaign promises to redo Obamacare.

“I don’t want that to happen,” Ryan said, referring to Trump’s offer to work with Democrats.

Carrying out those reforms with Democrats is “hardly a conservative thing,” Ryan said, according to interview excerpts released on Wednesday. “I don’t want government running health care. The government shouldn’t tell you what you must do with your life, with your healthcare,” he said.

On Tuesday, Trump told senators attending a White House reception that he expected lawmakers to reach a deal “very quickly” on healthcare, but he did not offer specifics.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

Trump said after the failure of the Republican plan last week that Democrats, none of whom supported the bill, would be willing to negotiate new healthcare legislation because Obamacare is destined to “explode.”

(Reporting by Lisa Lambert and Eric Beech; Editing by Leslie Adler)

Trump tells lawmakers he expects deal ‘very quickly’ on healthcare

U.S. President Donald Trump and First Lady Melania Trump host a reception for Senators and their spouses at the East Room of the White House in Washington, U.S., March 28, 2017. REUTERS/Carlos Barria

WASHINGTON (Reuters) – U.S. President Donald Trump told a group of senators on Tuesday that he expected lawmakers would be able to reach a deal on healthcare, without offering specifics on how they would do it or what had changed since a healthcare reform bill was pulled last week for insufficient support.

“I have no doubt that that’s going to happen very quickly,” Trump said at a bipartisan reception held for senators and their spouses at the White House.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

A Republican plan backed by Trump to overhaul the U.S. healthcare system was pulled on Friday after it failed to garner enough support to pass the Republican-controlled House of Representatives.

Trump, a Republican, did not mention that failure at the reception nor did he offer specifics on how he planned for lawmakers to reach a consensus on a healthcare bill that would repeal and replace the Affordable Care Act, familiarly known as Obamacare.

Trump told lawmakers at the reception that he would be talking about infrastructure and investing in the military, without offering a time frame or details.

“Hopefully, it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love,” he said.

(Reporting by Ayesha Rascoe; Editing by Leslie Adler, Toni Reinhold)

How Republicans can hobble Obamacare even without repeal

People march in a "Save Obamacare" rally in Los Angeles.

By Julie Steenhuysen

CHICAGO (Reuters) – Republicans may have failed to overthrow Obamacare this week, but there are plenty of ways they can chip away at it.

The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.

Earlier this week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.

The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.

The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law. Price’s power resides in how to interpret that law, and which programs to emphasize and fund.

Hospitals and physician groups have been counting on support from Medicare – the federal insurance program for the elderly and disabled – to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.

The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.

Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government’s blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.

Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.

Price “can’t change the legislation, but of course he’s supposed to implement it. He could impact it,” said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.

The move Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday “will soon explode.”

“It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.

“The ACA marketplaces weren’t collapsing, but they could be made to collapse through administrative actions,” he added.

NEW PAYMENT PLANS AT RISK

The United States spends $3 trillion a year on healthcare – more by far than 10 other wealthy countries – yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report.

Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient’s health improves.

“We have a completely broken economy in healthcare,” said Blair Childs, senior vice president at hospital purchasing group Premier Inc. “Literally, all of the incentives in fee-for-service are for higher cost.”

Alternative payment models are designed to remove incentives that reward overtreatment of patients. Private insurers are on board, with Aetna Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers announcing plans to shift half of their reimbursement to alternative payment models to control costs.

To promote the shift to alternative payments, the ACA created an incubator program at the Centers for Medicare Medicaid Services (CMS). The CMS innovation center is funded by $10 billion over 10 years to test payment schemes aimed at improving quality and cutting the cost of care.

The Obama administration’s decision to make some of these payment programs mandatory has drawn the ire of Price, a former U.S. senator and orthopedic surgeon. In response to a mandatory payment program for joint replacements last September, for example, Price charged that the CMS innovation center was “experimenting with Americans’ health.”

In his January 17 confirmation, Price said he was a “strong supporter of innovation,” but said he believed the CMS innovation center “has gotten a bit off track.”

TRUMP SETS WHEELS IN MOTION ON DAY 1

President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law.

The order directed departments to “waive, defer, grant exemptions from, or delay the implementation” of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.

David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.

“If he wants to blow it up, he can,” Cutler said in an email. But if they do, he added, “they alone will own the failure.”

(Editing by Edward Tobin)

House speaker tells Trump healthcare bill lacks votes: CNN

U.S. House Energy and Commerce Committee Chairman Representative Greg Walden (R-OR) (center L, at table) and Ways and Means Committee Chairman Representative Kevin Brady (R-TX) (center R, at table) testify at an early-morning Rules Committee hearing as Congress considers health care legislation to repeal Obamacare at the U.S. Capitol in Washington, U.S., March 24, 2017. REUTERS/Jonathan Ernst

By Richard Cowan and Dustin Volz

WASHINGTON (Reuters) – Republicans in Congress said they lacked the votes needed for passage of their U.S. healthcare system overhaul and a key committee chairman came out in opposition after Donald Trump demanded a vote on Friday in a gamble that could hobble his presidency.

Amid a chaotic scramble for votes, House of Representatives Speaker Paul Ryan, who has championed the bill, met with Trump at the White House. Ryan told the president there were not enough votes to pass the plan, U.S. media reported.

The showdown on the House floor follows Trump’s decision to cut off negotiations to shore up support inside his own party, with moderates and the most conservative lawmakers balking. On Thursday night he had issued an ultimatum that lawmakers pass the legislation that has his backing or keep in place the Obamacare law that Republicans have sought to dismantle since it was enacted seven years ago.

“We’ll see what happens,” Trump said at the White House, adding that Ryan should keep his job regardless of the outcome.

The White House said the vote was set for about 3:30 p.m. (1930 GMT) on Friday on the bill to replace Democratic former President Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act, widely known as Obamacare.

“There’s nobody that objectively can look at this effort and say the president didn’t do every single thing he possibly could with this team to get every vote possible,” White House spokesman Sean Spicer told reporters.

Republicans control Congress and the White House but have deep divisions over the first major legislative test since Trump became president on Jan. 20.

In a blow to the bill’s prospects, House Appropriations Committee Chairman Rodney Frelinghuysen announced his opposition, expressing concern about reductions in coverage under the Medicaid insurance program for the poor and the retraction of “essential” health benefits that insurers must cover.

“We need to get this right for all Americans,” Frelinghuysen said.

Representative Rodney Davis, a member of the House Republican team trying to win passage, said the bill was short of the needed votes, and White House budget director Mick Mulvaney added it was unclear if enough support was present.

Vice President Mike Pence, a former House member and influential among Republican lawmakers, postponed a planned trip to Arkansas and Tennessee to help secure passage.

“I’m still optimistic,” Spicer said. “I feel like we’re continuing to work hard. But at the end of the day you can’t force somebody to do something.”

Trump and House Republican leaders cannot afford to lose many votes in their own party because Democrats are unified in opposition, saying the bill would take away medical insurance from millions of Americans and leave the more-than-$3 trillion U.S. healthcare system in disarray.

Republican supporters said the plan would achieve their goal of rolling back the government’s “nanny state” role in healthcare.

FOREHEAD TATTOO

House Democratic leader Nancy Pelosi said, “What’s happening today is a lose-lose situation for the Republicans. It’s a lose-lose for the American people, that’s for sure. But the people who vote for this will have this vote tattooed to their foreheads as they go forward.”

Failure of the measure would call into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

“If it doesn’t pass, this issue is dead,” Republican Representative Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. “This is the one shot.”

Even if the legislation passes in the House, it faces an uncertain future in the Senate, where Republicans have expressed misgivings.

Healthcare was the first major test of how Trump, a real estate magnate who touted his deal-making prowess in the 2016 presidential campaign, would work with Congress. Days of negotiations led to some changes in the bill but failed to produce a consensus deal.

U.S. stocks were mixed on Friday in early afternoon trading, having pared earlier gains, while U.S. treasuries were mostly higher.

Leading Republicans had taken to the House floor to make their case to pass the bill and implored conservatives to seize the opportunity to make good on the party’s long promise to get rid of Obamacare.

‘ONLY OUR FIRST STEP’

“Today we are faced with a stark choice,” said Republican Diane Black, who heads the Budget Committee. “While no legislation is perfect, this bill does accomplish some important reforms.”

Black called the bill “only our first step.”

Trump added on Twitter, “This is finally your chance for a great plan!”

Democratic Representative Debbie Wasserman Schultz, a breast cancer survivor, called the bill “an immoral piece of legislation” that would gut medical coverage and patient protections.

A Quinnipiac University poll released on Thursday found 56 percent of U.S. voters opposed the House bill, with only 17 percent supporting it. Quinnipiac said its poll had a margin of error of plus or minus 3 percentage points.

Replacing Obama’s signature health care plan was a key campaign pledge for Trump and Republicans, who view it as overly intrusive and expensive.

Obamacare boosted the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The nonpartisan Congressional Budget Office said under the Republican legislation 14 million people would lose medical coverage by next year and more than 24 million would be uninsured in 2026.

The House plan would rescind a range of taxes created by Obamacare, end a penalty on people who refuse to obtain health insurance, end Obamacare’s income-based subsidies to help people buy insurance while creating less-generous age-based tax credits

It also would end Obamacare’s expansion of the Medicaid state-federal insurance program for the poor, cut future federal Medicaid funding and let states impose work requirements on some Medicaid recipients.

House leaders agreed to a series of last-minute changes to try to win over disgruntled conservatives, including ending the Obamacare requirement that insurers cover certain “essential benefits” such as maternity care, mental health services and prescription drug coverage.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans’ views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, Susan Cornwell, Jeff Mason, David Morgan, David Lawder, Amanda Becker, and Doina Chiacu; Writing by Will Dunham; Editing by Bernadette Baum and Bill Trott)

Obamacare supporters rally against congressional repeal efforts

Protesters demonstrate against U.S. President Donald Trump and his plans to end Obamacare as they march to the White House in Washington, U.S., March 23, 2017. REUTERS/Kevin Lamarque

By Ian Simpson

WASHINGTON (Reuters) – Supporters of Obamacare staged rallies across the country on Thursday denouncing efforts by President Donald Trump and Republican congressional leaders to repeal the landmark law that has extended medical insurance coverage to some 20 million Americans.

Hundreds of demonstrators turned out in Washington, Chicago and Los Angeles marking the seventh anniversary of enactment of Obamacare, as the Affordable Care Act (ACA) has become widely known.

Many talked about a very personal stake in the outcome of the healthcare debate roiling Capitol Hill.

“I feel sick today, but I came here because I’m terrified,” said Steve Martin, 27, an unemployed Los Angeles resident who was diagnosed with cancer a year ago. “The legislators have the best healthcare in the world, and we deserve the same.”

The ACA, considered former Democratic President Barack Obama’s premiere domestic achievement, has drawn unrelenting scorn from Republicans, with promises to repeal and replace it a centerpiece of Trump’s presidential campaign.

Thursday’s rallies coincided with planned action in the House of Representatives on a Republican-backed bill to begin dismantling Obamacare, but the vote was indefinitely postponed as Republican leaders and the White House scrambled to muster enough votes for passage.

Many moderate Republicans as well as Democrats have raised concerns that repeal-and-replace would leave too many Americans without health coverage.

Supporters of the bill say it would lower premiums, but critics counter that those savings would in many cases be more than offset by higher co-pays and other out-of-pocket costs.

Obamacare backers also worry about the fate of millions who gained insurance under the bill’s major expansion of Medicaid, the federal-state program providing coverage for the needy, the elderly and the disabled.

In the nation’s capital, several hundred chanting protesters gathered at Freedom Plaza, a few blocks from the White House, carrying signs with slogans such as “We Fight Back” and “Keep America Healthy.”

Robinette Barmer, 61, a former seamstress and caterer from Baltimore now on a disability pension, said that without Obamacare she could not afford the various medications she takes for ailments such as asthma and high blood pressure.

“It’s co-pay this, co-pay that. I can’t pay that. I’m struggling as it is right now,” she said.

After the rally, protesters marched a block to the Trump International Hotel on Pennsylvania Avenue, where several dozen sprawled on the sidewalk in a “die-in” symbolizing the effect of rolling back Obamacare. Some 24 protesters were arrested in front of the White House after they refused get off the ground, organizers said.

Protest organizers said smaller gatherings were also held outside the congressional district offices of various Republican lawmakers around the country.

(Additional reporting by Olga Grigoryants in Los Angeles and Robert Chiarito in Chicago; Writing by Steve Gorman; Editing by Leslie Adler and Michael Perry)

Republicans scramble for health bill votes after Trump ultimatum

U.S. House Speaker Paul Ryan (R-WI) (C) walks to the House floor for the opening of a morning session as Congress considers health care legislation to repeal Obamacare at the U.S. Capitol in Washington, U.S., March 24, 2017. REUTERS/Jonathan Ernst

By Susan Cornwell and Richard Cowan

WASHINGTON (Reuters) – U.S. Republican lawmakers struggling to overcome differences over new healthcare legislation confronted a stark choice after President Donald Trump delivered an ultimatum: pass the bill on Friday or keep Obamacare in place.

Trump, a real estate magnate who touted his dealmaking prowess in the 2016 presidential campaign, faced the first major test of how well his skills would translate in Congress. Days of negotiations failed to produce a deal amid opposition from moderates and conservatives in his own Republican Party, and it was far from clear the bill had enough support to pass.

Financial markets, which have been buoyed by Trump’s plans to cut taxes and boost infrastructure spending, are watching closely. U.S. stock markets fell on Thursday as Republican leaders delayed a vote, and European stock markets opened lower on Friday, although the U.S. equity market looked set for a higher open.

The House of Representatives was set to vote late Friday afternoon on the Trump-backed bill to replace Democratic President Barack Obama’s 2010 Affordable Care Act.

“Lawmakers will have to be accountable as to why they didn’t vote to get rid of Obamacare when they had the chance, and that chance is today,” White House budget director Mick Mulvaney told CBS “This Morning.”

The House Rules Committee, which sets the duration of the debate on legislation and decides whether amendments will be allowed to be offered, was expected to formally send the Republican healthcare bill to the House floor on Friday morning.

Democrats uniformly oppose the bill, and it appeared to lack the needed Republican support as well, despite last-minute changes intended to broaden its appeal.

At least 35 Republicans still plan to vote against the bill, according to CBS News. If all House members were to vote, Republicans can only afford to lose 21 votes.

The American Health Care Act is the first foray into legislation for Trump, a New York businessman and reality television star who took office on Jan. 20.

The vote had been set for Thursday, the seventh anniversary of the signing of Obamacare. In an embarrassing setback, it was postponed because of tepid support.

By Thursday evening, Trump signaled he was done negotiating and demanded lawmakers back the bill, or face the consequences.

“The message is … it’s done tomorrow, or Obamacare stays,” said Representative Chris Collins of New York, a Trump ally.

KEY CAMPAIGN PLEDGE

Replacing Obama’s signature health care plan was a key campaign pledge for Trump and Republicans, who viewed it as overly intrusive and expensive.

Obamacare aimed to boost the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The House replacement plan would rescind taxes created by Obamacare, repeal a penalty against people who do not buy coverage, slash funding for the Medicaid program for the poor and disabled, and modify tax subsidies that help individuals buy plans.

Conservatives believe the Republican bill does not go far enough to repeal Obamacare and moderates think the plan could hurt their constituents.

House leaders agreed to four pages of last-minute amendments, including allowing states to choose which “essential benefits” are required in insurance plans, keeping a 0.9 percent surcharge on Medicare for high-income Americans for six years, and giving states more money for maternal health and mental health.

It was unclear whether that was enough to win over skeptics.

Trump has indicated an eagerness to move on to tax reform, trade deals and infrastructure, but a defeat in Congress will cast doubt on his ability to deliver.

If Republicans manage to ram the legislation through the House, it faces a tough fight in the Senate. It could draw opposition from moderate Senate Republicans who do not like the House measure’s new restrictions on federal funding for women’s healthcare provider Planned Parenthood.

Many senators, especially those who represent poor, rural states, worry that constituents who for the first time have health insurance because of Obamacare, will lose that coverage and not be able to afford the Republican replacement.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans’ views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, David Morgan, David Lawder, and Amanda Becker; Writing by Roberta Rampton and Doina Chiacu; Editing by Simon Cameron-Moore and Bernadette Baum)

Vote looming, Trump struggles to win Obamacare repeal

U.S. President Donald Trump walks from Marine One as he returns to the White House in Washington. REUTERS/Joshua Roberts

By Roberta Rampton and David Morgan

WASHINGTON (Reuters) – U.S. President Donald Trump on Thursday was set to make a final push on Thursday to secure the votes to begin dismantling Obamacare in the House of Representatives, with signs that enough Republicans might defect to jeopardize one of his top legislative priorities.

Trump has mounted an intensive campaign to garner support for the initiative and the effort is seen by financial markets as a crucial test of his ability to move his legislative agenda, including planned tax cuts, through Congress.

Republican leaders hoped to vote on Thursday but there were signs the deadline could be pushed back. Trump scheduled an 11:30 a.m. ET/1530 GMT meeting with members of the conservative House Freedom Caucus at the White House.

“We’re still open for negotiations,” Representative Ted Yoho, a member of the conservative group, told CNN. “There is still time.”

Democratic Representative Steny Hoyer said the majority Republicans clearly did not have enough votes to pass the bill, which has been championed by House Speaker Paul Ryan.

Trump and Ryan need strong support from their side of the aisle and can only afford to lose 21 Republican votes.

As part of his effort, Trump urged Americans in a tweet early on Thursday to press their representatives to vote for the bill, known formally as the American Health Care Act.

Uncertainty over the bill has rattled financial markets and a failure just two months into Trump’s presidency would be a setback for the White House, which as late as Wednesday had cautioned there was “no Plan B” for the healthcare measure.

Stocks on Tuesday posted their biggest one-day drop since the Nov. 8 presidential election on concerns about the healthcare drama.

Failure to pass the legislation would cast doubt on Trump’s ability to deliver other parts of his agenda that need the cooperation of the Republican-controlled Congress, including ambitious plans to overhaul the tax code and invest in infrastructure.

The House vote had been expected by about 7 p.m. (2300 GMT). But by midnight on Wednesday, lawmakers had not yet settled on the timing of the vote as conservative and moderate Republicans split on whether there should be additional changes to the proposal.

House Rules Committee Chairman Pete Sessions said the vote could happen as early as Thursday or as late as Monday.

Democratic representatives are united against the bill, which seeks to repeal and replace Democratic President Barack Obama’s 2010 Affordable Care Act.

Conservative Republicans have complained the replacement is too similar to Obamacare, and some moderate Republicans are concerned it will weaken health coverage for millions of voters.

An aide to the Freedom Caucus said at one point on Wednesday that more than 25 of its members opposed the plan. The chairman of the group, Representative Mark Meadows, said negotiations late on Wednesday were making headway.

Moderate Republicans huddled late into the evening in Ryan’s office. Afterward, Representative Charlie Dent issued a statement saying he could not back the bill.

Trump and fellow Republicans campaigned during 2016 elections on a promise to repeal and replace Obamacare, a program that aimed to boost the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies.

Their replacement plan would rescind the taxes created by Obamacare, repeal a penalty against people who do not buy coverage, slash funding for the Medicaid program for the poor and disabled, and modify tax subsidies that help individuals buy plans.

The nonpartisan Congressional Budget Office estimated 14 million people would lose medical coverage under the Republican plan by next year. It also said that 24 million fewer people would be insured by 2026.

Even if the legislation passes the House, it faces a second hurdle in the Senate, where a number of Republicans have spoken out against that version.

(Additional reporting by Susan Cornwell and Jeff Mason; Editing by Michael Perry and Bill Trott)

Trump warns Republican lawmakers of backlash for healthcare failure

U.S. President Donald Trump (C) and Health and Human Services Secretary Tom Price (L) enter the U.S. Capitol in Washington, U.S., March 21, 2017. REUTERS/Kevin Lamarque

By Susan Cornwell

WASHINGTON (Reuters) – U.S. President Donald Trump warned Republican lawmakers on Tuesday that voters could punish them if they do not approve a plan he favors to dismantle Obamacare, as pressure grew on the businessman-turned-politician to win the first major legislative battle of his presidency.

In one of the few visits he has made to the U.S. Capitol since taking office, Trump told fellow Republicans in the House of Representatives they would face “political problems” for opposing the bill that takes apart Obamacare and partially replaces it.

“The president was really clear: he laid it on the line for everybody,” House Speaker Paul Ryan, the leading proponent of the bill, told reporters. “We made a promise. Now is our time to keep that promise … If we don’t keep our promise, it will be very hard to manage this.”

While Republicans control both chambers of Congress, the party’s leaders face a difficult task in uniting their members behind the healthcare bill, just the first of a series of reforms that Trump has promised including overhauls of the tax system and business regulations.

U.S. stocks turned sharply lower on Tuesday, led by a fall in financial shares, as investors began to question how quickly the Trump administration can implement pro-growth policies.

Sectors that could benefit from policies of lower taxes and fiscal stimulus were weaker as investors perceived those plans may take longer to implement if the Trump administration has to expend more time and energy to get a healthcare plan passed.

Some conservatives believe the healthcare bill does not go far enough, while moderate Republicans worry it goes too far and that millions of Americans will be hurt by dismantling the 2010 Affordable Care Act, former President Barack Obama’s signature healthcare legislation.

Party leaders hope to move the bill to the House floor for debate as early as Thursday. But the administration and House leadership can afford to lose only about 20 votes from Republican ranks or risk the bill failing since Democrats are united against it.

Repealing and replacing Obamacare was one of Trump’s main campaign promises and has been a goal of Republicans since it was enacted. Trump, who took office two months ago, has yet to push any major legislation through Congress.

Republican Representative Walter Jones said Trump told lawmakers in a closed-door meeting that if the Republican bill does not pass, they would face “political problems.” Jones said he thought Trump meant lawmakers could lose their seats.

While Trump predicted that Republicans could face challenges in primary contests ahead of the 2018 midterm elections if they do not gut Obamacare, there is also danger to them in doing so. Millions of voters might lose their healthcare coverage if the Republican bill is passed.

The Congressional Budget Office said last week that 14 million people would lose coverage under the House bill over the next year, although that number could change based on the most current version of the legislation.

CRITICS REMAIN

Republican leaders recrafted the bill on Monday to satisfy critics, mainly fellow Republicans, in part by proposing major changes to tax credits and provisions to alter the Medicaid publicly funded insurance program for low-income people.

Representative Bill Flores said Trump singled out one critic on the right flank of the party, Mark Meadows, chairman of the conservative House Freedom Caucus, during his Capitol Hill visit, saying Meadows would eventually come around to vote for the bill.

“Mark Meadows, he called out two or three times,” Flores told reporters. “The reaction, when he said, ‘Mark Meadows, I’m coming after you’, was pretty loud cheers … I think he was tongue-in-cheek, half joking.”

Despite Monday’s changes, the Wall Street Journal reported the House Freedom Caucus has enough votes to block the bill.

Trump, who has not offered Obamacare repeal legislation of his own, did not talk “a whole lot about the healthcare bill except to vote for it,” Jones said.

The Club for Growth, an influential conservative lobby group, said it would spend at least $500,000 for ads on television and digital platforms urging members of Congress to defeat the bill.

The Senate will also vote on the legislation and more changes could still be made.

At a rally in Kentucky on Monday night, Trump said he wanted to add a provision to the bill to lower prescription drug costs through a competitive bidding process. There was no such provision in Monday’s changes.

Republican chairmen for two key committees said late Monday they proposed more funding for tax credits, which conservatives have opposed, that would give the Senate flexibility to help older people afford health insurance. Additionally, Obamacare’s taxes would be eliminated in 2017 instead of 2018.

Monday’s amendments also addressed Medicaid, which is the country’s largest health insurance program and covers about 70 million people, mostly the poor. The changes would allow states to implement work requirements for certain adults and to decide how they receive federal funds.

The nonpartisan Congressional Budget Office, which said last week the original bill would cause 24 million people to lose coverage over the next decade, is expected to update its analysis of the legislation to include the proposed changes.

Democrats oppose Republicans’ plan, saying it would throw millions off health insurance and hurt the elderly, poor, and working families while giving tax cuts to the wealthy.

(Additional reporting by Jeff Mason Susan Heavey, Yasmeen Abutaleb and Richard Cowan; Writing by Alistair Bell; Editing by Bill Trott and Frances Kerry)

Wall Street sinks on fears of delays to Trump tax cuts

Traders work on the floor of the New York Stock Exchange (NYSE) shortly after the opening bell in New York, U.S., March 21, 2017. REUTERS/Lucas Jackson

By Noel Randewich

(Reuters) – Wall Street fell sharply on Tuesday as investors worried that President Donald Trump will struggle to deliver promised tax cuts that propelled the market to record highs in recent months, with nervousness deepening ahead of a key healthcare vote.

The S&P 500 and Dow Jones Industrial Average lost over 1 percent in their worst one-day performances since before Trump’s election victory in November.

The S&P financial index <.SPSY> sank 2.87 percent, its biggest daily fall since June. That added to losses in the sector since the Federal Reserve last week raised interest rates by 25 basis points and signaled it would remain on a gradual pace of hikes, a less aggressive stance than some investors expected.

Banks benefit from higher interest rates and their stocks are sensitive to changes in expectations of how quickly the Fed will adjust rates. Bank of America <BAC.N> slumped 5.77 percent, the biggest drag on the S&P 500, while a 3.72-percent drop in Goldman Sachs <GS.N> pulled the Dow lower.

“There was a feeling the Fed was going to possibly be more hawkish last week. That didn’t happen,” said Mark Kepner, managing director at Themis Trading in Chatham, New Jersey. “That takes a little out of the higher rates that the banks want.”

Republican party leaders aim to move controversial healthcare legislation to the House floor for debate as early as Thursday. But they can only afford to lose about 20 votes from Republican ranks, or risk the bill failing, since minority Democrats are united against it.

With valuations stretched, investors see the Trump administration’s struggles to push through the healthcare overhaul as a sign he may also face setbacks delivering promised corporate tax cuts. Expectations of those tax cuts are a major reason for the 10-percent surge in the S&P 500 since Trump’s election.

“The market is starting to get a little fed up with the lack of progress in healthcare because everything else is being put on the back burner,” said RJ Grant, head of trading at Keefe, Bruyette & Woods in New York.

The Russell 2000 <.RUT> index of smallcap stocks fell 2.71 percent, its worst day since September.

The financial sector has been the best performing of the 11 major S&P sectors since Trump’s election, surging 18 percent on his proposals to cut bank regulations and reduce taxes.

The Dow Jones Industrial Average <.DJI> dropped 1.14 percent to end at 20,668.01 points, while the S&P 500 <.SPX> lost 1.24 percent to 2,344.02.

The Nasdaq Composite <.IXIC> fell 1.83 percent to 5,793.83.

The CBOE Volatility index <.VIX>, Wall Street’s “fear gauge”, jumped 10 percent.

Under Trump, Wall Street has become unaccustomed to steep selloffs. The last time the S&P 500 lost 1 percent or more in a day was 110 trading sessions ago on October 11. Over the past two years, the S&P 500 has suffered losses of 1-percent or more about once every 11 sessions, according to Thomson Reuters data.

But investors have grown worried about elevated valuations. The S&P 500 is trading at about 18 times forward earnings estimates against the long-term average of 15, according to Thomson Reuters data.

Shares of FedEx Corp <FDX.N> dropped 3 percent in extended trade after the delivery company’s quarterly report disappointed investors.

Declining issues outnumbered advancing ones on the NYSE by a 3.92-to-1 ratio; on Nasdaq, a 5.25-to-1 ratio favored decliners.

The S&P 500 posted 27 new 52-week highs and 7 new lows; the Nasdaq Composite recorded 78 new highs and 79 new lows.

About 8.3 billion shares changed hands in U.S. exchanges, compared with the 7.1 billion daily average over the last 20 sessions.

(Additional reporting by Chuck Mikolajczak and Sinead Carew in New York, editing by Nick Zieminski)