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"This is the chance. This is a once-in-a-lifetime opportunity," said the speaker, roving the stage with a wireless mic, gesturing at both the audience in front of him and the PowerPoint presentation behind him.

TED Talk? Late-night infomercial? Nope — it was House Speaker Paul Ryan, making a hard pitch for his health care plan after a week of loud conservative criticism.

After listening to conservative groups like the Club For Growth blast the bill as a "warmed-over substitute for government-run health care," Ryan went on offense, saying this is just the first step of an ongoing overhaul of the health system.

The bill, drafted by Ryan and other House Republican leaders, cleared a key hurdle Thursday, passing two House committees after marathon markup sessions. But many members from the Tea Party wing are upset that it keeps too much of the Affordable Care Act in place and effectively replaces the law's signature tax with a heavy surcharge assessed to people who forgo health insurance.

"There are only so many things you can do in that bill because of Senate floor rules, reconciliation," Ryan said. "You can't put everything you want in that legislation, because if you did it would be filibustered, and you couldn't even bring it up for a vote in the Senate."

Then Ryan applied some public pressure. "We as Republicans have been waiting seven years to do this. We as Republicans, who fought the creation of [Obamacare], and accurately predicted it would not work, ran for office in 2010, in 2012, in 2014, in 2016, on a promise that if given the ability we would repeal and replace this law.

"This is the closest we will ever get to repealing and replacing Obamacare. The time is here; the time is now. This is the moment," said Ryan, summing up the situation as a "binary choice" for Republicans: Ditch Obamacare, or keep it.

Ryan's pitch comes at a time when many key trade groups are voicing major concerns about the repeal. The American Medical Association sent a letter to lawmakers bemoaning an "expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations."

The American Hospital Association urged Republican leaders to wait until the Congressional Budget Office analyzes the bill.

That's something Democrats are homing in on. "Look: No one likes this bill," said Senate Minority Leader Chuck Schumer. "Hospitals, doctors, governors. Conservatives, liberals, nonpartisan groups. And most of all, the people who would no longer have affordable health care.

"We Democrats are here today to tell our Republican friends, turn back. Drop this irresponsible plan."

Currently, Ryan and other Republican leaders don't need Democrats to pass the bill. They can afford to ignore Schumer.

But with just a two-vote margin in the Senate, they can't ignore Republican senators. So it was notable when Arkansas Sen. Tom Cotton tweeted that the House bill won't be able to win a Senate majority. "To my friends in House: pause, start over. Get it right, don't get it fast."


Florida Sen. Marco Rubio voiced similar worries 

. Ryan and Senate Majority Leader Mitch McConnell want the bill on President Trump's desk by the end of April. "I think if that's the approach they take, they won't have the votes in the Senate," Rubio warned.


That's why Republican leaders have now pulled out all the stops in their attempts to get rank-and-file members on board. As Schumer and other Democrats were blasting the bill outside the Senate on Thursday morning, they had to raise their voices at one point to speak over sirens.


It was Vice President Pence's motorcade driving by. He was back on Capitol Hill for the second time this week, meeting with fellow Republicans to talk and pitch the health care bill.  Copyright 2019 NPR. To see more, visit https://www.npr.org.

Health

Politics and Government News

Scott Detrow

Author

With conservative lawmakers and interest groups blasting the Republican health care overhaul effort, the House speaker is making a hard sell for his bill.

Paul Ryan sells health care bill as a 'once-in-a-lifetime opportunity'

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