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Four Reasons the Health Care Bill Might Pass — and 7 Reasons It Might Not

First Read is a morning briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter
Image: Large Storm System From Midwest Makes Its Way East
WASHINGTON, DC - JUNE 13: Storm clouds fill the sky over the U.S. Capitol BuildingMark Wilson / Getty Images file

First Read is a morning briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter

Four reasons why the House bill could pass (and seven reasons why it still might not)

It’s Judgment Day on the House legislation to repeal and replace the Affordable Care Act. And while prospects for passage looked grim as of Wednesday afternoon — with both GOP conservatives and moderates lining up against the bill — a potential breakthrough to placate opposed conservatives emerged by including the elimination of Essential Health Benefits (more on those below). And that could be enough to get the necessary 215 votes to pass the legislation, though it could also complicate matters for Senate Republicans. So how will it all turn out? It’s anyone’s guess, but here are four reasons why the bill will pass — and seven reasons why it might still not.


  1. Last best chance to repeal/replace Obamacare: If Republicans don’t get this done, they will fail on a key promise to their voters.
  2. A sizable majority: House Republicans currently enjoy a 237-193 majority, and so there’s margin for error. The magic number for passage is 215 votes (down from 216, because Democratic Rep. Bobby Rush’s wife died and he’ll be away from Capitol Hill). That means Republicans can afford 22 defections.
  3. Don’t underestimate the chances of a president who has A LOT to lose if this fails: It would be catastrophic for Trump’s first 100 days, and maybe even his entire presidency, if this vote fails — especially for someone billed as a winner/closer/great negotiator. Hence yesterday’s potential deal on Essential Health Services.
  4. Don’t underestimate the chances of a speaker who has A LOT to lose if this fails: This is Speaker Paul Ryan’s first big legislative test with Republicans in control of government. To lose a vote like this — when the GOP is charge — would be devastating. Hence yesterday’s potential deal on Essential Health Services


  1. Inability to govern: After being conditioned to saying “no” during the Obama years, too many Republicans are unable to get to “yes,” no matter how imperfect the legislation is.
  2. A divided party: The GOP remains fractured, which is illustrated by opposition to the House bill. One opponent is Ileana Ros-Lehtinen (R-FL), and Hillary Clinton carried her district by 20 points in 2016. Another GOP opponent is Rep. Louie Gohmert (R-TX), and Trump carried that district by 47 points. Others hail from districts that were decided by just a handful of points, like Leonard Lance of New Jersey and Brian Fitzpatrick of Pennsylvania.
  3. Flawed policy: The Congressional Budget Office’s numbers on the legislation are jaw-dropping: 14 million fewer Americans would have insurance by 2018, and 24 million fewer would have it over 10 years. What’s more, older and more rural residents (read Trump voters) get hit hard, while wealthy investors get big tax breaks.
  4. Broken promises: During the campaign and this legislative fight, Trump and his team promised: 1) “We’re going to have insurance for everybody”; 2) “I firmly believe that nobody will be worse off financially”; 3) “I’m not going to cut Medicare or Medicaid” -- but the CBO shows that the legislation breaks those promises.
  5. Didn’t learn Obamacare’s important lessons: In 2009-2010, Democrats got industry and major stakeholders to support their legislation; they went slow (the process took them a year); they reached out to the political opposition (Olympia Snowe voted for the Senate legislation out of committee); they united the party around the central tenets of the legislation; and most importantly, they held a supermajority in the Senate — or close to it. This current GOP legislative effort has followed none of these things.
  6. A GOP Senate that’s not all that enthusiastic about House bill: “I would say to my friends in the House of Representatives with whom I serve, ‘Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote,” Sen. Tom Cotton (R-AR) has said.
  7. Trump’s bad Monday: Confirmation of an FBI investigation into your campaign’s possible contacts with Russia and repudiation of your claim that Barack Obama wiretapped your phones didn’t help Trump win over wavering lawmakers.

NBC’s latest whip count: 29 House Republicans are against or leaning against the House GOP health-care bill

  • Rep. Jim Jordan (R-OH)
  • Rep. Mark Meadows (R-NC)
  • Rep. Justin Amash (R-MI)
  • Rep. Dave Brat (R-VA)
  • Rep. Raul Labrador (R-ID)
  • Rep. Mo Brooks (R-AL)
  • Rep. Rob Wittman (R-VA)
  • Rep. Thomas Massie (R-KY)
  • Rep. Tom Garrett (R-VA)
  • Rep. Ileana Ros-Lehtin (R-FL)
  • Rep. Leonard Lance (R-NJ)
  • Rep. Jim Bridenstine (R-OK)
  • Rep. Louie Gohmert (R-TX)
  • Rep. Mark Sanford (R-SC)
  • Rep. John Katko (R-NY)
  • Rep. Brian Fitzpatrick (R-PA)
  • Rep. Walter Jones (R-NC)
  • Rep. Ted Budd (R-NC)
  • Rep. Rick Crawford (R-AR)
  • Rep. Ted Yoho (R-FL)
  • Rep. Scott DesJarlais (R-TN)
  • Rep. Warren Davidson (R-OH)
  • Rep. Paul Gosar (R-AZ)
  • Rep. Rod Blum (R-IA)
  • Rep. Andy Harris (R-MD)
  • Rep. David Young (R-IA)
  • Rep. Frank LoBiondo (R-NJ)
  • Rep. Dan Donovan (R-NY)
  • Rep. Charlie Dent (R-PA)

Explaining the possible deal on Essential Health Benefits

And given that Republicans can afford just 22 defections, those 29 in opposition are enough to sink the deal. Which is why a deal emerged yesterday on including an elimination of Obamacare’s Essential Health Benefits: “The White House made a major concession to the Freedom Caucus on Wednesday night. It agreed to add a provision to the health care bill to eliminate an Obamacare mandate that forces insurance plans to provide a minimum menu of benefits. Ryan and other top Republicans had balked at making such a move, fearing it would derail the bill under the Senate’s arcane procedural rules,” Politico writes. “But with a possible defeat looming on Thursday, the White House went along. The concession showed how far Trump is willing to go to prevail, though problems remain with some moderate Republicans.”

Business Insider’s Josh Barro adds: “Without the EHB rules, insurers could, for example, sell some plans that cover maternity care and others that do not. Men would not buy maternity coverage, and many women would wait to buy maternity coverage until they thought they were likely to get pregnant. The problem is, if you choose to pay for something, insurers will assume you are highly likely to use it and price accordingly.” Not all conservative opponents are sold. “Repealing EHB, w/out making other substantial changes, would make the bill worse, not better. It would hurt the sickest people on exchanges,” Rep. Amash (R-MI) tweeted yesterday.

If there’s a deal, don’t be surprised if there’s a vote delay

The way to understand this possible deal on Essential Health Benefits is that there are more gettable votes from the right for Trump/Ryan. But while this deal might increase the chances for passage, it might not come today. After all, there’s no been no CBO score on any new changes. And, of course, there hasn’t been enough time to read any revised bill. Don’t be surprised if there’s a delay to get the rest of these conservatives on board.

Three new developments add fuel to the Trump-Russia storyline

Beyond today’s health-care drama, check out all of the new developments when it comes to Russia and Team Trump.

One, the top Democrat on the House Intelligence Committee, Rep. Adam Schiff (D-CA) said on MSNBC’s “MTP Daily” yesterday that he has seen "more than circumstantial evidence" that associates of President Donald Trump colluded with Russia… Two, CNN reported that the FBI “has information that indicates associates of President Donald Trump communicated with suspected Russian operatives to possibly coordinate the release of information damaging to Hillary Clinton's campaign.”… And three, the AP has this story: “U.S. Treasury Department agents have recently obtained information about offshore financial transactions involving President Donald Trump's former campaign chairman, Paul Manafort, as part of a federal anti-corruption probe into his work in Eastern Europe.” Drip, drip, drip.

Schiff: Nunes has to decide — is he leading an independent investigation, or is he a White House surrogate?

The other big story from yesterday: “House Intelligence Committee Chairman Devin Nunes … has risked undermining the credibility of the panel's investigation of Russian interference of the 2016 election by sharing new information with the White House, his Democratic counterpart said Wednesday,” per the LA Times.

“By briefing the public and then President Trump about intercepted communications involving members of the transition team, but not other members of the committee involved in the investigation, Nunes cast ‘quite a profound cloud over our ability to do our work,’ Rep. Adam B. Schiff … told reporters. ‘The chairman will either need to decide if he's leading an investigation into conduct which includes allegations of potential coordination between the Trump campaign and the Russians, or he is going to act as a surrogate of the White House.’”

What were other presidents doing on March 23?