House Speaker Paul D. Ryan (R-Wis.) doubled down Wednesday on the embattled Republican plan to revise the Affordable Care Act, calling the measure a “trillion-dollar tax cut” and saying its core elements would remain in place despite broad opposition from Republicans, Democrats and the health-care industry.
“Obviously the major components are staying intact, because this is something we wrote with President [Donald] Trump. This is something we wrote with the Senate committees. This is the plan we ran on all of last year,” Ryan told the Fox Business Network.
“It’s about a trillion-dollar tax cut,” he said later. “This is about a trillion-dollar tax cut.”
The widespread dissatisfaction among House and Senate lawmakers – conservatives and moderates alike – showed no signs of dissipating early in the week, posing a serious challenge for Ryan as he searches for enough votes to pass the bill on the House floor.
Ryan urged senators to amend the measure once it reaches the upper chamber – an outcome that remains in doubt as more and more House Republicans express their concerns.
“It’s a very good start. It’s actually an excellent start,” Ryan said of the bill, known as the American Health Care Act.
“The point is, we had a plan. We have a plan. We’re moving this plan. And we’re making fine-tuning refinements to this plan as it goes through the legislative process.”
On Tuesday, the White House launched its own effort to salvage support for the plan as a growing number of lawmakers weighed in against the proposal.
One day after the Congressional Budget Office released its analysis showing that 14 million fewer Americans would be insured next year under the GOP plan, Vice Mike President Pence and Health and Human Services Secretary Tom Price went to Capitol Hill to rally backing for the proposal.
Still, key lawmakers continued to voice their opposition.
“I have serious concerns about the current draft of the House bill,” Sen. Ted Cruz (R-Texas) said in an interview. “As written, I do not believe the House bill would pass the Senate.”
Cruz went to the White House on Tuesday along with a small group of conservatives to discuss health care.
Trump has enthusiastically backed the GOP plan in various statements and tweets, and its failure – or the failure of a similar measure – would probably tarnish his promise to replace the Affordable Care Act with a better system.
The president also planned to speak about health care with Ryan and House Majority Leader Kevin McCarthy (R-Calif.) by phone Tuesday afternoon.
Senate Majority Leader Mitch McConnell (R-Ky.) attempted to play down the severity of the GOP split after a closed-door party lunch attended by Pence, Price and some of the architects of the House bill, including Ways and Means Committee Chairman Kevin Brady (R-Tex.).
Following the lunch, McConnell tried to shift the focus from the coverage numbers to more favorable terrain for Republicans: the CBO’s projection that Ryan’s plan would reduce the federal budget deficit over the next decade and produce a 10 percent average decrease in premiums after that.
“Regarding the projection of fewer people purchasing, I think that’s the inevitable result of the government not making you purchase something you may not want,” McConnell told reporters. “And so we are hoping to have a more vibrant market that will attract a greater number of people to actually be able to buy, at an affordable cost, insurance that actually makes sense for them rather than one prescribed by the government.”
Sen. Bob Corker (R-Tenn.), who is normally chatty with reporters, was more guarded than usual coming out of the meeting. He declined to discuss specifics but said House leaders and the White House were making a good-faith effort to hear the concerns of Republican senators.
“They really are taking input. So I don’t think they would be over here unless they really do want to take input from folks,” Corker said.
The GOP legislation faces an important test Thursday, when the House Budget Committee will meet to combine pieces passed by separate committees into a single bill and advance it to the House floor. The budget panel cannot make substantive changes to the bill, but it can make nonbinding recommendations before it goes to the floor for a final vote.
Several members of the hard-line conservative House Freedom Caucus, which has expressed serious concerns that the measure does not go far enough in repealing the Affordable Care Act, are on the Budget Committee and could decline to support the bill there.
Republicans hold an eight-vote advantage over Democrats on the Budget Committee, and if four GOP members oppose it, the bill could stall. Three of the 22 Republicans on the panel are members of the House Freedom Caucus.
Aides to those three members – Reps. Dave Brat (Va.), Gary Palmer (Ala.) and Mark Sanford (S.C.) – did not respond to inquiries Tuesday about whether they intended to support the legislation in committee. Three other Budget Committee Republicans, Reps. John Faso (N.Y.), Mario Diaz-Balart (Fla.) and Bruce Westerman (Ark.), said Tuesday that they were undecided on their committee votes.
Near the close of the Tuesday Senate lunches, Rep. Mark Meadows (R-N.C.), the head of the Freedom Caucus, was seen walking down a hallway near the room where the lunch was held.
“We’ve got some work to do, still,” said Meadows, adding that he had received “no assurances” from the White House or anyone else about changes to the bill that would attract his support.
Among the commitments that White House staff members have pledged to support is amendments at the budget panel this week, according to one senior White House official. But special budget rules established more than four decades ago make that plan impossible to fulfill.
Budget Committee members do not have the authority to offer any substantive or binding amendments to the legislation. Their sole job is to combine the recommendations of previous committees – which have passed the GOP proposal – and send the legislation to the House Rules Committee.
House Budget Committee Chairman Diane Black (R-Tenn.) said Tuesday that she is in talks with her members about potential “motions” to ask the Rules Committee to modify the bill when it takes it up, probably early next week. “Really our role and responsibility is to take the Ways and Means and Energy and Commerce bills and put them together,” Black said in an interview.
Rep. Todd Rokita (R-Ind.), the Budget Committee’s vice chairman, said Tuesday that while the panel cannot directly make changes to the bill, members can suggest recommendations.
“I think that is fair game if you’re trying to be an honest broker and better the bill, and I think we should welcome that kind of discussion,” he said. “If you’re doing it because you want to sabotage the bill, you’re going to find guys like me swat that down pretty vehemently.”
Rokita said he has attempted to persuade the bill’s skeptics by asking: “Do they not have the courage to do the big thing? And that’s how I’m framing it with them.”
The House Republicans’ legislation would keep a few of the ACA’s most popular features, such as forbidding insurers from denying coverage or charging more to people with preexisting medical problems, and allowing young adults to stay on their parents’ insurance policies until age 26.
The plan would erase penalties the ACA imposes on people who do not buy health coverage and, instead, would have a deterrent: a 30 percent surcharge on premiums that insurers could levy for a year if consumers let their coverage lapse. The bill would remove the ACA’s subsidies, replacing them with new tax credits and insurance rules that, together, would provide more help to younger people than older ones. The tax credits could be used for any plan sold in a state as long as it didn’t provide coverage for abortion.
The legislation would gradually eliminate an expansion of Medicaid, the public insurance program for lower-income Americans, that was accepted by 31 states under the ACA and would give states an annual fixed sum based on the number of people in the program.
Moderate Republicans from states that expanded Medicaid have voiced concerns that the bill would not do enough to protect those who obtained coverage through that expansion.
They worry that the projected deficit reduction would not be enough of a benefit to compensate for the number of people who stand to lose coverage.
On the right, conservatives have complained that the bill is not a forceful enough rollback of the Obama administration’s health-care law. Sen. Rand Paul (R-Ky.), along with Sen. Mike Lee (R-Utah) and Cruz, has been a chief conservative critic of the law.
“There is a solution for House Leaders that conservatives have offered: abandon Obamacare Lite now,” Paul wrote Tuesday on Twitter. “It is bad law & it can’t pass.”
In a later tweet, he added: “If House leaders try do a little less using the same basic framework as the failed Obamacare experiment, then it will fail too.”
Lee also raised concerns in an editorial for the conservative Daily Signal that the House bill contains policy changes that would violate strict Senate rules.
One such worry involves a provision that would forbid the use of insurance tax credits for coverage of health-care providers that offer abortion services.
But moderates warned that addressing the conservatives’ concerns would threaten their own support. Reps. Ileana Ros-Lehtinen (R-Fla.) and Leonard Lance (R-N.J.) said Tuesday that they would oppose the bill, while Rep. Charlie Dent (R-Pa.) – a leader of the moderate GOP faction – said he has “serious concerns and reservations” about supporting the measure without changes.
(c) 2017, The Washington Post · Elise Viebeck, Kelsey Snell, Sean Sullivan, Mike Debonis