WASHINGTON -- After an 18-hour session, the House Ways and Means Committee has become the first to approve the Republicans' Obamacare repeal bill.
Opposition to the Republican health care bill strengthened Wednesday, as key industry groups that had supported Obamacare said the replacement backed by President Donald Trump could harm vulnerable Americans.
But the White House and Republican congressional leaders brushed off criticism as they seek to fast track the legislation through Congress. Democrats made clear it wouldn't be easy -- dragging out a grueling day of committee sessions well past midnight.
In two committee rooms, GOP lawmakers dismissed questions about the bill's cost and claims it would result in millions of Americans losing insurance coverage. Democrats mixed assaults on the legislation with diversionary tactics meant to embarrass Trump -- such as highlighting his refusal to release his tax returns.
The action on Capitol Hill comes against a backdrop of pitched controversy over the legislation, which is posing a crucial first test to Trump's capacity to move his agenda through Congress and as conservative Republicans complain that the initiative does not go far enough in erasing his predecessor Barack Obama's signature domestic achievement.
The American Medical Association, which bills itself as the largest organization of doctors in the nation, sent a letter to the two committees, detailing its critique of the bill, known as the American Health Care Act.
"While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," the letter stated.
Major hospital organizations, including the American Hospital Association and the Federation of American hospitals have also come out against the bill. The largest seniors organization, the AARP had warned on Tuesday the measure would weaken Medicare and Medicaid. Some conservative medical lobby groups have supported the measure.
White House spokesman Sean Spicer shrugged off the building opposition from the medical establishment.
"We would love to have every group on board," Spicer said, adding, "This isn't about figuring out how many special interests in Washington we can get paid off. It's about making sure that patients get the best deal, that lowers prices and brings back cost."
Trump also showed willingness to jump into the fray, meeting with the leaders of conservative groups that have lined up against the bill.
"This is going to be great. You're going to make it even greater," the President told the group, sources at the White House meeting told CNN. "I'm going to work hard to get it done."
But should the bill eventually fail, Trump outlined a backup plan: Allow Obamcare to fail and let Democrats take the blame, sources said.
It was a full day -- and night -- for lawmakers on Capitol Hill. Two committees started their markups Wednesday morning at 10:30 a.m. and worked past 1 a.m., without making a significant amount of progress through the legislation.
Twelve hours in, the Energy and Commerce Committee was still debating the first Democratic amendment -- which was to change the name of the bill. The Ways and Means Committee ended debate on the second of five subtitles in the bill shortly before 11 p.m.
In the Ways and Means meeting room, there were signs that the long day was wearing on lawmakers.
Around 8 p.m., the panel's chairman, Rep. Kevin Brady, leaned back in his chair and put in eye drops.
Later, as restless staffers' side conversations rose to regular volumes rather than whispers, Brady had to call the room to order.
Aides sat with blankets in their laps or around their shoulders in the overly air-conditioned room. One snuck in a box of Dunkin' Donuts "Munchkins" to share.
The long day unfolded with a series of dry-as-a-bone discussions about health care policy and Democratic procedural measures to make the process as painful as possible for their Republican colleagues.
At one point, the minority forced the clerk of the House Energy and Commerce Committee to read the full bill -- a procedure that took about an hour. Democrats have promised at least 100 amendments, most of which have no chance of passage. For instance, one defeated measure would have blocked health care reform coming into force unless it ensured coverage for every taxpayer and all their dependents.
One Republican aide reported that Democratic leaders were pulling lawmakers out of committees for seemingly endless adjournment votes on the House floor, to make the process drag on even longer.
The only break to the tedium came amid buzz over an invitation from Trump to the House Freedom Caucus to throw down a few frames at the White House Bowling alley in a bid to strike a deal over the group's reservations about the bill.
Brady, the Republican chairman of the House Ways and Means Committee, the other panel holding a hearing, tried to keep the process on track. He said the Affordable Care Act was collapsing but that "relief is on the way" following a full-throated endorsement of the bill from Trump, who is planning to mount an intense lobbying effort to get the measure quickly out of the House and to the Senate.
"Today's markup is a critical step to providing all Americans with affordable, patient-centered health care that is tailored to their needs," Brady said.
The GOP legislation unveiled Monday would get rid of Obamacare's individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood.
The bill looks to preserve some of the more popular elements of Obamacare, including protections for people with pre-existing conditions (though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed) and letting children stay on their parents' insurance plans until the age of 26.
Democrats want CBO score
Democrats are complaining that the hearings are taking place before the Congressional Budget Office has a chance to "score" the House legislation, a process that will provide answers on how much it will cost and how many people it will cover.
Rep. Richard Neal, the top Democrat on the Ways and Means panel, cited the lack of the report as a reason the effort should be postponed. "To consider a bill of this magnitude without a CBO score is not only puzzling and concerning, but also irresponsible," Neal said.
Democratic Rep. Lloyd Doggett said the GOP bill had been kept "as secret as Donald Trump's tax returns."
"It is surprising that you're so determined to hide your panacea," the Texas congressman told his Republican colleagues.
Rep. Sander Levin of Michigan asked his fellow Republicans: "what are you afraid of, what are you afraid of?" before answering his own question, saying that the bill would increase the ranks of the uninsured and could interfere with the private health care market.
GOP leaders have said that the bill will not be brought to the floor until the CBO scores the legislation.
But while Republican Majority Whip Steve Scalise told the Energy committee that while he is also waiting for a CBO score, he will not let "unelected bureaucrats in Washington" slow down the Republican promise to repeal and replace Obamacare.
Democrats forcing delays
Democrats used arcane parliamentary procedures to give a series of five-minute speeches in a bid to slow the panel's progress.
"What we're trying to do is make sure we're having a totally transparent process, that it's not going to be a bill that's going to be crammed through, that the American people are gonna understand the consequences of what the provisions are. We're gonna take the time to talk about all the implications," said Rep. Debbie Dingell, a Democrat from Michigan.
In theory Democrats could force the chair to permit five-minute speeches on every amendment.
Back at Ways and Means, Republicans tried to expedite the process by offering no amendments to the bill. Brady said that was because Republicans were happy with the bill as it stood.
"We feel very good about not just repealing the bad aspects of the Affordable Care Act but beginning to restore state control and more personal control over healthcare, so we feel good about the bill," he said.
One Democratic committee aide said the intent is to "make some Republicans take some really tough votes" that are "revealing" about the GOP's priorities on health care.
Democratic Rep. Brian Higgins highlighted a provision of the bill that provides a tax break for health insurance companies amid criticism that it will simply be passed onto industry executives. Higgins listed the million-dollar salaries enjoyed by CEOs at health care giants like Aetna, Anthem, Cigna and United Healthcare.
It's "morally reprehensible," Higgins said.
"We're sitting here talking about giving big insurance companies a tax break?"
Despite the fraught political circumstances, there was a moment of levity at the Energy and Commerce Committee.
Rep. Jan Schakowsky, a Democrat from Illinois, said she was going to blast the Republican plan using President Trump's Twitter vernacular.
"Bad!" she said loudly. "Sad!"