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GOP Factions In Fight Over Republican Health Care Plan


Now to another fight with President Trump at the center of it - health care. Republicans are divided about how to replace the Affordable Care Act. Some House conservatives want a clean repeal of Obamacare. Some senators worry that the House Republicans' plan would leave millions of Americans without coverage. President Trump spoke out about the bill last night in an interview on Fox News. He said there's still room for negotiation, and he vowed that, quote, "we will take care of our people or I'm not signing it." NPR's Mara Liasson has more.

MARA LIASSON, BYLINE: If you listen to the message on health care from Donald Trump and Republican congressional leaders like House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell, you'd think they were selling completely different products. Here's how McConnell describes the benefits of the Republican bill.


MITCH MCCONNELL: Lower taxes, lower deficits and the most significant entitlement reform in history.

LIASSON: Really? Donald Trump didn't campaign on reducing the deficit or reforming entitlements. Quite the opposite.


PRESIDENT DONALD TRUMP: Save Medicare, Medicaid and Social Security without cuts. Have to do it.

LIASSON: And when it came to replacing Obamacare, Trump told "60 Minutes" everyone would be covered.


TRUMP: I am going to take care of everybody. I'm - I don't care if it cost me votes or not. Everybody is going to be taken care of much better than they're taken care of now.

LIASSON: Conservative analyst Matt Lewis thinks Trump's embrace of the GOP health care plan is a big detour from the populist message that got him elected.

MATT LEWIS: He ran as a guy - I will solve your problems. I want to take care of everybody. Nobody's going to lose anything. Everybody's going to have the best health care. This health care plan is off-brand for Donald Trump. It's actually much more likely to hurt Trump voters than sort of young millennials.

LIASSON: According to the Congressional Budget Office, a typical 64-year-old making $26,000 a year would end up paying $14,000 a year for insurance, a big jump from $1,700 under Obamacare. This is the Trump demographic - older, rural voters with lower incomes. Mike Huckabee knows a lot about these voters. Years ago, he was the populist Republican governor of Arkansas.

MIKE HUCKABEE: Trump voters are basically middle America. The guy that worked in the coal mine or the guy who's a self-employed plumber, the person who stands on the concrete floor and lifts heavy things all day, that person is not going to be helped necessarily by this wonderful philosophical plan put forth by the Republicans as hey, this is really great market-based approach - well, delightful. But if you barely can put food on your table, telling you that you're going to get a tax credit a year from now doesn't mean diddly squat. You don't need a tax credit. You need cash in your pocket.

LIASSON: There's a growing chorus of Trump supporters who are warning that the Republican health care plan is a trap for Trump. Breitbart, the conservative website once run by Trump's top strategist, Steve Bannon, has been on a tear about what they call Ryancare, predicting it will hurt Trump voters and cause a political backlash that will only help Democrats. Christopher Ruddy is the chairman of Newsmax and a good friend of the president's.

CHRISTOPHER RUDDY: The Paul Ryan plan, I think, doesn't win on either side. It doesn't really repeal Obamacare and make the conservative base, the Tea Party group happy. And then it doesn't really make the moderates happy because it's reducing Medicaid coverage.

LIASSON: Part of Trump's problem is that there are so few Trumpists in Congress. Most Republicans are traditional small-government conservatives. They want to cut taxes and deficits and do entitlement reform, all things the Republican health care bill accomplishes, but not necessarily what Trump voters want. It's not clear how this clash between Trump-style populism and small-government conservatism will get resolved. And the stakes are very high, says Republican strategist Ed Rogers.

ED ROGERS: If this doesn't pass, if we can't beat Obamacare with something, it'll say something really bad about our ability to govern as a party that has been given huge institutional power.

LIASSON: Rogers says it would also send a message about President Trump, whose identity is all about closing the deal.

ROGERS: He can't ride herd over them. Even when the leadership and he get together, they couldn't get something done. There's no sugarcoating this. This will be bad.

LIASSON: Rogers believes in the end, the bill will pass because Republicans will be faced with two simple choices. One - do they want to repeal Obamacare or not? And two - do you want to hand President Trump a big defeat in his first legislative fight? It's not clear if that kind of pressure will be enough to heave the American Health Care Act over the finish line. Mara Liasson, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Mara Liasson is a national political correspondent for NPR. Her reports can be heard regularly on NPR's award-winning newsmagazine programs Morning Edition and All Things Considered. Liasson provides extensive coverage of politics and policy from Washington, DC — focusing on the White House and Congress — and also reports on political trends beyond the Beltway.